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PubMed1986

Autotomy following sciatic and saphenous nerve sections: sparing of the medial toes after treatment of the sciatic nerve with capsaicin.

Autotomy, or self-mutilation of the foot following sciatic and saphenous nerve lesions, was examined in rats after pretreatment of the sciatic nerve with capsaicin. This pretreatment produced an alteration in autotomy behavior which resulted in the sparing of the medial side of the foot. The effect occurred following a long (12-week) pretreatment-test interval, but not after shorter (1- and 4-week) intervals. The effect also depended on the successive transecting of the saphenous and sciatic nerves. Sparing of the medial side of the foot occurred only when the saphenous nerve was transected at the time of the sciatic nerve treatment with capsaicin. Because the side of the foot innervated by the saphenous nerve was spared by treating the sciatic nerve with capsaicin, we suggest that capsaicin alters the course of autotomy by preventing collateral innervation of the saphenous region by the intact sciatic nerve during the pretreatment-test interval. The fact that this occurs only after a 12-week interval suggests that capsaicin's effect on collateral innervation is a gradual process that requires a long time to develop.

Animals↗
PubMed1993

Evidence for endogenous inhibition of autotomy by galanin in the rat after sciatic nerve section: demonstrated by chronic intrathecal infusion of a high affinity galanin receptor antagonist.

We have studied the effect of M-35 [Galanin(1-12)-Pro-bradykinin(2-9)-amide], a newly developed high affinity antagonist for galanin receptors, on self-mutilation (autotomy) behavior of the deafferented limb in rats after unilateral section of sciatic nerves. M-35 (1.3 micrograms/microliters) or saline was applied to the lumbar spinal cord through a chronically implanted intrathecal catheter at a rate of 0.5 microliter/h for 10 days post axotomy via an osmotic minipump. Axotomized rats infused with M-35 autotomized significantly more than those perfused intrathecally with saline or those axotomized rats not implanted with an intrathecal catheter. The severity of autotomy was also markedly greater in the group treated with M-35 than in the two other groups. M-35 did not noticeably influence either the galanin mRNA level in corresponding dorsal root ganglia and dorsal horn region or the percent of lumbar sensory neurons expressing detectable levels of mRNA for galanin. It is suggested that galanin can endogenously suppress autotomy behavior in rats after nerve injury and thus may play an important role in the control of the development of neuropathic pain.

Animals↗
PubMed1993

The differential effects of morphine and the alpha 2-adrenoceptor agonists clonidine and dexmedetomidine on the prevention and treatment of experimental neuropathic pain.

The effect of intrathecal morphine (MO) and the alpha 2-adrenoceptor agonists clonidine (CLON) and dexmedetomidine on self-mutilation (autotomy), a behavior that may indicate the presence of neuropathic pain, has been examined in rats. In one experiment, a single dose of MO (50 micrograms), but not CLON (50 micrograms) or saline (SAL), injected 60 min before unilateral sciatic nerve section caused a significant decrease in autotomy during the 28-day observation period. In a second experiment, the same dose of MO administered 15 min after nerve section had no beneficial effect on autotomy compared to CLON or SAL. In a third experiment, MO (10 micrograms), CLON (10 micrograms), and dexmedetomidine (1 microgram), an alpha 2-agonist with higher affinity for the alpha 2-receptor than CLON, or SAL were injected intrathecally twice daily for 21 days starting 24 h after axotomy. The rats administered CLON or dexmedetomidine autotomized significantly less than those receiving MO or SAL at 14 days and 21 days after nerve section. Thus, MO, but not alpha 2-agonists, is beneficial in preventing autotomy, a possible sign of neuropathic pain after nerve injury, whereas alpha 2-agonists, but not opioids, are useful in treating such pain chronically.

Adrenergic alpha-Agonists↗
PubMed1998

Differential sensory-motor effects of pentobarbital in intact rats genetically selected for high vs. low neuropathic pain-related behaviour.

