Assessment of pain quality in chronic neuropathic and nociceptive pain clinical trials with the Neuropathic Pain Scale

Introduction: Administering systemic lidocaine has been shown to deliver effective analgesia for both cancer-related and non-cancer pain. Adverse effects and toxicity are rare with controlled administration. Objective: To report the results obtained after the indication to manage with IV lidocaine infusion to control neuropathic pain flares in 9 cancer patients. Methodology: Observational, descriptive, case series-type study. A search was conducted in the files of the Pain and Palliative Care Service of the National Cancer Institute - Instituto Nacional de Cancerología - in Bogotá. Patients over 18 years old diagnosed with cancer, who experienced high intensity neuropathic pain and with the cognitive ability to rate their pain in a numerical analogue scale (NAS), without any absolute contraindications for the use of IV lidocaine were included; patients were assessed between September 27 and November 21, 2019. Results: 9 patients experiencing a pain flare-up which was characterized as neuropathic were registered, of which 89 % had some improvement following the administration of an initial lidocaine bolus. After one hour, 60 % reported over 40% improvement in the initial NAS. After 24 hours all patients had experienced some improvement, with a reduction of 46% in the pain scale as compared to the baseline. Conclusions: In this series of cases, the intravenous infusion of lidocaine as an option for the management of neuropathic pain flares seems to reduce pain intensity following the initial bolus administration.

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Assessing symptom profiles in neuropathic pain clinical trials: Can it improve outcome?

European Journal of Pain ◽

10.1016/j.ejpain.2011.03.005 ◽

2011 ◽

Vol 15 (5) ◽

pp. 441-443 ◽

Cited By ~ 63

Author(s):

Nadine Attall ◽

Didier Bouhassira ◽

Ralf Baron ◽

Jonathan Dostrovsky ◽

Robert H. Dworkin ◽

...

Keyword(s):

Clinical Trials ◽

Neuropathic Pain ◽

Improve Outcome ◽

Symptom Profiles

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Pregabalin for neuropathic pain based on recent clinical trials

Current Pain and Headache Reports ◽

10.1007/s11916-006-0043-x ◽

2006 ◽

Vol 10 (3) ◽

pp. 179-184 ◽

Cited By ~ 17

Author(s):

Brett R. Stacey ◽

Jon N. Swift

Keyword(s):

Clinical Trials ◽

Neuropathic Pain

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EVALUATION OF NEUROPATHIC PAIN SCALE KNOWLEDGE

Coluna/Columna ◽

10.1590/s1808-185120191802195408 ◽

2019 ◽

Vol 18 (2) ◽

pp. 130-133

Author(s):

Marcos Antônio Ribeiro de Menezes Lopes ◽

Maurício Alcântara Angelim ◽

Davi Dominguez Sousa

Keyword(s):

Neuropathic Pain ◽

Clinical Practice ◽

Clinical Diagnosis ◽

Somatosensory System ◽

Total Sample ◽

Cross Sectional Study ◽

Pain Scale ◽

Level Of Evidence ◽

Cross Sectional ◽

Method Of Evaluation

ABSTRACT Objectives: Neuropathic pain (ND) is defined as “one that results from injury or disease that directly affects the somatosensory system”, differing from other types of pain in terms of symptoms, mechanisms and therapeutics, being the early diagnosis prerequisite for the appropriate management. Pain evaluation scales are very useful in clinical diagnosis. It is critical that orthopedic doctors are familiar with such tools. The objective was to evaluate whether the orthopedic physicians in Salvador know the tools of evaluation and clinical diagnosis of neuropathic pain (ND), as well as to determine which method of evaluation of ND is most used in their clinical practice. Methods: Data were analyzed from 74 orthopedic physicians working in the city of Salvador, who were interviewed from January to November 2017. Data were collected through a structured questionnaire consisting of subjective and objective questions and analyzed with SPSS 22.0 software. Results: Among the interviewed physicians, 41.9% knew some of the scales and, of these, 64.5% used in their clinical practice, being 70.3% of the total sample. The LANSS scale was used by 25.8% of the physicians in their practice as a tool to diagnose neuropathic pain, 22.6% used DN4 and 35.5% did not use any. Conclusions: The orthopedic physicians know little about the tools of evaluation and diagnosis of neuropathic pain and those with greater time of activity know less these tools than those who have less time. Many who know the tools do not use them in their clinical practice. LANSS and DN4 are the most commonly used scales. Level of Evidence III; Cross Sectional Study.

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Evaluation of composite responder outcomes of pain intensity and physical function in neuropathic pain clinical trials

Pain ◽

10.1097/j.pain.0000000000001324 ◽

2018 ◽

Vol 159 (11) ◽

pp. 2245-2254 ◽

Cited By ~ 10

Author(s):

Kushang V. Patel ◽

Robert Allen ◽

Laurie Burke ◽

John T. Farrar ◽

Jennifer S. Gewandter ◽

...

