The Diversity of Neuropathic Pain

2018 ◽  
pp. 658-678
Author(s):  
Nanna Brix Finnerup ◽  
Nadine Attal
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Recent Progress ◽  
Surgical Trauma ◽  
System Disease ◽  
Cord Injury ◽  
Current Classification ◽  
History Of ◽  
Somatosensory Nervous System ◽  
Pain Distribution

This article presents an update of the current classification, diagnosis, assessment, mechanisms, and treatment of neuropathic pain. Neuropathic pain, which is defined as pain associated with a lesion or disease of the somatosensory nervous system, may be caused by a variety of conditions, such as diabetic neuropathy, herpes zoster, surgical trauma, spinal cord injury, and stroke. The diagnostic criteria for neuropathic pain are a history of a nervous system disease or lesion and pain distribution and sensory signs in a neuroanatomically plausible distribution. The treatment of neuropathic pain is often multidisciplinary and involves specific drugs. Recent progress in the diagnosis, assessment, and understanding of its mechanisms offers the perspective of a more rational therapeutic management, which should result in better therapeutic outcome.

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.

scholarly journals Contemporary treatment neuropathic pain

2011 ◽  
Vol 64 (9-10) ◽  
pp. 443-447
Author(s):  
Milan Cvijanovic ◽  
Svetlana Simic ◽  
Sofija Banic-Horvat ◽  
Zita Jovin ◽  
Petar Slankamenac ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Common Symptom ◽  
Chronic Neuropathic Pain ◽  
Cord Injury ◽  
The Central Nervous System ◽  
New Applications

Introduction. Neuropathic pain, or pain associated with disease or injury to the peripheral or central nervous system, is a common symptom of a heterogeneous group of conditions, including diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia and spinal cord injury. Chronic neuropathic pain should not be thought of as a symptom. It should truly be thought of as a disease with a very complicated pathophysiology. Pathophysiology. The mechanisms involved in neuropathic pain are complex and involve both peripheral and central pathophysiologic phenomenon. The underlying dysfunction may involve deafferentation within the peripheral nervous system (e.g. neuropathy), deafferentation within the central nervous system (e.g. post-thalamic stroke) or an imbalance between the two (e.g. phantom limb pain). Clinical characteristics. Neuropathic pain is non-nociceptive, in contrast to acute nociceptive pain, and it can be described as ?burning?, ?electric?, ?tingling?, and ?shooting? in nature. Treatment. Rational polypharmacy is often necessary and actually it is almost always the rule. It would be an exception if a patient was completely satisfied with his treatment. Treatment goals should include understanding that our patients may need to be titrated and managed with more than one agent and one type of treatment. There should be the balance of safety, efficacy, and tolerability. Conclusion. There are many new agents and new applications of the existing agents being currently studied which will most certainly lead to even more improved ways of managing this very complicated set of disorders.

Neuropathic Pain During Common Lumboradiculalgia in Subsaharian Africa: Bicentric Study About 409 Patients.

2020 ◽  
Author(s):  
Fulgence Kaboré ◽  
Baly Ouattara ◽  
Stéphanie Wendlassida Joelle Tiendrébéogo ◽  
Mohamed Diomandé ◽  
Charles Sougué ◽  
...  
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Statistical Analysis ◽  
Sex Ratio ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Somatosensory Nervous System ◽  
Age Over 60

Abstract Background: Neuropathic pain is defined as pain caused by injury or disease of the somatosensory nervous system. Our purpose was to study the frequency of neuropathic pain among common lumboradiculalgia patients in subsaharian Africa patients. Methods: This was a bicentric cross-sectional study from February 2015 to 30 July 2015 in the first center and then from February 2017 to 30 July 2017 in the second center, i.e. a duration of 6 months for each study site. All patients with a common lomboradiculalgie were included. DN4 questionnaire was used for the diagnosis of neuropathic pain.Results : Four hundred and nine patients with common lumboradiculalgia were included. There were 278 females (67.97%) and 131 males (32.03%), for a sex ratio of 0.47. The average age was 51.75 ± 13.84 years with extremes of 16 and 88 years. One hundred and seventy-five patients ( 42.8%) had NP. Statistical analysis showed a statistically significant association between the existence of NP and age over 60 years and the existence of radiculalgia. Conclusions: Our study confirms the high frequency of neuropathic pain during common lumboradiculalgia. Age over 60 years and Poorly systematized radiculalgia were associated to NP.

