Adaptations in the gait pattern with experimental hamstring pain

Pain changes movement but most studies have focused on basic physiological adaptations during non-functional movement tasks. The existing studies on how pain affects lower extremity gross movement biomechanics have primarily involved movements in which the quadriceps is the primary muscle and little attention has been given to how pain in other muscles affects functional movement. The purpose of this study was to investigate the changes in the gait patterns of healthy subjects that occur during experimental muscle pain in the biceps femoris.In a cross-over study design, 14 healthy volunteers underwent EMG assisted 3D gait analyses before, during and after experimental biceps femoris pain induced by intramuscular injections of hypertonic saline. Isotonic saline injections were administered as a non-painful control.The experimental biceps femoris pain led to reductions in hip extensor moments, knee flexor and lateral rotator moments. No changes in lower extremity kinematics and EMG activity in any of the recorded muscles were observed.It is concluded that experimental muscle pain in the biceps femoris leads to changes in the gait pattern in agreement with unloading of the painful muscle. The changes are specific to the painful muscle. The present study provides support to the theory that musculoskeletal pain is a protective signal leading to changes in movement patterns that serve to unload the painful tissue.     

Experimental Muscle Pain Impairs the Synergistic Modular Control of Neck Muscles

A motor task can be performed via different patterns of muscle activation that show regularities that can be factorized in combinations of a reduced number of muscle groupings (also referred to as motor modules, or muscle synergies). In this study we evaluate whether an acute noxious stimulus induces a change in the way motor modules are combined to generate movement by neck muscles. The neck region was selected as it is a region with potentially high muscular redundancy. We used the motor modules framework to assess the redistribution of muscular activity of 12 muscles (6 per side) in the neck region of 8 healthy individuals engaged in a head and neck aiming task, in non-painful conditions (baseline, isotonic saline injection, post pain) and after the injection of hypertonic saline into the right splenius capitis muscle. The kinematics of the task was similar in the painful and control conditions. A general decrease of activity was noted for the injected muscle during the painful condition together with an increase or decrease of the activity of the other muscles. Subjects did not adopt shared control strategies (motor modules inter subject similarity at baseline 0.73±0.14); the motor modules recorded during the painful condition could not be used to reconstruct the activation patterns of the control conditions, and the painful stimulus triggered a subject-specific redistribution of muscular activation (i.e., in some subjects the activity of a given muscle increased, whereas in other subjects it decreased with pain). Alterations of afferent input (i.e., painful stimulus) influenced motor control at a multi muscular level, but not kinematic output. These findings provide new insights into the motor adaptation to pain.     

Indwelling catheter and vanishing intracardiac mass

A 36-year-old male was admitted for painful swelling of his right upper extremity. He had had an indwelling port-a-cath placed in his right subclavian vein eight months prior to admission. On admission the patient was afebrile and his vital signs were normal. His right upper extremity was swollen, erythematous and tender. Blood leucocyte count was normal and D-Dimer was elevated. Venous Doppler examination showed partial thrombosis of the distal right subclavian vein. Removal of the port-a-cath by interventional radiology was scheduled.     

The effects of muscle stretching and shortening on isometric forces on the descending limb of the force-length relationship

The purpose of this study was to examine the effects of stretching and shortening on the isometric forces at different lengths on the descending limb of the force-length relationship. Cat soleus (N = 10) was stretched and shortened by various amounts on the descending limb of the force-length relationship, and the steady-state forces following these dynamic contractions were compared to the isometric forces at the corresponding muscle lengths. We found a shift of the force-length relationship to greater force values following muscle stretching, and to smaller force values following muscle shortening. Shifts in both directions critically depended on the magnitude of stretching/shortening and the final muscle length. We confirm recent findings that the steady-state isometric force following some stretch conditions clearly exceeded the maximal isometric forces at optimum muscle length, and that force enhancement was associated with an increase in the passive force, i.e., a passive force enhancement. When the passive force enhancement was subtracted from the total force enhancement, forces following stretch were always equal to or smaller than the isometric force at optimum muscle length. Together, these findings led to the conclusions: (a). that force enhancement is composed of an "active and a "passive" component; (b). that the "passive" component of force enhancement allows for forces greater than the maximal isometric forces at the muscle's optimum length; and (c). that force enhancement and force depression are critically affected by muscle length and stretch/shortening amplitude.     

