Dorsal Root Ganglion Stimulation for the Treatment of Non‐Complex Regional Pain Syndrome Related Chronic Pain Syndromes: A Systematic Review

The Oxford Handbook of Rheumatology 4th edition, has been extensively updated to thoroughly review aspects of musculoskeletal pain. Pain pathophysiology is reviewed. Chronic pain and fibromyalgia in adults and in children and adolescents is dealt with in detail. The reader is advised to cross reference from this chapter to Chapters 1–3 in the Handbook, where regional musculoskeletal pain conditions are listed and reviewed. In localized pain syndromes, the chapter has an overview of complex regional pain syndrome (CRPS), which is not infrequently encountered in rheumatology and musculoskeletal clinics. Included in detail for this edition, is the assessment and management of pain in children, which is a highly specialized clinical area of medicine and will be of use to the adult rheumatologist and general practitioner as well as paediatric specialists. Readers should cross reference to Chapter 23 on medications, for ‘pain medications’ in the Handbook

Download Full-text

Dorsal Root Ganglion Stimulation for the Treatment of Chronic Pain Syndromes

Archives of Anesthesiology ◽

10.22259/2638-4736.0302001 ◽

2020 ◽

Vol 3 (2) ◽

pp. 1-6

Author(s):

Natalie H Strand ◽

Timothy R. Deer ◽

Ryan S D'Souza

Keyword(s):

Chronic Pain ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Pain Syndromes ◽

Chronic Pain Syndromes

Download Full-text

Low-Dose Naltrexone Use for Patients with Chronic Regional Pain Syndrome: A Systematic Literature Review

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e393 ◽

2021 ◽

pp. E393-E406

Keyword(s):

Chronic Pain ◽

Complex Regional Pain Syndrome ◽

Case Studies ◽

Low Dose ◽

Pain Syndrome ◽

The United States ◽

Qualitative Review ◽

Pain Syndromes ◽

Low Dose Naltrexone ◽

Chronic Pain Syndromes

BACKGROUND: Complex regional pain syndrome is a rare, neuropathic disorder that affects fewer than 200,000 individuals in the United States annually. Current treatments often focus on pain management and fall short of relieving symptoms of pain and dystonia in patients. OBJECTIVE: The goal of this systematic qualitative review is to evaluate the evidence for the use of low-dose naltrexone in the treatment of chronic pain syndromes. STUDY DESIGN: This is a systematic review. METHODS: PubMed, Embase, and Web of Science were searched for articles containing the keywords “low-dose naltrexone” AND (“pain” OR “chronic pain” OR “fibromyalgia” OR “complex regional pain syndrome” OR “neuropathic pain” OR “nociceptive pain”) between 1950 and July 17, 2020. A total of 30 publications were systematically reviewed. Exclusion criteria were articles that were unavailable in English, focused on acute pain only, and evaluated only animal models. Case studies were included for the purposes of our qualitative review. RESULTS: Out of 29 articles, we reviewed 11 prospective studies, 10 case studies, 3 systematic reviews, 2 retrospective studies, 2 simulation models, and one combination study. Articles focused on chronic pain syndromes as well as painful rheumatologic disorders and neurological disorders. We found that low-dose naltrexone treatment was positively associated with symptom relief in patients experiencing chronic pain, dystonia, and sleep disturbances. LIMITATIONS: Due to the limited number of available articles focusing on the treatment of complex regional pain syndrome with low-dose naltrexone, the majority of studies analyzed focused on other chronic pain syndromes. CONCLUSIONS: There is a need for additional prospective and interventional studies addressing the use of low-dose naltrexone in the treatment of complex regional pain syndrome symptoms. KEY WORDS: Complex regional pain syndrome, reflex sympathetic dystrophy, low-dose naltrexone, chronic pain, opioid antagonist

Download Full-text

Chronic pain syndromes: overlapping phenotypes with common mechanisms

F1000Research ◽

10.12688/f1000research.16814.1 ◽

2019 ◽

Vol 8 ◽

pp. 255 ◽

Cited By ~ 2

Author(s):

Geoffrey Owen Littlejohn ◽

Emma Guymer

Keyword(s):

Chronic Pain ◽

Complex Regional Pain Syndrome ◽

Emotional Distress ◽

Pain Syndrome ◽

Physical Factors ◽

Pain Syndromes ◽

The Common ◽

Chronic Pain Syndromes

The common chronic pain syndromes of fibromyalgia, regional pain syndrome, and complex regional pain syndrome have been made to appear separate because they have been historically described by different groups and with different criteria, but they are really phenotypically accented expressions of the same processes triggered by emotional distress and filtered or modified by genetics, psychology, and local physical factors.

