Management issues in neuropathic pain

2015 ◽  
Author(s):  
Nanna Brix Finnerup ◽  
Troels Staehelin Jensen
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Cancer Survivors ◽  
Tricyclic Antidepressants ◽  
Topical Lidocaine ◽  
Noradrenaline Reuptake ◽  
Somatosensory Nervous System ◽  
Disease Free ◽  
Management Issues

Neuropathic pain is a common complication to cancer, cancer treatment, HIV, and other conditions that may affect the somatosensory nervous system. Neuropathic pain may be present in up to 40% of cancer patients and may persist independently of the cancer and affect the quality of life in disease-free cancer survivors. Particular surgical treatment and chemotherapy may cause chronic persistent neuropathic pain in cancer survivors. The diagnosis of neuropathic pain can be challenging and requires documentation of a nervous system lesion and pain in areas of sensory changes. The pharmacological treatment may include tricyclic antidepressants, selective serotonin noradrenaline reuptake inhibitors (duloxetine or venlafaxine), calcium channel α2↓ agonists (gabapentin or pregabalin), and opioids. Topical lidocaine and capsaicin, NMDA antagonists, carbamazepine, oxcarbazepine, and cannabinoids may be indicated. Due to limited efficacy or intolerable side effects at maximal doses, combination therapy is often required and careful monitoring of effect and adverse reactions is important.

Management issues in neuropathic pain

2021 ◽  
pp. 485-490
Author(s):  
Lise Ventzel ◽  
Nanna Brix Finnerup
Keyword(s):  
Neuropathic Pain ◽  
Cancer Survivors ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Cancer Treatments ◽  
Topical Lidocaine ◽  
Noradrenaline Reuptake ◽  
Third Line ◽  
Strong Opioids

Neuropathic pain is a common complication to cancer and cancer treatments, such as surgery, chemotherapy, and radiation therapy. Neuropathic pain may be present in up to 40% of cancer patients and may persist independently of the cancer and affect the quality of life in disease-free cancer survivors. Particular surgery and chemotherapy may cause chronic neuropathic pain in cancer survivors. The diagnosis of neuropathic pain can be challenging and requires documentation of a nervous system lesion and pain in areas of sensory changes. The pharmacological treatment includes tricyclic antidepressants, selective serotonin–noradrenaline reuptake inhibitors (duloxetine or venlafaxine), gabapentin, and pregabalin as first-line treatments. Topical lidocaine 5%, capsaicin 8% patches, botulinum toxin type A, tramadol, and strong opioids are second- and third-line treatments. Steroids may have a role in the acute management of cancer-related neuropathic pain. Due to limited efficacy or intolerable side effects at maximal doses, combination therapy is often required and careful monitoring of effect and adverse reactions is important.

scholarly journals An overview of analgesics - anticonvulsants, antidepressants, and other medications (Part 3)

2019 ◽  
Vol 61 (3) ◽  
pp. 59-63
Author(s):  
R. Van Rensburg ◽  
H. Reuter
Keyword(s):  
Chronic Pain ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Tissue Damage ◽  
Tricyclic Antidepressants ◽  
Treatment Options ◽  
First Line ◽  
Patient Profile ◽  
Noradrenaline Reuptake ◽  
Associated Conditions

Pain is classified by various descriptions. Chronic pain has been described as being neuropathic (due to nervous system lesions), nociceptive (due to tissue damage), or mixed (a combination of neuropathic and nociceptive). The addition of the term nociplastic pain is used to describe patients who experience chronic pain without tissue damage or nervous system lesions. Chronic pain is often difficult to manage, particularly neuropathic pain. Evidence-based pharmacological treatment options include anticonvulsants and antidepressants. The choice of medication will depend on various factors, including patient profile, type of pain, and associated conditions. Medications with the best evidence of efficacy for first-line use in neuropathic pain are the gabapentinoids, carbamazepine, the tricyclic antidepressants, and the serotonin-noradrenaline reuptake inhibitors duloxetine and venlafaxine. The cannabinoids and ketamine are being actively investigated for use in chronic pain. Currently the cannabinoids’ potential benefit is outweighed by the adverse effects, and recommendations for the use of ketamine is limited by its parenteral route of administration and low evidence of efficacy in chronic pain.

scholarly journals The Rehabilitation of Oncological Patients Presenting Neuropathies