Experimental regulation of granulomatous reactions around Schistosoma japonicum eggs implanted into the liver of mice.

Using a liver model, various granulomatous responses against Schistosoma japonicum eggs were studied in C57BL/6 mice immunized with tissue-extracted eggs prior to challenge implantation with freshly laid eggs. In mice receiving two ip injections of 20,000 eggs, there was little effect on early granuloma formation. Three weeks after implantation, however, tissue reaction accompanied by marked fibrosis was significantly augmented, compared to that in the untreated mice. In contrast, when mice were given four ip injections, the early reaction was accelerated and the subsequent fibrosis came to an end earlier than in the twice immunized or untreated mice. Different routes of injection produced differing effects on 2-week granulomas, with an augmented reaction following two sc injections and a diminished reaction following the same number of ip injections. Histologically, the diminished reaction was characterized by less cellularity, especially in the case of eosinophil infiltration.     

Leukocyte-derived microparticles and scanning electron microscopic structures in two fractions of fresh cerebrospinal fluid in amyotrophic lateral sclerosis: a case report

ABSTRACT: INTRODUCTION: Amyotrophic lateral sclerosis is a progressive neurodegenerative disorder characterized by degeneration of motoneuron cells in anterior spinal horns. There is a need for early and accurate diagnosis with this condition. In this case report we used two complementary methods: scanning electron microscopy and fluorescence-activated cell sorting. This is the first report to our knowledge of microparticles in the cerebrospinal fluid of a patient with amyotrophic lateral sclerosis. CASE PRESENTATION: An 80-year-old Swedish man of Caucasian ethnicity presented to our facility with symptoms of amyotrophic lateral sclerosis starting a year before his first hospital examination, such as muscle weakness and twitching in his right hand progressing to arms, body and leg muscles. Electromyography showed classical neurophysiological findings of amyotrophic lateral sclerosis. Routine blood sample results were normal. A lumbar puncture was performed as a routine investigation and his cerebrospinal fluid was normal with regard to cell count and protein levels, and there were no signs of inflammation. However, scanning electron microscopy and fluorescence-activated cell sorting showed pronounced abnormalities compared to healthy controls. Flow cytometry analysis of two fractions of cerebrospinal fluid from our patient with amyotrophic lateral sclerosis was used to measure the specific binding of antibodies to phosphatidylserine (lactadherin), CD42a, CD144 and CD45. Our patient displayed over 100 times more phosphatidylserine-positive microparticles and over 400 times more cell-derived microparticles of leukocyte origin in his cerebrospinal fluid compared to healthy control subjects. The first cerebrospinal fluid fraction contained about 50% more microparticles than the second fraction. The scanning electron microscopy filters used with cerebrospinal fluid from our patient were filled with compact aggregates of spherical particles of lipid appearance, sticking together in a viscous batter. The quantitative increase in scanning electron microscopy findings corresponded to the flow cytometry result of an increase in leukocyte-derived microparticles. CONCLUSIONS: Microparticles represent subcellular arrangements that can influence the pathogenesis of amyotrophic lateral sclerosis and may serve as biomarkers for underlying cellular disturbances. The increased number of leukocyte-derived microparticles with normal cell counts in cerebrospinal fluid may contribute to the amyotrophic lateral sclerosis inflammatory process by formation of immune complexes of prion-like propagation, possibly due to misfolded proteins. The two complementary methods used in this report may be additional tools for revealing the etiology of amyotrophic lateral sclerosis, for early diagnostic purposes and for evaluation of clinical trials, long-term follow-up studies and elucidating the pathophysiology in amyotrophic lateral sclerosis.     

