The Effects of Early Neuropathic Pain Control With Gabapentin on Long-Term Chronic Pain and Itch in Burn Patients

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.

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Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

The Open Pain Journal ◽

10.2174/1876386302013010035 ◽

2020 ◽

Vol 13 (1) ◽

pp. 35-41

Author(s):

Alfonso Papa ◽

Elisabetta Saracco ◽

Maria Teresa Di Dato ◽

Pietro Buonavolontà ◽

Anna Maria Salzano ◽

...

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Dorsal Root Ganglion ◽

Data Collection ◽

Dorsal Root ◽

Case Series ◽

Chronic Neuropathic Pain ◽

Neuropathic Pain Syndrome

Objectives: The dorsal root ganglion (DRG) is involved in the transduction of pain signals to the central nervous system (CNS) and undergoes a number of physiopathological changes during chronic pain. The purpose of this data collection was to evaluate the long-term safety and efficacy of DRG stimulation for the treatment of chronic pain and its impact on functional aspects. Materials and Methods: Forty-four subjects with non-reactive chronic neuropathic pain syndrome were implanted with DRG stimulation. Patients were evaluated at baseline as well as at 15, and 30 days, and at 3, 6, 12, 24, 36 and 48 months after medical intervention/surgery using the Visual Analogic Scale (VAS), which measures pain intensity, and the Oswestry Scale, for the estimation of disability (ODI). Results: After four years of simulation, VAS and ODI showed a statistically significant reduction throughout the follow-up period. The average pain relief obtained after 48 months of treatment was 74.1% ± 3.4. Conclusion: The results of this data collection demonstrate the feasibility of DRG stimulation, the correspondence between the clinical indications at the DRG implant and what is commonly found in the literature on this technique.(18,20) Patients defined as clinical responders to DRG stimulation and so implanted with definitive IPG showed a sustained and long term efficacy. Eight patients had previously been implanted with a traditional SCS without any clinically relevant efficacy; they were then explained for unsatisfactory results. Six of them (75%) were later implanted with DRG, with long-term effectiveness. Another advantage of this therapy is the absence of positional effects and lead migration. The adverse events proved to be independent of the anatomical level of insertion; moreover, this series of cases show a lower incidence of lead migration than reported in the literature. In summary, DRGs have been ignored for too long, probably due to the technical difficulty of reaching their deep, almost extra-spinal anatomical position.

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Teenager With Disabling Leg Pain

Psychological and Psychiatric Issues in Patients with Chronic Pain ◽

10.1093/med/9780197544631.003.0020 ◽

2021 ◽

pp. 179-186

Author(s):

Daniel M. Doleys ◽

Nicholas D. Doleys

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Dietary Supplements ◽

Dietary Habits ◽

Food Selection ◽

Treatment Options ◽

Age Groups ◽

Leg Pain ◽

Younger Age

The incidence and prevalence of chronic pain among children and adolescents appears to be increasing. The treatment options are limited. Understandably, one would want to minimize, if not avoid, long-term use of opioids. There are a number of modality and nonopioid therapies available. One approach often overlooked and underutilized, with all age groups, in the use of nutritional and dietary supplements. Many painful conditions, especially neuropathic pain, can be initialed and maintained by neuroinflammatory substances. Certain nutritional and dietary supplements can alter the effect of these substances and the abnormal neuronal functioning associated with pain. Unfortunately, the increased incidence of obesity, even among the younger age groups, reflects a continued trend toward poor dietary habits and food selection. This, along with other lifestyle issues, results in a population that is more vulnerable to developing painful disorders. For this reason, nutritional pain management should be given serious consideration.

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Opioids as a Treatment Option for MS Patients with Chronic Pain

International Journal of MS Care ◽

10.7224/1537-2073-7.1.10 ◽

2005 ◽

Vol 7 (1) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

Anthony H. Guarino ◽

Martha Cornell

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Treatment Option ◽

Opioid Therapy ◽

Term Therapy ◽

Drug Category ◽

Pain Syndromes ◽

Long Term Therapy ◽

Addictive Potential

Neuropathic and nociceptive pain are commonly observed in patients with MS. Among the analgesic options available for treating pain in MS, opioids may be too often avoided because of concerns about prescribing restrictions and addictive potential. However, when these fears are misplaced, they deny the patient of a powerful and potentially effective pain reduction option. Proper screening and management can help select appropriate patients for opioid therapy and maintain patients on long-term therapy while monitoring for signs of behaviors such as addiction or diversion. One such method involves entering into a “contract” with the patient with guidelines for renewing prescriptions. Although the literature contains few studies on opioids specific to MS patients, a number of studies support the use of this drug category in patients experiencing neuropathic pain syndromes.