Keyword(s):

Clinical Trials ◽

Neuropathic Pain ◽

Pain Intensity ◽

Physical Function

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Effects of Pregabalin in Patients with Neuropathic Pain Previously Treated with Gabapentin: A Pooled Analysis of Parallel-Group, Randomized, Placebo-controlled Clinical Trials

Pain Practice ◽

10.1111/papr.12516 ◽

2016 ◽

Vol 17 (6) ◽

pp. 718-728 ◽

Cited By ~ 6

Author(s):

John D. Markman ◽

Troels Staehelin Jensen ◽

David Semel ◽

Chunming Li ◽

Bruce Parsons ◽

...

Keyword(s):

Clinical Trials ◽

Neuropathic Pain ◽

Pooled Analysis ◽

Controlled Clinical Trials ◽

Parallel Group ◽

Previously Treated

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Pain neurophysiology

10.1093/med/9780199642489.003.0059 ◽

2013 ◽

Author(s):

Hans-Georg Schaible ◽

Rainer H. Straub

Keyword(s):

Neuropathic Pain ◽

Central Sensitization ◽

Cell Activation ◽

Warning Signal ◽

Nociceptive Pain ◽

Neural Function ◽

Peripheral Sensitization ◽

Nerve Fibres ◽

Glial Cell Activation ◽

Ectopic Discharges

Physiological pain is evoked by intense (noxious) stimuli acting on healthy tissue functioning as a warning signal to avoid damage of the tissue. In contrast, pathophysiological pain is present in the course of disease, and it is often elicited by low-intensity stimulation or occurs even as resting pain. Causes of pathophysiological pain are either inflammation or injury causing pathophysiological nociceptive pain or damage to nerve cells evoking neuropathic pain. The major peripheral neuronal mechanism of pathophysiological nociceptive pain is the sensitization of peripheral nociceptors for mechanical, thermal and chemical stimuli; the major peripheral mechanism of neuropathic pain is the generation of ectopic discharges in injured nerve fibres. These phenomena are created by changes of ion channels in the neurons, e.g. by the influence of inflammatory mediators or growth factors. Both peripheral sensitization and ectopic discharges can evoke the development of hyperexcitability of central nociceptive pathways, called central sensitization, which amplifies the nociceptive processing. Central sensitization is caused by changes of the synaptic processing, in which glial cell activation also plays an important role. Endogenous inhibitory neuronal systems may reduce pain but some types of pain are characterized by the loss of inhibitory neural function. In addition to their role in pain generation, nociceptive afferents and the spinal cord can further enhance the inflammatory process by the release of neuropeptides into the innervated tissue and by activation of sympathetic efferent fibres. However, in inflamed tissue the innervation is remodelled by repellent factors, in particular with a loss of sympathetic nerve fibres.

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The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities

Current Pharmaceutical Biotechnology ◽

10.2174/1389201020666191202111534 ◽

2020 ◽

Vol 21 (5) ◽

pp. 390-402 ◽

Cited By ~ 8

Author(s):

Dixon H. Xu ◽

Benjamin D. Cullen ◽

Meng Tang ◽

Yujiang Fang

Keyword(s):

Neuropathic Pain ◽

Placebo Group ◽

Peripheral Neuropathy ◽

Symptomatic Relief ◽

Symptom Relief ◽

Treatment Algorithm ◽

Pain Scale ◽

Current Treatment ◽

Chronic Noncancer Pain ◽

Noncancer Pain

Background: Peripheral neuropathy can significantly impact the quality of life for those who are affected, as therapies from the current treatment algorithm often fail to deliver adequate symptom relief. There has, however, been an increasing body of evidence for the use of cannabinoids in the treatment of chronic, noncancer pain. The efficacy of a topically delivered cannabidiol (CBD) oil in the management of neuropathic pain was examined in this four-week, randomized and placebocontrolled trial. Methods: In total, 29 patients with symptomatic peripheral neuropathy were recruited and enrolled. 15 patients were randomized to the CBD group with the treatment product containing 250 mg CBD/3 fl. oz, and 14 patients were randomized to the placebo group. After four weeks, the placebo group was allowed to crossover into the treatment group. The Neuropathic Pain Scale (NPS) was administered biweekly to assess the mean change from baseline to the end of the treatment period. Results: The study population included 62.1% males and 37.9% females with a mean age of 68 years. There was a statistically significant reduction in intense pain, sharp pain, cold and itchy sensations in the CBD group when compared to the placebo group. No adverse events were reported in this study. Conclusions: Our findings demonstrate that the transdermal application of CBD oil can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy. The treatment product was well tolerated and may provide a more effective alternative compared to other current therapies in the treatment of peripheral neuropathy.

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