Download Full-text

P124 Are chronic pain syndromes associated with a unique cytokine profile? A systematic review and meta-analysis

Rheumatology ◽

10.1093/rheumatology/keab247.119 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Luke Furtado O'Mahony ◽

Arnav Srivastava ◽

Puja Mehta ◽

Coziana Ciurtin

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Meta Analysis ◽

Pooled Analysis ◽

Cross Sectional ◽

Pain Syndromes ◽

Newcastle Ottawa Scale ◽

Cytokine Milieu ◽

Analysis Models ◽

Chronic Pain Syndromes

Abstract Background/Aims The aetiology of primary chronic pain syndromes (CPS) is highly disputed. One theory suggests that pain is due to a pro-inflammatory cytokine milieu leading to nociceptive activation. We performed a systematic review and meta-analysis aiming to assess differences in cytokines levels in CPS patients versus healthy controls (HC). Methods Human studies published in English from PubMed, MEDLINE/Scopus and Cochrane databases were searched from inception up to January 2020. We included full text cross-sectional or longitudinal studies with cytokine measurements in CPS patients and HC. We excluded studies with underlying organic pathology. Quality assessment was completed using a modified version of the Newcastle-Ottawa Scale. Random-effects meta-analysis models were used to report pooled effects and 95% CIs. Study registered with PROSPERO (CRD42020193774). Results Initial search yielded 324 papers, 36 studies (3229 participants) eligible for systematic review and 26 studies (2048 participants) suitable for metaanalysis. There were reproducible findings supporting trends of cytokine levels comparing CPS patients with HC. Eotaxin (chemokine) however was consistently raised in CPS. Meta-analysis showed significantly increased tumour necrosis factor (TNF) (SMD=0.39, p = 0.0009, %95I=0.16-0.63, p < 0.001; I2=70%, Q2 p < 0.001), interleukin (IL)-6 (SMD=0.15, 8 (SMD=0.26, p = 0.01, 95%CI =0.05-0.47; I2=61%, Q2 p = 0.005) and IL-10 (SMD=0.61; %95 = 0.34-0.89, p < 0.001; I2 = 10%, Q2 p = 0.34) in CPS compared to HC. Conclusion We found significant differences in peripheral blood cytokine profiles of CPS patients compared to HC. However, the distinctive profile associated with CPS includes both pro-inflammatory (TNF-α, IL-6, IL-8), and anti-inflammatory cytokines (IL-10) in pooled analysis, as well as chemokine (eotaxin) signatures. Disclosure L. Furtado O'Mahony: None. A. Srivastava: None. P. Mehta: None. C. Ciurtin: None.

Download Full-text

Dorsal root ganglion stimulation lead fractures: potential mechanisms and ways to avoid

BMJ Case Reports ◽

10.1136/bcr-2020-241353 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241353

Author(s):

Gaurav Chauhan ◽

Brandon I Roth ◽

Nagy Mekhail

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Case Report ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Unusual Case ◽

Pain Syndrome ◽

Structural Instability ◽

Probable Mechanism ◽

Lead Fracture

Dorsal root ganglion stimulation (DRGS) therapy is a rapidly emerging tool being used by pain physicians in the treatment of chronic pain. Complex regional pain syndrome (CRPS), a debilitating disease whose mechanism is still has yet to be fully elucidated, is a common pathology targeted by DRGS therapy, often better results than traditional spinal cord stimulation. DRGS therapy, however, is not bereft of complications. Lead migration and fracture are two examples in particular that are among the most common of these complications. The authors report an unusual case of lost efficacy due to lead fractures in patients with CRPS treated with DRGS. The case report narrates identification, management and probable mechanism of DRGS lead fracture. The structural instability of DRGS leads can yield distressing symptoms at any point during the therapy, and physicians should be cognisant of the complications of DRGS therapy.

Download Full-text

Cost‐Effectiveness of Dorsal Root Ganglion Stimulation or Spinal Cord Stimulation for Complex Regional Pain Syndrome

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13134 ◽

2020 ◽

Author(s):

Nagy Mekhail ◽

Timothy R. Deer ◽

Lawrence Poree ◽

Peter S. Staats ◽

Allen W. Burton ◽

...

Keyword(s):

Spinal Cord ◽

Cost Effectiveness ◽

Dorsal Root Ganglion ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Dorsal Root ◽

Pain Syndrome

Download Full-text

Metabolic Therapy and Pain

10.1093/med/9780190497996.003.0022 ◽

2016 ◽

Author(s):

David N. Ruskin

Keyword(s):

Chronic Pain ◽

Pain Syndrome ◽

Poor Quality ◽

Fatty Acid Supplementation ◽

Pain Syndromes ◽

Drug Treatments ◽

Dietary Treatments ◽

Dietary Modifications ◽

Chronic Pain Syndromes

Chronic pain is associated strongly with poor quality of life. Drug treatments for pain can be problematic; with the understanding that chronic pain syndromes often involve derangement of homeostasis, there is an increased interest in applying nonpharmacological metabolic therapies. This chapter surveys clinical and animal research into the effects of fasting, calorie restriction, ketogenic diet, and polyunsaturated fatty acid supplementation on pain. These dietary treatments can significantly ameliorate pain in inflammatory and neuropathic disorders. The choice among these treatments might depend on the specific pain syndrome and the tolerance of the patient for particular dietary modifications. Several possible mechanisms are discussed, some of which might be in common among these treatments, and some treatments might engage multiple mechanisms. Multiple mechanisms acting together could be ideal for restoring the disordered metabolism underlying some pain syndromes.

Download Full-text