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Psychological Assessment of Control and Coping with Neuropathic Pain in the Lumbar Spine

Rehabilitacja Medyczna ◽

10.5604/01.3001.0015.5902 ◽

2021 ◽

Vol 25 (3) ◽

Author(s):

Agata Kryszak ◽

Zbigniew Czernicki ◽

Damian Wiśniewski

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Lumbar Spine ◽

Coping Strategy ◽

Pain Control ◽

Lumbar Region ◽

Pain Coping ◽

Random Events ◽

And Coping ◽

Pain Coping Strategy

Background: Pain in the lumbar spine is an increasingly common problem, not only neurological or orthopaedic, but also psychological. In epidemiological studies on the prevalence of neuropathic pain, conducted in countries such as the United Kingdom, the United States France, and Brazil, it has been shown that the prevalence of chronic pain with neuropathic properties is estimated at 7-10%. Chronic neuropathic pain is more common in women (8% versus 5.7% in men) and in patients > 50 years of age (8.9% versus 5.6% in women < 49 years old). It most frequently concerns the lumbar region and lower limbs. However, in Germany, it has been revealed that 40% of all patients experience at least some features of neuropathic pain such as burning, numbness and/or tingling, especially those with chronic pain in the lumbar spine and radiculopathy. Chronic pain not only hinders a patient's daily life activities, but over time, it has negative impact on the patient's psyche: it reduces his/her well-being, causing anxiety, fear, helplessness, regret and even hostility. It should be emphasized that each of these reactions is an individual feature. Objectives: The aim of the study is to assess pain control as well as the strategies of coping with neuropathic pain in the lumbar spine. Material and methods: The study comprised 50 people with neuropathic pain in the lumbar region, including 41 women and 19 men. The average age of the respondents was 56 years, the average duration of the symptoms was 8 years. The following questionnaires were used to assess neuropathic pain: Lanss Pain Scale and DN4, and the Visual Analogue Scale (VAS) to assess pain intensity. For Pain Control Assessment - the Beliefs Questionnaire for Pain Control (BPCQ) and Pain Coping Strategy Questionnaire (CSQ). Results: Among the 3 measured factors of pain control, internal control dominates in young people, external control in middle-aged individuals, and the attitude towards random events in the elderly. There was significant statistical dependence between pain coping strategy and type of pain control. Conclusions: With the duration of pain and the age of the patient, random events play an increasingly important role in pain control. Hence, tests on pain control and coping should be carried out among patients as this would determine the most favourable treatment method.

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A Systematic Review of The Professional Medical Conversation Regarding Conflict Related Chronic Post Amputation & Neuropathic Pain 1914-1985

10.31219/osf.io/bkwdr ◽

2020 ◽

Author(s):

Sarah Dixon Smith

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

First World War ◽

Phantom Limb ◽

Long Term Effects ◽

World War ◽

The Uk ◽

The Impact ◽

First World

The First World War resulted in the largest amputee cohort in history, with over 41,000 amputees in the UK alone. Limb wounds were (and still are) the most common site of survivable injury in conflict and accounted for 70% of all British casualties from 1914 to 1918. Of these casualties, 59% were caused by artillery or high velocity munitions, wounds that today, in some cases, could be termed ‘blast injury’.To date, there appears to have been no detailed analysis of the impact of this type of injury or pain on veterans’ long-term health and quality of life, or into the evolution of the professional, political and lay concepts, attitudes or clinical assessment and management for these types of chronic pain and the inherent years lost to disability [YLD] it caused.Although amputation rates have been reduced in recent conflicts, chronic residual stump, phantom limb and peripheral neuropathic pain are still significant issues in the rehabilitation of conflict wounds, and it is estimated that up to 85% of amputees suffer from chronic pain as a result of amputation. Given the similarities between the injury patterns caused by First World War weaponry and those from the improvised explosive devices [IEDs] of 21st century conflicts, this project has the potential to inform contemporary medical researchers, clinicians and disability policy as the long-term effects of blast injuries sustained by UK military personnel in Iraq and Afghanistan (329 blast-related amputations in total) become more evident.

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Pain and its control

10.1093/med/9780199550647.003.0007 ◽

2011 ◽

Author(s):

Henry McQuay

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Pain Control ◽

Close Link ◽

Pain Scales ◽

Subjective Pain

♦ The origin, transmission, and reception of chronic pain is not easy to understand♦ The perception of pain is altered by mood and itself alters mood. There is, therefore, a close link between chronic pain and depression♦ Although pain is subjective, pain scales and diaries can be used to provide reproducible measures of pain♦ The choice of method of pain control is not simply a ladder. New stronger agents need to be added in, not substituted for weaker ones♦ Neuropathic pain will require unconventional analgesics in combination.