2014 ◽  
Vol 87 (2) ◽  
pp. 67-72
Author(s):  
Elena Claudia Micu ◽  
Laszlo Irsay
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
International Association ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Morbidity Rate ◽  
Oncological Patients ◽  
Somatosensory Nervous System

The International Association for the Study of Pain (IASP 2011) defines neuropathic pain as “the pain caused by an injury or disease of the somatosensory portion of the nervous system”. The central neuropathic pain is defined as “the pain caused by an injury or disease of the central somatosensory central nervous system”, whereas the peripheral neuropathic pain is defined as “the pain caused by an injury or disease of the peripheral somatosensory nervous system”. The peripheral neuropathy describes any affection of the peripheral nervous system. The etiology is vast, there being a number of over 100 possible causes, which causes the global morbidity rate to reach approximately 2.4%. The chronic nature of the pain superposes the everyday routine and leads to the high intake of medication for pain alleviation. The number of cases of neuroplasia has always increased today. This disturbing diagnosis which can potentiate the signs and symptoms of peripheral neuropathy as well as reduce and limit the treatment options associated with neuropathies. The treatment presupposes a multidisciplinary approach, while the solution to prevent complications involves the control of risk factors and pathophysiological treatment.  Chemotherapy-induced peripheral neuropathy (CPIN) is a significant disabling symptom that is tightly connected to the administration of neurotoxic cytostatic agents used for the treatment of neoplasia. CPIN compromises the quality of life and produces pain or discomfort. I have sought to produce a presentation of the medicated and physical-kinetic treatment options that have proved their effectiveness during clinical studies or random trials and can be applied to cancer patients presenting with symptoms associated with peripheral neuropathy, namely with neuropathic pain, and support it with arguments

scholarly journals Neuropathic pain in rheumatoid arthritis

2020 ◽  
Vol 12 (5) ◽  
pp. 60-65
Author(s):  
E. S. Filatova ◽  
A. M. Lila ◽  
V. A. Parfenov
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Pain Syndrome ◽  
Chronic Pain Syndrome ◽  
Paindetect Questionnaire ◽  
Somatosensory Nervous System

Objective: to identify the signs of neuropathic pain (NP) in patients with rheumatoid arthritis (RA) on the basis of the PainDETECT questionnaire and neurological examination.Patients and methods. A total of 208 RA patients (39 men and 169 women; mean age, 47.7 years) with chronic pain syndrome were examined. The patients underwent rheumatological and neurological examinations; NP was diagnosed using the PainDETECT questionnaire; inflammation severity (DAS28 index), pain intensity (VAS), affective disorders (HADS), and quality of life (EQ-5D) were assessed.Results and discussion. 172 (82.7%) patients had moderate and high disease activity according to the DAS28. The signs of possible and highly probable NP according to the PainDETECT questionnaire were detected in 29.8 and 26.9% of patients, respectively; they were significantly more likely to be detected in patients with more severe pain syndrome, clinically significant anxiety, and worse quality of life, but were unassociated with RA activity according to the DAS28. Somatosensory nervous system injury (polyneuropathy, tunnel syndromes, and cervical myelopathy) was found in 77.6% of patients with possible NP and in 80.4% with highly probable NP. In other patients, NP might be caused by central sensitization. Conclusion. In patients with a RA exacerbation, chronic pain syndrome is caused not only by an active inflammatory process in the joint area and adjacent tissues, but also by somatosensory nervous system injury and central sensitization.

scholarly journals B12 as a Treatment for Peripheral Neuropathic Pain: A Systematic Review

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2221
Author(s):  
Thomas Julian ◽  
Rubiya Syeed ◽  
Nicholas Glascow ◽  
Efthalia Angelopoulou ◽  
Panagiotis Zis
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Post Herpetic Neuralgia ◽  
Peripheral Neuropathic Pain ◽  
Treatment Regimens ◽  
Level Ii ◽  
Somatosensory Nervous System

Neuropathic pain describes a range of unpleasant sensations caused by a lesion or disease of the somatosensory nervous system. The sensations caused by neuropathic pain are debilitating and improved treatment regimens are sought in order to improve the quality of life of patients. One proposed treatment for neuropathic pain is vitamin B12, which is thought to alleviate pain by a number of mechanisms including promoting myelination, increasing nerve regeneration and decreasing ectopic nerve firing. In this paper, the evidence for B12 as a drug treatment for neuropathic pain is reviewed. Twenty four published articles were eligible for inclusion in this systematic review in which a range of treatment regimens were evaluated including both B12 monotherapy and B12 in combination with other vitamins or conventional treatments, such as gabapentinoids. Overall, this systematic review demonstrates that there is currently some evidence for the therapeutic effect of B12 in the treatment of post-herpetic neuralgia (level II evidence) and the treatment of painful peripheral neuropathy (level III evidence).