scholarly journals The role of connexin43 in neuropathic pain induced by spinal cord injury

2019 ◽  
Vol 51 (6) ◽  
pp. 555-561 ◽  
Author(s):  
Anhui Wang ◽  
Changshui Xu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Cell Metabolism ◽  
Pain Models ◽  
Cord Injury ◽  
The Central Nervous System ◽  
And Function

Abstract Neuropathic pain is caused by the damage or dysfunction of the nervous system. In many neuropathic pain models, there is an increase in the number of gap junction (GJ) channels, especially the upregulation of the expression of connexin43 (Cx43), leading to the secretion of various types of cytokines and involvement in the formation of neuropathic pain. GJs are widely distributed in mammalian organs and tissues, and Cx43 is the most abundant connexin (Cx) in mammals. Astrocytes are the most abundant glial cell type in the central nervous system (CNS), which mainly express Cx43. More importantly, GJs play an important role in regulating cell metabolism, signaling, and function. Many existing literatures showed that Cx43 plays an important role in the nervous system, especially in the CNS under normal and pathological conditions. However, many internal mechanisms have not yet been thoroughly explored. In this review, we summarized the current understanding of the role and association of Cx and pannexin channels in neuropathic pain, especially after spinal cord injury, as well as some of our own insights and thoughts which suggest that Cx43 may become an emerging therapeutic target for future neuropathic pain, bringing new hope to patients.

scholarly journals Prevalence of Neuropathic Pain and the Need for Treatment

2006 ◽  
Vol 11 (suppl a) ◽  
pp. 5A-10A ◽  
Author(s):  
Pat Morley-Forster
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Postherpetic Neuralgia ◽  
Unmet Need ◽  
The United States ◽  
Nerve Damage ◽  
Phantom Limb ◽  
Disc Disease ◽  
Pain Syndromes ◽  
Cord Injury

Recent publications have suggested that more than two million adults in the United States suffer from neuropathic pain, but this number seems to be a significant underestimate. The prevalence of neuropathic pain from diabetes and postherpetic neuralgia alone, using the most conservative estimates of incidence, would equal two million Americans. Lesions of the nervous system responsible for pain genesis can occur either in the central or the peripheral nervous system. The most common causes of peripheral neuropathic pain syndromes worldwide are diabetes, HIV infection, cancer-related neuropathy (due to tumour invasion, surgical nerve damage, radiation or chemotherapy-induced nerve damage) and lumbar degenerative disc disease. Other less common, but significant, sources of suffering are postherpetic neuralgia, complex regional pain syndrome, phantom limb pain and postsurgical nerve trauma. Central neuropathic pain can be caused by stroke (infarct or hemorrhage), multiple sclerosis, spinal cord injury and syringomyelia. Certain pain syndromes such as trigeminal neuralgia and vulvodynia, although clearly neuropathic and a source of tremendous suffering, are not discussed in the present article due to space constraints. There is an unmet need for the treatment of neuropathic pain as evidenced by reports of pain despite the use of opioids and anticonvulsants, continuing psychological difficulties, lack of access to treatments and patients seeking access to complementary therapy.

scholarly journals Small compounds mimicking the adhesion molecule L1 improve recovery in a zebrafish demyelination model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Suhyun Kim ◽  
Dong-Won Lee ◽  
Melitta Schachner ◽  
Hae-Chul Park
Keyword(s):  
Nervous System ◽  
Adhesion Molecule ◽  
Demyelinating Diseases ◽  
Transgenic Zebrafish ◽  
Clinical Settings ◽  
System Disease ◽  
Cord Injury ◽  
Neural Cell Adhesion ◽  
Severe Reduction ◽  
Cell Adhesion Molecule L1