Adaptations of upper trapezius muscle activity during sustained contractions in women with fibromyalgia

The study compared the distribution of electromyographic (EMG) signal amplitude in the upper trapezius muscle in 10 women with fibromyalgia and in 10 healthy women before and after experimentally-induced muscle pain. Surface EMG signals were recorded over the right upper trapezius muscle with a 10 × 5 grid of electrodes during 90° shoulder abduction sustained for 60 s. The control subjects repeated the abduction task following injections of isotonic and hypertonic (painful) saline into the upper trapezius muscle. The EMG amplitude was computed for each electrode pair and provided a topographical map of the distribution of muscle activity. The pain level rated by the patients at the beginning of the sustained contraction was 5.9 ± 1.5. The peak pain intensity for the control group following the injection of hypertonic saline was 6.0 ± 1.6. During the sustained contractions, the EMG amplitude increased relatively more in the cranial than caudal region of the upper trapezius muscle for the control subjects (shift in the distribution of EMG amplitude: 2.3 ± 1.3 mm; P < 0.01). The patient group showed lower average EMG amplitude than the controls during the contraction (P < 0.05) and did not show different changes in EMG amplitude between different regions of the upper trapezius. A similar behavior was observed for the control group following injection of hypertonic saline. The results indicate that muscle pain prevents the adaptation of upper trapezius activity during sustained contractions as observed in non-painful conditions, which may induce overuse of similar muscle compartments with fatigue.     

Focus: Rare Disease: Sinonasal Glomangiopericytoma: Review of Imaging Appearance and Clinical Management Update for a Rare Sinonasal Neoplasm

Introduction: Glomangiopericytoma (GPC) is a rare tumor in the nasal cavity or paranasal sinuses with low malignant potential. Initially deemed a hemangiopericytoma, in 2005 it was classified as a distinct entity by the World Health Organization (WHO). Case Presentation: A male patient in his early 60s presented with new-onset right arm and leg weakness/numbness, who was incidentally found to have a left ethmoid sinus mass with extension in the olfactory fossa. On CT and MRI, the mass enhanced with well-defined borders and eroded the bone, but without dural enhancement. The mass was surgically excised, and pathology confirmed the diagnosis of glomangiopericytoma by microscopic appearance and staining. Discussion: Glomangiopericytoma has less than 0.5% incidence of all neoplasms of the sinonasal cavity, making it rare. Most diagnosed patients are in their 6th or 7th decade of age, with a slight female predominance. Treatment is complete surgical excision, with excellent prognosis, although there is up to 17% local recurrence. Despite the non-specific appearance on CT and MRI, imaging can help provide differential diagnosis, tumor extent, size, and reassuring non-aggressive characteristics of the tumor prior to surgery. GPC tumors are relatively resistant to radiation and chemotherapy. Conclusion: It is important to recognize glomangiopericytoma in the differential of masses of the nasal cavities or paranasal sinuses, as they rarely warrant aggressive treatment beyond local excision. Each reported case of glomangiopericytoma helps to build guidance for imaging and treatment since GPC is rare and not well-represented in the medical literature.     

Contractile characteristics of single skinned rat soleus muscle fibers under gravitational load: effects of a calcium-binding agent

Excessive intracellular calcium accumulation is believed to trigger the development of functional and structural changes in muscle fibers under microgravity conditions. The hypothesis was testified in the 14-day hindlimb suspension study with the application of a Ca(2+)-binding agent (10% EGTA). Twenty one rats were divided into 3 groups: cage controls (7), hindlimb-suspended rats that received intraperitoneal injections of saline (7), and hindlimb-suspended rats with EGTA treatment. Whereas the diameter of muscle fibers of unloaded rat soleus muscle was 20% less than in the control group (and there were no significant differences between rats with injections of EGTA and without them), the decrease of maximal tension was more pronounced (more than 50%). This discrepancy resulted in a decrease of maximal specific tension. The value of absolute tension in rats treated with placebo was by 52%, and in EGTA-treated rats by 41% less than in the control group. Thus, there were no significant differences in specific tension between this group and the control group. Obviously, the injections of EGTA prevented the effects of those mechanisms that induce a decline of tension in muscle fibers but are not linked with the reduction of fiber size. The Ca/tension curve in hindlimb-suspended saline-treated rats shifted to the right so that the pCa thresholds changed from 6.85 +/- 0.03 in cage controls to 6.70 +/- 0.04 (p < 0.05), which indicates that myofibrils of unloaded soleus are less sensitive to Ca2+. At the same time, the pCa threshold in EGTA-treated hindlimb-suspended rats was 6.93 +/- 0.02. It is concluded that chronic binding of excess calcium results in an increase in Ca sensitivity indices.     