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Deep brain stimulation for the treatment of various chronic pain syndromes

Neurosurgical FOCUS ◽

10.3171/foc.2006.21.6.10 ◽

2006 ◽

Vol 21 (6) ◽

pp. 1-8 ◽

Cited By ~ 113

Author(s):

Dirk Rasche ◽

Patricia C. Rinaldi ◽

Ronald F. Young ◽

Volker M. Tronnier

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Neuropathic Pain ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Long Term Results ◽

Pain Syndromes ◽

Chronic Pain Syndromes ◽

Deep Brain

Object Electrical intracerebral stimulation (also referred to as deep brain stimulation [DBS]) is a tool for the treatment of chronic pain states that do not respond to less invasive or conservative treatment options. Careful patient selection, accurate target localization, and identification with intraoperative neurophysiological techniques and blinded test evaluation are the key requirements for success and good long-term results. The authors present their experience with DBS for the treatment of various chronic pain syndromes. Methods In this study 56 patients with different forms of neuropathic and mixed nociceptive/neuropathic pain syndromes were treated with DBS according to a rigorous protocol. The postoperative follow-up duration ranged from 1 to 8 years, with a mean of 3.5 years. Electrodes were implanted in the somatosensory thalamus and the periventricular gray region. Before implantation of the stimulation device, a double-blinded evaluation was carefully performed to test the effect of each electrode on its own as well as combined stimulation with different parameter settings. The best long-term results were attained in patients with chronic low-back and leg pain, for example, in so-called failed–back surgery syndrome. Patients with neuropathic pain of peripheral origin (such as complex regional pain syndrome Type II) also responded well to DBS. Disappointing results were documented in patients with central pain syndromes, such as pain due to spinal cord injury and poststroke pain. Possible reasons for the therapeutic failures are discussed; these include central reorganization and neuroplastic changes of the pain-transmitting pathways and pain modulation centers after brain and spinal cord lesions. Conclusions The authors found that, in carefully selected patients with chronic pain syndromes, DBS can be helpful and can add to the quality of life.

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Long term study on the effects of microsurgical DREZotomy for chronic pain control

Romanian Neurosurgery ◽

10.33962/roneuro-2020-042 ◽

2020 ◽

pp. 288-293

Author(s):

Fayçal Aichaoui ◽

Khelifa Adel ◽

Muneer Al-Zekri ◽

Walid Bennabi ◽

Sid Abderahman Myara ◽

...

Keyword(s):

Chronic Pain ◽

Pain Control ◽

Spinal Cord Injuries ◽

Phantom Pain ◽

Root Entry Zone ◽

Long Term Study ◽

Kaplan Meier ◽

Significant Difference ◽

Global Pain

The DREZotomy (Dorsal Root Entry Zone tomy) is an analgesic procedure. The analgesic effect is evaluated on 30 patients with chronic pain resulting from respectively: brachial plexus avulsion (66.6%), postherpetic pain (10%), hyperspastic states (6.6%), phantom pain (6.6%), the pain in the stump (6.6%), and spinal cord injuries (3.3%). Pain intensity was evaluated using a visual analogue scale (VAS). At last evaluation, between 12 and 60 months, after DREZotomy, 93% had a good or excellent global pain relief after surgery. According to the component types of pain, 9.6% of patients had good or excellent control of the paroxysmal pain, and 84% of the continuous pain. Kaplan–Meier prediction of lasting global pain control at 60 months of follow-up was calculated at 75.5%. Comparison of the 2 corresponding Kaplan–Meier curves at long term, namely, pain control in 82.8% for the paroxysmal component and in 51.7% for the continuous component, showed a statistically significant difference (P < 0.0001). Functional effects are improved by more than 70% according to patients.

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Chronic pain, functionality and quality of life in cancer survivors

British Journal of Pain ◽

10.1177/2049463720972730 ◽

2020 ◽

pp. 204946372097273

Author(s):

João Poço Gonçalves ◽

Dalila Veiga ◽

António Araújo

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Cancer Survivors ◽

Long Term Effects ◽

Average Life ◽

Average Life Span ◽

Oncological Disease

The increasing number of cancer survivors associated to a longer average life-span after diagnosis of an oncological disease facilitates the observation of deleterious long-term effects of both oncological disease and its treatment. Among these effects, chronic pain emerges as one of the most prevalent and, with its onset, there is a decrease in these patients’ functionality and quality of life. The main focus in oncological disease treatment has been tumour eradication and average life expectancy extension after diagnosis, neglecting these deleterious long-term effects. This study aims at assessing the prevalence and characteristics of chronic pain in cancer survivors as well as pain interference in their quality of life and functionality. The study selected cancer survivors (n = 85) after dismissal from oncology service to assess the presence and characteristics of chronic pain, their health-related quality of life (HRQoL) and pain-related disability through a combination of different questionnaires. Chronic pain prevalence was 23.5%. In total, 85% of patients reported neuropathic pain descriptors and 45% presented diagnostic criteria for neuropathic pain. Of these patients, 45% were followed-up for pain surveillance and 35% underwent analgesic medication. There was a median pain disability index of 20.50 (14.50–35.00) and an average HRQoL of 0.5338 in chronic pain patients and 0.8872 in patients without pain. We found that chronic pain was the main negative predictor of HRQoL and was associated with decreased functionality. This study also concluded that these patients often were not offered the appropriate long-term medical follow-up. These findings highlight a need to raise awareness among health professionals to the importance of timely diagnosis and treatment of pain and its impact on HRQoL and functionality of long-term cancer survivors as well as the need to change clinical practice in order to improve healthcare provided to these patients.

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