Treatment of Neuropathic Pain

1998 ◽  
Vol 11 (5) ◽  
pp. 382-387
Author(s):  
Jorge E. Mendizabal ◽  
Richard M. Zweifler
Keyword(s):  
Quality Of Life ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Tricyclic Antidepressants ◽  
Sensory System ◽  
The Novel ◽  
Pain Syndromes ◽  
Drug Classes ◽  
Inflammatory Drugs

Neuropathic pain is generated by disruption of normal nerve connections and/or abnormal hyperactivity at some level of the pain sensory system. Neuropathic pain syndromes due to peripheral nervous system injury are commonly encountered in clinical practice and often adversely affect patients’ quality of life. Pharmacotherapy is the mainstay of neuropathic pain management, with the majority of clinical data supporting the use of three main drug classes: (1) tricyclic antidepressants; (2) anticonvulsants; and (3) anesthetic-antiarrhythmics. Clonidine, opioids, capsaicin, nonsteroidal anti-inflammatory drugs, immunosuppressants, and the novel antidepressants may also have a role in some patient populations.

Quality of Life Among Disease-Free Survivors of Rectal Cancer

2004 ◽  
Vol 22 (2) ◽  
pp. 354-360 ◽  
Author(s):  
Philippe Rauch ◽  
Joelle Miny ◽  
Thierry Conroy ◽  
Lionel Neyton ◽  
Francis Guillemin
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Cancer Survivors ◽  
German Population ◽  
European Organization ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
The Impact ◽  
Disease Free

Purpose To identify factors affecting the quality of life (QoL) of disease-free survivors of rectal cancer. Patients and Methods One hundred twenty-one patients in complete remission more than 2 years after diagnosis were asked to complete three QoL questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30; its colorectal module, QLQ-CR38; and the Duke generic instrument. Results Patients reported less pain (P = .002) than did controls drawn from the general population. EORTC QLQ-C30 physical scores were also higher among rectal cancer survivors than in the general Norwegian or German population (P = .0005 and P = .002, respectively). Unexpectedly, stoma patients reported better social functioning than did nonstoma patients (P = .005), with less anxiety (P = .008) and higher self-esteem (P = .0002). In the present authors' experience, the QLQ-CR38 does not discriminate between these groups. Residual abdominal or pelvic pain and constipation had the most negative influence on QoL. Conclusion QoL is high among rectal cancer survivors, including stoma patients. Simultaneous use of several QoL questionnaires appears to have value in follow-up and in monitoring the effects of therapy. The impact of residual pain and constipation on long-term QoL should be considered when establishing a treatment regimen.

scholarly journals Whole-body vibration as a modality for the rehabilitation of peripheral neuropathies: implications for cancer survivors suffering from chemotherapy-induced peripheral neuropathy

2015 ◽  
Author(s):  
Anna L.J. Verhulst ◽  
Hans H.C.M. Savelberg ◽  
Gerard Vreugdenhil ◽  
Massimo Mischi ◽  
Goof Schep
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
Muscle Strength ◽  
Cancer Survivors ◽  
Methodological Quality ◽  
Whole Body Vibration ◽  
Whole Body ◽  
Peripheral Neuropathies ◽  
Body Vibration