Denervation of the hindpaw in rodents triggers autotomy, a behaviour of licking, scratching and self-mutilation of the denervated paw. This behaviour has been used as a model of paraesthesia, dysaesthesia and neuropathic pain. HA and LA rats are lines that have been genetically selected for high or low levels of autotomy, respectively. Compared to intact LA rats, HA rats are more sensitive to convulsions induced by pentylenetetrazol (PTZ), a blocker of the chloride channel associated with the GABA(A) receptor. Here we tested whether an acute administration of a sedative but not anaesthetic dose of pentobarbital (PB) would differentiate between these rat lines, in a number of sensory and motor tests performed in intact rats. This drug was tested since in contrast to PTZ, PB enhances central nervous system (CNS) inhibition by increasing chloride flux through the same channel. We found that PB was significantly more ataxic, antinociceptive, and reduced touch sensitivity in LA rats, compared to HA rats. These results suggest that HA and LA rats genetically differ in the levels of central inhibitions mediated by the GABA system presumably at the chloride channel. This difference may be associated with the dichotomous expression of neuropathic pain in these rat lines.

Animals↗
PubMed2000

Comparison of autotomy behavior induced in rats by various clinically-used neurectomy methods.

When a peripheral nerve is cut, a neuroma develops at its proximal end. Nerve-end neuromas are known to be a source of ectopic sensory input. In some humans this input may cause spontaneous and evoked neuropathic pain. There is currently no available animal model for developing better methods of cutting nerves that produce less painful neuromas than those currently in clinical use. Transection of the sciatic and saphenous nerves in rats also produces nerve-end neuromas. Afferent fibers in such neuromas spontaneously emit ectopic input that coincides with the outbreak of licking, scratching and self-mutilation of the denervated limb ('autotomy'). This behavior is considered to be the expression of spontaneous disagreeable sensations such as paresthesias, dysesthesias or neuropathic pain. We propose here that the autotomy model can be used as the first step for development of better neurectomy methods. As a demonstration, in this report we compared the course of autotomy expressed by rats following several methods of cutting peripheral nerves that are currently in clinical use. We found that the lowest extent of autotomy was caused by sciatic and saphenous neurectomy with a CO(2) laser. Tight ligation of the nerve, or a simple cut with scissors, also yielded significantly lower autotomy scores compared to cryoneurolysis and electrocut. The differing scores of autotomy caused by these neurectomy methods may derive from different properties of the injury discharge produced by these methods at the time of nerve cut. Our results raise the possibility that a higher incidence of neuropathic pain or related sensory disorders in humans may be expected following cryosurgical and electrocut neurectomies. If validated by further studies, neurectomy methods eliciting lower incidence of autotomy, and sensory disorders in models not based on autotomy may produce lower levels of neuropathic pain in humans.

Animals↗
PubMed1993

The role of previous nociceptive input in development of autotomy following cordotomy.

Intractable pains have been described after surgical or accidental lesions in the peripheral or central nervous system. The possible contribution of antecedent injury to the appearance of these pains was examined in an animal model for chronic pain which involved observing self-mutilation or autotomy behavior in rats. Various combinations of previous injury, selective spinal cut, and peripheral denervation were carried out on rats. Injuries ranged from mild to moderate and were produced by nociceptive stimuli from formaldehyde injection, induced local arthritis, or hot water application. Selective spinal cuts included either a dorsal column (DC), a dorsal quadrant which included a DC and a dorsolateral funiculus, an anterolateral column (ALC), or a hemisection. In rats without prior exposure to injury the various types of spinal cuts were not associated with any autotomy. In rats with prior exposure to formaldehyde injection, autotomy was associated only with spinal cuts that involved the ALC. In an otherwise similar group of rats but with prior induction of local arthritis, a stronger association of ALC lesion and autotomy was observed. In an earlier study, rats with ALC lesion prior to denervation showed reduced autotomy. In this study, we demonstrated that in rats with previous exposure to heat injury, an ALC lesion was strongly associated with autotomy. Autotomy was absent, however, in rats with heat injury only. These findings strongly suggest that pain resulting from previous exposure to injury produces a memory trace in the central nervous system which can account for the phantom pains encountered in various clinical conditions.