Neuropathy in a patient with McArdle's syndrome and diabetes mellitus.

A juvenile-type diabetic patient of five years standing presented with a mononeuritis and gave a history of painful muscle swelling induced by exertion. Failure of the blood lactate to rise during ischaemic exercise and a normal blood glucose rise following intravenous glucagon confirmed the clinical diagnosis of muscle glycogenosis. The association of diabetes and McArdle's Syndrome has not previously been documented. An ulnar nerve palsy, which persisted for many months, followed the ischaemic exercise test possibly due to compression by muscular swelling, but may have been exacerbated by the co-existing diabetes.     

Experimental muscle pain reduces initial motor unit discharge rates during sustained submaximal contractions.

The aim of this human study was to investigate the effect of experimentally induced muscle pain on the modifications of motor unit discharge rate during sustained, constant-force contractions. Intramuscular and multichannel surface electromyographic (EMG) signals were collected from the right and left tibialis anterior muscle of 11 volunteers. The subjects performed two 4-min-long isometric contractions at 25% of the maximal dorsiflexion torque, separated by a 20-min rest. Before the beginning of the second contraction, hypertonic (painful; right leg) or isotonic (nonpainful; left leg) saline was injected into the tibialis anterior. Pain intensity scores did not change significantly in the first 150 s of the painful contraction. Exerted torque and its coefficient of variation were the same for the painful and nonpainful contractions. Motor unit discharge rate was higher in the beginning of the nonpainful contraction than the painful contraction on the right side [means +/- SE, 11.3 +/- 0.2 vs. 10.6 +/- 0.2 pulses/s (pps); P < 0.01] whereas it was the same for the two contractions on the left side (11.6 +/- 0.2 vs. 11.5 +/- 0.2 pps). The decrease in discharge rate in 4 min was smaller for the painful (0.4 +/- 0.1 pps) than for the control contractions (1.3 +/- 0.1 pps). Initial value and decrease in motor unit conduction velocity were not different in the four contractions (right leg, 4.0 +/- 0.1 m/s with decrease of 0.6 +/- 0.1 m/s in 4 min; left leg, 4.1 +/- 0.1 m/s with 0.7 +/- 0.1 m/s decrease). In conclusion, stimulation of nociceptive afferents by injection of hypertonic saline did not alter motor unit conduction velocity but reduced the initial motor unit discharge rates and the difference between initial and final discharge rates during sustained contraction.     

Ursodesoxycholic acid and heme-arginate are unable to improve hematopoiesis and liver injury in an erythropoietic protoporphyria mouse model

Erythropoietic protoporphyria (EPP) is an inherited disorder of heme biosynthesis caused by partial ferrochelatase deficiency, resulting in protoporphyrin overproduction which is responsible for painful skin photosensitivity. Chronic liver disease is the most severe complication of EPP, requiring liver transplantation in some patients. Data from a mouse model suggest that cytotoxic bile formation with high concentrations of bile salts and protoporphyrin may cause biliary fibrosis by damaging bile duct epithelium. In humans, cholestasis is a result of intracellular and canalicular precipitation of protoporphyrin. To limit liver damage two strategies may be considered: the first is to reduce protoporphyrin production and the second is to enhance protoporphyrin excretion. Bile salts are known to increase protoporphyrin excretion via the bile, while heme arginate is used to decrease the production of porphyrins in acute attacks of hepatic porphyrias. The Griseofulvin-induced protoporphyria mouse model has been used to study several aspects of human protoporphyria including the effects of bile salts. However, the best EPP animal model is an ethylnitrosourea-induced point mutation with fully recessive transmission, named ferrochelatase deficiency (Fech(m1Pas)). Here we investigate the effect of early ursodesoxycholic acid (UDCA) administration and heme-arginate injections on the ferrochelatase deficient EPP mouse model. In this model UDCA administration and heme-arginate injections do not improve the protoporphyric condition of Fech(m1Pas)/Fech(m1Pas) mice.     