The objective was to study the effect of whole-body vibration (WBV) on strength, balance and pain in patients with peripheral neuropathies and to consider its significance for the rehabilitation of patients suffering from chemotherapy-induced peripheral neuropathy (CIPN). Using a broad search strategy, PubMed was searched for clinical trials on WBV interventions aimed at improving strength, balance or pain in patients with peripheral neuropathies, which were published in English until 5th June 2014. The search was performed by the first author and generated a total of 505 results, which yielded 5 articles that met the inclusion criteria, being studies: i) published in English; ii) involving adult human subjects’ peripheral neuropathies; iii) evaluating the effect of WBV as a therapeutic intervention; and iv) reporting findings for at least one of the following outcomes: strength, balance or pain. Methodological quality of included studies was assessed independently by first and second author, using the physiotherapy evidence database scale. The overall methodological quality of included studies was low. Two studies found a beneficial effect of WBV on neuropathic pain, but another study failed to find the same effect. One study found significant improvements in both muscle strength and balance, while another study found improvements only in some, but not all, of the applied tests to measure muscle strength and balance. The results of this literature search suggest insufficient evidence to assess the effectiveness for the effects of WBV on neuropathic pain, muscle strength and balance in patients with peripheral neuropathies. More high-quality trials are needed to guide the optimization of rehabilitation programs for cancer survivors with CIPN in particular.

Rationalized Approach for The Treatment of Neuropathic Pain

2021 ◽  
pp. 2887-2895
Author(s):  
Srishti Chaudhary ◽  
Pankaj Kumar Prashar ◽  
Anamika Gautam ◽  
Ankita Sood ◽  
Sachin Kumar Singh ◽  
...  
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Good Choice ◽  
Opioid Agonist ◽  
Painful Condition ◽  
Inflammatory Drugs ◽  
Topical Glyceryl Trinitrate ◽  
Multiple Drugs ◽  
Somatosensory Nervous System ◽  
Global Population

Injury to the nerves causes alteration in normal neurobiological sequences lead to disease of somatosensory nervous system called as neuropathic pain (NP). It affects both central as well as peripheral nervous system. It is a chronic painful condition occurs due to various diseases like HIV, diabetes, lesions, infection, trauma, and metabolic insults. NP affects 7-10% of global population, hence subsequently is a major concern. Pharmacotherapy for NP remains a major clinical challenge due to its complex pathophysiology. Current treatments like Analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, tri-cyclic antidepressants, sodium channel blocker and opioid agonist administrated individually to patients of NP are providing only meager and partial relief. Furthermore, these drugs have limited efficacy as well as adverse effects. Hence instead of monotherapy, pathophysiology of NP suggests that administering multiple drugs (polypharmacy) show quick and sufficient effect in the treatment of NP. Recent updates indicate that combination of Morphine and gabapentin, Pregabalin and duloxetine, Gabapentin and nortriptyline, Amitriptyline and ketamine (topical), Doxepin and capsaicin (topical), Glyceryl trinitrate (topical) and valproate are also a good choice for the treatment of NP. Several clinical trials also established that combination pharmacotherapy showed greater efficacy than monotherapy in treating NP. Physicians, scientists working in the area of NP are not only looking for its treatment but also in resolving the issues of co-morbidities associated with it. Hence the present review focuses on rationalized approach of combination therapy for the treatment of various aspects of NP.

scholarly journals ALIAmides Update: Palmitoylethanolamide and Its Formulations on Management of Peripheral Neuropathic Pain

2020 ◽  
Vol 21 (15) ◽  
pp. 5330 ◽  
Author(s):  
Ramona D’Amico ◽  
Daniela Impellizzeri ◽  
Salvatore Cuzzocrea ◽  
Rosanna Di Paola
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Mast Cells ◽  
Inflammatory Responses ◽  
Bioactive Lipids ◽  
Peripheral Neuropathic Pain ◽  
Novel Approach ◽  
Preclinical And Clinical Studies ◽  
Somatosensory Nervous System

Neuropathic pain results from lesions or diseases of the somatosensory nervous system and it remains largely difficult to treat. Peripheral neuropathic pain originates from injury to the peripheral nervous system (PNS) and manifests as a series of symptoms and complications, including allodynia and hyperalgesia. The aim of this review is to discuss a novel approach on neuropathic pain management, which is based on the knowledge of processes that underlie the development of peripheral neuropathic pain; in particular highlights the role of glia and mast cells in pain and neuroinflammation. ALIAmides (autacoid local injury antagonist amides) represent a group of endogenous bioactive lipids, including palmitoylethanolamide (PEA), which play a central role in numerous biological processes, including pain, inflammation, and lipid metabolism. These compounds are emerging thanks to their anti-inflammatory and anti-hyperalgesic effects, due to the down-regulation of activation of mast cells. Collectively, preclinical and clinical studies support the idea that ALIAmides merit further consideration as therapeutic approach for controlling inflammatory responses, pain, and related peripheral neuropathic pain.

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