A brief, high-dose remifentanil infusion partially reverses neuropathic pain in a subgroup of post herpetic neuralgia patients

2017 ◽  
Vol 40 ◽  
pp. 195-197
Author(s):  
Julian Prosenz ◽  
Herwig Kloimstein ◽  
Ulrich Thaler ◽  
Ruth Drdla-Schutting ◽  
Jürgen Sandkühler ◽  
...  
2021 ◽  
Vol 11 (8) ◽  
pp. 758
Author(s):  
Songjin Ri ◽  
Anatol Kivi ◽  
Jörg Wissel

There are few reports on the safety and effectiveness of long-term botulinumtoxin A (BoNT A) therapy in severe chronic pain of post-herpetic neuralgia (PHN). The literature was searched with the term “neuropathic pain” and “botulinum” on PubMed (up to 29 February 2020). Pain was assessed with the Visual Analogue Scale (VAS) before and after BoNT A therapy. A total of 10 clinical trials and six case reports including 251 patients with PHN were presented. They showed that BoNT A therapy had significant pain reduction (up to 30–50%) and improvement in quality of life. The effect duration seems to be correlated with BoNT A doses injected per injection site. Intervals between BoNT A injections were 10–14 weeks. No adverse events were reported in cases and clinical studies, even in the two pregnant women, whose babies were healthy. The repeated (≥6 times) intra/subcutaneous injections of incobotulinumtoxin A (Xeomin®, Merz Pharmaceuticals, Germany) over the two years of our three cases showed marked pain reduction and no adverse events. Adjunctive local BoNT A injection is a promising option for severe PHN, as a safe and effective therapy in long-term management for chronic neuropathic pain. Its effect size and -duration seem to be depended on the dose of BoNT A injected per each point.


2003 ◽  
Vol 99 (4) ◽  
pp. 834-840 ◽  
Author(s):  
Walter Klimscha ◽  
Roman Ullrich ◽  
Christian Nasel ◽  
Wolfgang Dietrich ◽  
Udo M. Illievich ◽  
...  

Background Cerebrovascular carbon dioxide reactivity during high-dose remifentanil infusion was investigated in volunteers by measurement of regional cerebral blood flow (rCBF) and mean CBF velocity (CBFv). Methods Ten healthy male volunteers with a laryngeal mask for artificial ventilation received remifentanil at an infusion rate of 2 and 4 microg x kg-1 x min-1 under normocapnia, hypocapnia, and hypercapnia. Stable xenon-enhanced computed tomography and transcranial Doppler ultrasonography of the left middle cerebral artery were used to assess rCBF and mean CBFv, respectively. If required, blood pressure was maintained within baseline values with intravenous phenylephrine to avoid confounding effects of altered hemodynamics. Results Hemodynamic parameters were maintained constant over time. Remifentanil infusion at 2 and 4 microg x kg-1 x min-1 significantly decreased rCBF and mean CBFv. Both rCBF and mean CBFv increased as the arterial carbon dioxide tension increased from hypocapnia to hypercapnia, indicating that cerebrovascular reactivity remained intact. The average slopes of rCBF reactivity were 0.56 +/- 0.27 and 0.49 +/- 0.28 ml. 100 g-1 x min-1 x mmHg-1 for 2 and 4 microg x kg-1 x min-1 remifentanil, respectively (relative change in percent/mmHg: 1.9 +/- 0.8 and 1.6 +/- 0.5, respectively). The average slopes for mean CBFv reactivity were 1.61 +/- 0.95 and 1.54 +/- 0.83 cm x s-1 x mmHg-1 for 2 and 4 microg x kg-1 x min-1 remifentanil, respectively (relative change in percent/mmHg: 1.86 +/- 0.59 and 1.79 +/- 0.59, respectively). Preanesthesia and postanesthesia values of rCBF and mean CBFv did not differ. Conclusion High-dose remifentanil decreases rCBF and mean CBFv without impairing cerebrovascular carbon dioxide reactivity. This, together with its known short duration of action, makes remifentanil a useful agent in the intensive care unit when sedation that can be titrated rapidly is required.


2009 ◽  
Vol 67 (3a) ◽  
pp. 741-749 ◽  
Author(s):  
Pedro Schestatsky ◽  
Osvaldo José M. Nascimento

Neuropathic pain (NP) is defined as pain caused by lesion or dysfunction of the somatosensory system, as a result of abnormal activation of the nociceptive pathway (small fibers and spinothalamic tracts). The most common causes of this syndrome are the following: diabetes, post-herpetic neuralgia, trigeminal neuralgia, stroke, multiple sclerosis, spinal cord injury, HIV infection, cancer. In the last few years, the NP has been receiving special attention for two main reasons: (1) therapeutical refractoriness of a variety of pain syndromes with predominant neuropathic characteristics and (2) the development of diagnostic tools for neuropathic pain complaints. The present review article provides relevant information on the understanding and recognition of NP, as well as evidence-based therapeutic approaches.


2015 ◽  
Vol 3 ◽  
pp. 257-259
Author(s):  
Jakub Kucharz ◽  
Iwona Filipczak-Bryniarska ◽  
Anna Michalowska-Kaczmarczyk ◽  
Roman M. Herman ◽  
Krzysztof Krzemieniecki

2000 ◽  
Vol 19 (6) ◽  
pp. 405-407 ◽  
Author(s):  
Yoko Tarumi ◽  
Sharon Watanabe ◽  
Eduardo Bruera ◽  
Kunihiko Ishitani
Keyword(s):  

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E905-E915
Author(s):  
Hélène Staquet

Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/ or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications. Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/dy and up to a median of 1.2 µg/dy [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/dy [0.24; 0.66] up to 0.6 mg/dy [0.45; 4.63] and 1.2 mg/dy [0; 2.4] up to 2.23 mg/dy [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. Key words: Intracerebroventricular infusion, ziconotide, intractable pain, nociceptive and neuropathic pain


Author(s):  
Andrea E. Cavanna

Gabapentin is a second-generation antiepileptic drug characterized by few antiepileptic indications, with very good interaction profile in polytherapy. The therapeutic indications of gabapentin for the treatment of epileptic seizures have been largely overshadowed by its widespread use for the treatment of neuropathic pain (especially post-herpetic neuralgia, diabetic neuropathy, and pain caused by a spinal cord injury). Gabapentin has a good behavioural tolerability profile and a good range of psychiatric uses (unlicensed indications for anxiety disorders and alcohol withdrawal symptoms). Despite the widespread use of gabapentin for behavioural conditions, its potential usefulness as adjunctive treatment of bipolar affective disorder is still controversial.


2013 ◽  
Vol 110 (2) ◽  
pp. 287-292 ◽  
Author(s):  
N.A. Manering ◽  
T. Reuter ◽  
H. Ihmsen ◽  
D.C. Yeomans ◽  
A. Tzabazis

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