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.     

The spinocervical tract as a possible pathway for muscular nociception.

In decerebrate and chloralose-anaesthetized spinal cats, micro-electrode recordings were made from axons of the spinocervical tract (SCT) during intra-arterial injection of bradykinin, 5-hydroxytryptamine and potassium into the gastrocnemius-soleus (GS) muscle. The results suggest that muscular group IV and group III afferent units which respond to the above painful stimulation project into the SCT. The portion of SCT units that could be activated by injections of these algesic substances into the GS-muscle was different in spinal and decerebrate preparations, showing that the SCT neurones are subject to a descending influence. It is concluded that the spinocervical tract, in addition to its function as a cutaneous sensory pathway, may serve as a pathway for muscular nociception in the cat.     

Involuntary movements of the lower extremity following dorsal root entry zone lesions in a man treated for phantom limb pain

A patient developed continuous patterned involuntary movements of abduction-adduction, flexion-extension of his right lower extremity following surgical placement of spinal dorsal root entry zone lesions for the treatment of phantom limb pain. The stereotype movements were monitored by video and electromyographic recording of quadriceps femoris and hamstring muscles. Administration of para-chlorophenylbutyric acid (baclofen) dramatically stopped the involuntary movements and electromyographic silence ensued. Voluntary muscle movements were preserved. The theoretical implications of this unique movement disorder and central patterning of motor activity within the spinal cord are discussed.     

Airway fibrosis in rats induced by vanadium pentoxide

Vanadium pentoxide (V(2)O(5)) is a cause of occupational asthma and bronchitis. We previously reported that intratracheal instillation of rats with V(2)O(5) causes fibrosis of the lung parenchyma (J. C. Bonner, P. M. Lindroos, A. B. Rice, C. R. Moomaw, and D. L. Morgan. Am. J. Physiol. Lung Cell. Mol. Physiol. 274: L72-L80, 1998). In this report, we show that intratracheal instillation of V(2)O(5) induces airway remodeling similar to that observed in individuals with asthma. These changes include airway smooth muscle cell thickening, mucous cell metaplasia, and airway fibrosis. The transient appearance of peribronchiolar myofibroblasts, which were desmin and vimentin positive, coincided with a twofold increase in the thickness of the airway smooth muscle layer at day 6 after instillation and preceded the development of airway fibrosis by day 15. The number of nuclear profiles within the smooth muscle layer also increased twofold after V(2)O(5) instillation, suggesting that hyperplasia accounted for thickening of the smooth muscle layer. The majority of cells incorporating bromodeoxyuridine at day 3 were located in the connective tissue surrounding the airway smooth muscle wall that was positive for vimentin and desmin. These data suggest that myofibroblasts are the principal proliferating cell type that contributes to the progression of airway fibrosis after V(2)O(5) injury.     

The role of passive structures in force enhancement of skeletal muscles following active stretch

We recently found that force enhancement following active stretch in skeletal muscles is accompanied by an increase in passive force following deactivation (J. Exp. Biol. 205 (2002) 1275). However, it is not known if this increase in passive force contributes to the force enhancement observed in the active muscle, and if it is observed at all muscle lengths. The purposes of this study were to quantify the amount of passive force increase as a function of muscle lengths, and to determine if this passive force contributes to the force enhancement observed in the active muscle. Experiments were performed on cat soleus (n = 24) using techniques published previously (J. Biomech. 30(9) (1997) 865). Conceptually, tests involved comparisons of force enhancement and passive force increase for a variety of stretch tests in soleus. Furthermore, in one test, activation of the soleus was interrupted for 1s in the force-enhanced state, and soleus was then re-activated. We found that total force enhancement and passive force increase were positively correlated for all test conditions, that passive force increase following stretch of the active soleus only occurred at muscle lengths corresponding to the descending limb of the force-length relationship, that increases in passive force for a given stretch magnitude became greater at long muscle lengths, and that upon reactivation, there was a remnant passive force enhancement. We conclude from these results that the passive force enhancement following stretch of an active muscle contributes to the total force enhancement, that this passive contribution increases with increasing muscle length, and that there must be at least one other factor than passive force increase that contributes to the total force enhancement, as the passive force increase was always smaller than the total force enhancement. A by-product of this investigation was that we observed a shift in the passive force-length relationship that was dependent on muscle activation, stretch magnitude and muscle length. Therefore, the passive force-length relationship is not a constant property of skeletal muscle, but depends critically on the muscle's contractile history.     