Animals↗
PubMed1993

Explosive autotomy induced by simultaneous dorsal column lesion and limb denervation: a possible model for acute deafferentation pain.

We report on a new "explosive" form of self-mutilation behavior (autotomy) characterized by rapid onset (1-2 days), short duration (1-2 days), and unpredictable progression. The possible neural mechanism(s) underlying this novel behavior were examined in rats by combining at varying time intervals one leg denervation with a lesion to the dorsal columns (DC lesion) or to a dorsolateral funiculus (DLF lesion). DC lesion, followed immediately by leg denervation, resulted in explosive autotomy in 62% of the rats and regular autotomy in 25% of the rats. Regular autotomy was characterized by slow onset (2-3 weeks), prolonged duration (2-3 weeks), and stereotyped progression from distal to proximal parts of the leg. DC lesion, followed 1 week later by leg denervation, resulted in regular autotomy in 71% of the rats which was not different from autotomy resulting from denervation alone. DC lesion preceded 1 week earlier by leg denervation resulted in slightly accelerated regular autotomy in 77% of the rats. Simultaneous DC lesion and leg denervation immediately preceded by application of a local anesthetic (4% procaine) for 30 or 60 min to the exposed lumbar spinal cord resulted in regular autotomy in all rats. All rats in a sham group, in which the procaine was replaced by normal saline, exhibited explosive autotomy. DLF lesion, followed immediately by leg denervation, resulted in accelerated regular autotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Afferent Pathways↗
PubMed1996

The role of spinal cord activation before neurectomy in the development of autotomy.

A model of deafferentation pain is provided by sectioning the sciatic and saphenous nerves in the rat and mouse. This procedure leads to self-mutilation of the denervated hindpaw (autotomy). A noxious stimulus to the denervated area before neurectomy is known to enhance the autotomy. To understand the mechanism underlying this enhancement by prior noxious stimuli, we examined the effects of intrathecal (i.t.) injection of substance P (SP) and somatostatin (SOM) on autotomy behavior. These peptides are known to be released from primary afferent terminals in the dorsal horn by noxious stimuli. A single i.t. injection of SP or SOM just before neurectomy dramatically enhanced autotomy behavior in mice. Autotomy was enhanced in a dose-dependent manner with i.t. injection of SP (0.1-20 nmol) 5 min before neurectomy or SOM (0.1-1.0 nmol) 20 min before neurectomy. Autotomy significantly decreased by extending the interval between i.t. injection of SP or SOM and neurectomy. Intact mice injected with the same doses of SP or SOM showed dose-dependent acute nociceptive responses directed to the hindpaw. The severity of autotomy in neurectomized mice and the duration of acute nociceptive responses induced by the same doses of SP or SOM in intact mice were related. These results suggest that neuropeptides applied to the spinal dorsal horn just before deafferentation induce a state of central neural activation with long-lasting effects on the function of CNS cells. Augmentation of autotomy is a result of this activation which is kept as a 'memory'.

Animals↗
PubMed1993

Magnesium sulphate injected subcutaneously suppresses autotomy in peripherally deafferented rats.