AbstractDemyelination leads to a loss of neurons, which results in, among other consequences, a severe reduction in locomotor function, and underlies several diseases in humans including multiple sclerosis and polyneuropathies. Considerable clinical progress has been made in counteracting demyelination. However, there remains a need for novel methods that reduce demyelination while concomitantly achieving remyelination, thus complementing the currently available tools to ameliorate demyelinating diseases. In this study, we used an established zebrafish demyelination model to test selected compounds, following a screening in cell culture experiments and in a mouse model of spinal cord injury that was aimed at identifying beneficial functions of the neural cell adhesion molecule L1. In comparison to mammalian nervous system disease models, the zebrafish allows testing of potentially promotive compounds more easily than what is possible in mammals. We found that our selected compounds tacrine and duloxetine significantly improved remyelination in the peripheral and central nervous system of transgenic zebrafish following pharmacologically induced demyelination. Given that both molecules are known to positively affect functions other than those related to L1 and in other disease contexts, we propose that their combined beneficial function raises hope for the use of these compounds in clinical settings.

scholarly journals Neuropathic pain: mechanisms of development, principles of diagnostics and treatment

Pain medicine ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 4-32
Author(s):  
Dmytro Dmytriiev ◽  
Pylyp Prudius ◽  
Olesia Zaletskaya ◽  
Yevhen Lisak ◽  
Yurii Rudnitsky ◽  
...  
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Pain Syndrome ◽  
Diabetic Polyneuropathy ◽  
Pain Mechanisms ◽  
Peripheral Neuropathic Pain ◽  
Pain Pathways ◽  
Mechanisms Of Development ◽  
Somatosensory Nervous System ◽  
Cause Of Pain

Neuropathic pain is a pain caused by a disease or focal damage to the somatosensory nervous system. The prevalence of chronic pain with neuropathic features in different countries is estimated at 7–10 %. Damages to the nervous system can occur at the level of peripheral nerves, plexus and dorsal roots (peripheral neuropathic pain) or spinal cord and brain (central neuropathic pain). Neuropathic pain is based on pathological activation of pain pathways. Neuropathic pain occurs with diabetic polyneuropathy more often than with all polyneuropathies of another etiology. Hyperglycemia is the major cause of chronic diabetes mellitus and its progression. Since the cause of pain can rarely be cured, treatment is usually symptomatic. Neuropathic pain is generally poorly controlled by analgesics. NB management is started with conservative pharmacotherapy before applying invasive analgesia. Although there are many drugs that can be used in patients with DPN, monotherapy can not always stop pain syndrome. In addition, the patient may not tolerate the full therapeutic dose of the drug. All this dictates the need for combination therapy.

AN EPIDEMIC OF ASEPTIC MENINGITIS SYNDROME DUE TO ECHO VIRUS TYPE 6

PEDIATRICS ◽  
1962 ◽  
Vol 29 (3) ◽  
pp. 432-437
Author(s):  
Dudley L. King ◽  
David T. Karzon
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Aseptic Meningitis ◽  
Virus Type ◽  
Central Nervous System Disease ◽  
Nervous System Disease ◽  
Paralytic Poliomyelitis ◽  
System Disease ◽  
Echo Virus ◽  
History Of

Ninety-three patients with aseptic meningitis syndrome due to ECHO virus type 6 were evaluated 3 years following their acute infection to determine the extent of neuromuscular residua. In addition, 9 patients with aseptic meningitis due to other enteroviruses and 19 patients with paralytic poliomyelitis were similarly evaluated. Forty-four individuals with no history of central nervous system disease were studied for comparison. Residua following aseptic meningitis were minimal and fell into two categories: 1. Approximately 20% gave a history of minor changes in behavior, easy fatigability, headaches or pain, stiffness or subjective weakness of the back or legs, the onsets of which were associated with the acute illness. 2. On examination approximately 25% revealed subtle neuromuscular changes such as altered reflexes, minor weaknesses in anterior neck or trunk muscles, or slight skeletal abnormalities, particularly scoliosis. The group with no history of central nervous system disease demonstrated an appreciable, but somewhat lesser, incidence of minor neuromuscular changes, further tending to minimize the specific significance of the findings in the study group.

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

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