Histiocytic necrotizing lymphadenitis without granulocytic infiltration

About 50 cases of histiocytic necrotizing lymphadenitis without granulocytic infiltration were published till now. The authors describe the case of a 19-year-old patient with the right ear and the right ring finger bitten by squirrel about 40-50 days before the appearance of an axillary homolateral painful lymphadenomegaly and fever. Histopathologic examination of excised lymph nodes showed areas of necrosis, necrobiosis and nodular histiocytosis. Histiocytes were dystrophic or showed evidence of macrophagy. Problems referring to morphogenesis and etiology are discussed.     

The anti-fibrotic effect of betulinic acid is mediated through the inhibition of NF-κB nuclear protein translocation

The purpose of the study was to investigate the anti-fibrotic effect and the potential mechanisms of action of betulinic acid (BA) against hepatic fibrosis in vivo and in vitro. BA is an active compound isolated from the bark of the birch tree Betula spp. (Betulaceae). Liver fibrosis was induced by intraperitoneal injections of thioacetamide (TAA, 200mg/kg) twice weekly for 6weeks in Wistar rats. The administration of BA (20 or 50mg/kg) was started following TAA injections and was continued for 6 or 8weeks to evaluate both the preventive and the protective effects. BA demonstrated great efficacy in preventing and curing hepatic fibrosis via attenuating the TAA-mediated increases in liver tissue hydroxyproline and α-smooth muscle actin (α-SMA). In vitro, BA effectively decreased the HSC-T6 cell viability induced by TNF-α and showed low toxicity in normal human chang liver cells. Moreover, BA significantly attenuated the expression of α-SMA and tissue inhibitor of metalloproteinase-1 (TIMP-1) and increased the levels of matrix metalloprotease (MMP)-13. BA also inhibited the expression of Toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and the activation of nuclear factor-κB (NF-κB) in a time-dependent manner. This study provides evidence that BA exerts a significant anti-fibrosis effect by modulating the TLR4/MyD88/NF-κB signaling pathway.     

CaV3.2 T-Type Calcium Channels in Peripheral Sensory Neurons Are Important for Mibefradil-Induced Reversal of Hyperalgesia and Allodynia in Rats with Painful Diabetic Neuropathy

We recently showed that streptozotocin (STZ) injections in rats lead to the development of painful peripheral diabetic neuropathy (PDN) accompanied by enhancement of Ca_V3.2 T-type calcium currents (T-currents) and hyperexcitability in dorsal root ganglion (DRG) neurons. Here we used the classical peripherally acting T-channel blocker mibefradil to examine the role of Ca_V3.2 T-channels as pharmacological targets for treatment of painful PDN. When administered intraperitoneally (i.p.), at clinically relevant doses, mibefradil effectively alleviated heat, cold and mechanical hypersensitivities in STZ-treated diabetic rats in a dose-dependent manner. We also found that Ca_V3.2 antisense (AS)-treated diabetic rats exhibit a significant decrease in painful PDN compared with mismatch antisense (MIS)-treated diabetic rats. Co-treatment with mibefradil (9 mg/kg i.p.) resulted in reversal of heat, cold and mechanical hypersensitivity in MIS-treated but not in AS-treated diabetic rats, suggesting that mibefradil and Ca_V3.2 AS share the same cellular target. Using patch-clamp recordings from acutely dissociated DRG neurons, we demonstrated that mibefradil similarly blocked T-currents in diabetic and healthy rats in a voltage-dependent manner by stabilizing inactive states of T-channels. We conclude that antihyperalgesic and antiallodynic effects of mibefradil in PDN are at least partly mediated by inhibition of Ca_V3.2 channels in peripheral nociceptors. Hence, peripherally acting voltage-dependent T-channel blockers could be very useful in the treatment of painful symptoms of PDN.