In rats, recent evidence suggests that injury discharge caused by peripheral nerve section releases excitatory amino acids into the spinal cord which in turn influences decisively the development of autotomy, a self-mutilation behaviour directed towards the denervated areas. Autotomy has been proposed as a behavioural correlate of the neuropathic pain which occurs in humans after complete nerve lesions. Mg2+ ions have been shown to offer protection from neurological and degenerative disorders in which excitatory amino acids are putatively involved. To ascertain the preventive value of Mg2+ administration on autotomy, male rats underwent unilateral ligation and transection of the sciatic and saphenous nerves 30 min after being injected subcutaneously (s.c.) with 300 or 600 mg/kg MgSO4 or saline. Thereafter, autotomy was monitored for 8 weeks. Serum, lumbosacral (L1-S1) and brain magnesium levels were analyzed 0, 30, 60, 120, 180, 240, 360 min and 24 h after the s.c. injection of 600 mg/kg MgSO4. Serum magnesium levels increased quickly from 1.02 mM (0 time) to 4.52 mM (at 60 min) and dropped afterwards to reach physiological levels at 6 h. Peak increments in L1-S1 and brain Mg2+ levels were smaller (32% and 30%, respectively) although maintained for at least 6 h. Magnesium pretreatment in a significant and dose-dependent manner (1) largely suppressed autotomy, (2) decreased final autotomy scores, (3) delayed autotomy onset, and (4) decreased the percentage of animals engaged in high autotomy behaviors. The data support a role for excitatory amino acids in determining susceptibility to autotomy and suggest a hopeful way to prevent neuropathic pain in humans after peripheral deafferentation.

Animals↗
PubMed1998

Suppression of autotomy by N-methyl-D-aspartate receptor antagonist (MK-801) in the rat.

The effects of different doses and time of administration of the N-methyl-D-aspartate (NMDA) receptor antagonist (MK-801) on the development of the autotomy (self-mutilation) were studied in the rats receiving dorsal root ganglionectomy (DRGn). The rats without any treatment and those treated with normal saline immediately after DRGn were the control groups. Three groups of rats were treated with 0.1, 0.5 or 1.0 mg/kg of MK-801 immediately after DRGn, and another three were treated with 1.0 mg/kg of MK-801 2, 4, or 7 days after DRGn. The behavioral observations of these rats were quantified using an autotomy grading scale ranging from 0 to 19, and the scores were compared among these groups. The rats in the control groups manifested autotomy from 5 to 17 days after DRGn and all of them (100%) attained the highest autotomy score. Lower doses (0.1 or 0.5 mg/kg) of MK-801 had no effect on the development of the autotomy. In contrast, higher dose (1.0 mg/kg) of MK-801 administered immediately after DRGn significantly suppressed the autotomy as compared to the control groups (P < 0.01) and only 17% of the rats in this group attained the highest score. The antagonistic effect was retained when the treatment of MK-801 was delayed to 2 days after DRGn, however, it disappeared when the treatment was delayed to 4 or 7 days after DRGn. Thus, the antagonistic effect of MK-801 on the autotomy induced by DRGn was dose-related and time-dependent. The main role of the NMDA receptor in the development of the autotomy was within several days after DRGn.

Afferent Pathways↗
PubMed1985

Evidence that D-1 dopamine receptors contribute to the supersensitive behavioral responses induced by L-dihydroxyphenylalanine in rats treated neonatally with 6-hydroxydopamine.

The present investigation supports the hypothesis that functionally supersensitive D-1 dopamine receptors are involved in the self-mutilation behavior (SMB) induced by L-dihydroxyphenylalanine (L-dopa) in rats treated neonatally with 6-hydroxydopamine (6-OHDA). This conclusion is based upon 1) the antagonism of this behavior by SCH-23390, a D-1 antagonist; 2) induction of SMB in neonatal-6-OHDA-treated rats by the D-1 agonist, SKF-38393; 3) the high correlation of the supersensitive locomotor responses to the D-1 agonist with the occurrence of L-dopa-induced SMB; and 4) the inability of the D-2 agonist, LY-171555, to induce SMB in rats treated neonatally with 6-OHDA. The specificity of SCH-23390 and SKF-38393 for the D-1 dopamine receptor was supported by the absence of action of SCH-23390 against locomotor activities induced by LY-171555 and its blockade of SKF-38393-induced locomotion in 6-OHDA-treated rats. Behavioral responses to D-1 and D-2 agonists did not show the same profile in adult and neonatally 6-OHDA-treated rats, providing further support for the view that the age at which dopaminergic neurons are destroyed has differing effects on motor output. Many of the behaviors observed when the D-2 dopamine receptor was activated by LY-171555 were apparent after SKF-38393 in neonatally 6-OHDA-treated rats. Similar behavioral responses to the D-1 and D-2 agonists were also observed in adult 6-OHDA-treated rats.(ABSTRACT TRUNCATED AT 250 WORDS)

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed2001

Riga-Fede disease: report of a case and review.

Self-mutilation of tongue is a type of self-injurious behavior. Ulcers of the lingual frenum in neonates with natal lower incisors are referred to as Riga-Fede disease. In this paper a case of Riga-Fede disease in a ten-month infant male with lower central incisors is reported. The ulcer resolved after the sharp incisal edges were smoothened and topical triameinolone was applied. As this lesion may be confused or associated with other serious disorders, a review of medical and dental literature was included.

Anti-Inflammatory Agents↗
PubMed1984

Behavioral differences between neonatal and adult 6-hydroxydopamine-treated rats to dopamine agonists: relevance to neurological symptoms in clinical syndromes with reduced brain dopamine.

Administration of L-dopa or apomorphine to neonatal and adult 6-hydroxydopamine (6-OHDA)-treated rats resulted in different behavioral responses depending on the age at which dopaminergic fibers were destroyed. When neonatal 6-OHDA-treated rats were tested as adults, they exhibited marked stereotypies, self-biting and self-mutilation behavior (SMB) when given these dopamine agonists. Self-biting as well as the incidence of SMB in neonatal 6-OHDA-treated rats showed dose-related changes between 10 and 100 mg/kg of L-dopa. This SMB and self-biting after L-dopa was observed as early as 22 to 24 days of age. Adult 6-OHDA-treated rats did not exhibit SMB or self-biting to L-dopa (100 mg/kg) or apomorphine (10 mg/kg), but did display paw treading and head nodding--behaviors not observed in neonatal 6-OHDA-treated rats. In addition, the locomotor response to apomorphine (1 mg/kg) was significantly greater in adult 6-OHDA-treated rats than in neonatal 6-OHDA-treated rats. Brain dopamine was reduced markedly in striatum, nucleus accumbens and olfactory tubercles in both 6-OHDA treatment groups with the reduction being slightly greater in rats treated with 6-OHDA neonatally. Serotonin content was elevated in striatum of rats treated neonatally with 6-OHDA, but not in adult 6-OHDA-treated rats. SMB and behaviors observed after L-dopa in rats treated neonatally with 6-OHDA were not apparent after L-dopa in rats with brain serotonin or norepinephrine reduced. Rats with brain dopaminergic fibers destroyed neonatally exhibited self-biting and SMB after L-dopa, suggesting that neonatal reduction of this amine is responsible for the SMB and self-biting in neonatal 6-OHDA-treated rats. 5-Hydroxytryptophan administration to neonatal 6-OHDA-treated rats did not induce SMB, indicating that release of serotonin by L-dopa is not responsible for this behavior. Because inhibition of dopamine-beta-hydroxylase did not alter the SMB response to L-dopa observed in neonatal 6-OHDA-treated rats, norepinephrine synthesized from L-dopa does not appear to contribute to the response. High doses of a decarboxylase inhibitor sufficient to inhibit conversion of dopa to dopamine in brain did not reduce the incidence of SMB. Administration of haloperidol (1 mg/kg) reduced the incidence of SMB, but did not antagonize the self-biting or the taffy pulling exhibited by L-dopa. In contrast, cisflupentixol completely blocked the SMB and self-biting induced by L-dopa.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1997

Self-inflicted burns.

Self-inflicted burns are a regular source of admissions to burns units world wide. This study examines the characteristics and outcomes of those who deliberately burn themselves. The medical records of all patients admitted to the Royal Brisbane Hospital Burns Unit and identified as having suffered a self-inflicted burn between 1990 and 1995 were reviewed. The records of patients who doused themselves with flammable liquid between 1984 and 1995 were examined as a separate group. Of 1072 admissions there were 44 cases (4.1 per cent) of deliberately self-inflicted burns. Average age was 30 yr with an average total burn surface area (TBSA) of 30 per cent (range 1-98 per cent). Schizophrenia, depression and personality disorder were diagnosed in 71 per cent. Alcohol intoxication was common in the rest. Suicide attempters were almost all male and the majority (60 per cent) were diagnosed with a major psychiatric illness. Self-mutilators suffered much less serious burns and none died. Self-inflicted burns accounted for 24 per cent of burns admitted to the intensive care unit. Self-immolation with flammable liquid resulted in severe burns with a 45 per cent mortality. A number of differences was demonstrated between those patients who had attempted suicide and those who had deliberately burnt themselves without suicidal attempt. Self-immolators constitute a considerable proportion of major burns admitted to this unit.

Adolescent↗
PubMed2000

A review of behavioral treatments used for Lesch-Nyhan syndrome.

Lesch-Nyhan syndrome is a genetic disorder resulting in hyperuricemia, choreoathetosis, mental retardation, and self-mutilation. The most salient feature of this disorder is the self-injurious behavior (SIB). Although the utility of behavioral interventions with SIB has been well documented, behavioral interventions with Lesch-Nyhan syndrome have been limited in number and long-term success. This article reviews the behavioral treatments that have been used in treating individuals with Lesch-Nyhan syndrome and discusses the strengths and weaknesses of these methods. Suggestions for future directions in the use of behavioral interventions for controlling SIB in Lesch-Nyhan syndrome are provided.

Behavior Therapy↗
PubMedDate not supplied

Lip biting in a patient with Chiari type II malformation: case report.

Self mutilation of lips and tongue is considered a common type of Self-Injurious Behavior (SIB). Treatment of SIB in the form of Lip-Biting in developmentally disabled individuals has been the focus of several related reports using different oral appliances preventing or inhibiting the SIB. In this paper we report a case of SIB in the form of Lip-Biting on an infant with Chiari Type II Malformation which was treated with a Lip-bumper. The Lip-bumper demonstrated to be a viable option in treating transient and acute episodes of SIB involving the lower lip and buccal mucosa.

Arnold-Chiari Malformation↗
PubMed2004

Self-extraction of teeth involving gamma-hydroxybutyric acid.

A case involving self-extraction of teeth linked to the abuse of gamma-hydroxybutyric acid (GHB) is reported. A 28-year-old woman and her 29-year-old boyfriend were discovered by paramedics following an extensive period of GHB use. The paramedics were alerted by a neighbor who had heard screaming from the house. On presentation to the accident and emergency department, it was noted that the female had 18 fresh extraction sockets visible intra-orally. At the scene, a mirror, a pair of pliers, and a bowl containing human teeth were found. Charges of assault were taken to the courts against the boyfriend who was subsequently acquitted. Odontological evidence centered on whether or not it was possible to self-extract the teeth using the pliers found. This case is the first to describe possible oral self-mutilation under the influence of GHB and odontologists should always consider self-injury as an explanation for intra- and perio-oral injuries of unknown origin.

Adjuvants, Anesthesia↗
PubMed2001

A witness breaks his silence: the meaning of a therapist's response to an adolescent's self-destruction.

I describe the case of a self-mutilating adolescent girl and my dilemma, as her therapist, about telling her parents about her self-abuse. I use two complementary, mutually enhancing relational theories of trauma--Ferenczi's (1933) and Davies and Frawley's (1994)--to help understand the minefield I was in. Davies and Frawley describe certain relational configurations that are typical of trauma victims. I believe that it is not only unavoidable but therapeutically vital for therapists to participate in these configurations so they can know the patient's experience in a personal way. It is also crucial that they be witnesses who provide recognition for the patient's pain and, in so doing, relieve the intolerable feeling of isolation that Ferenczi proposed was the most basic trauma. In addition, I discuss the observation that some people who have not been previously traumatized in any gross way manifest characteristics of trauma.

Adolescent↗