Multimodal Stepped Care Approach with Acupuncture and Ppar-α Agonist Palmitoylethanolamide in the Treatment of a Patient with Multiple Sclerosis and Central Neuropathic Pain

2012 ◽  
Vol 30 (1) ◽  
pp. 53-55 ◽  
Author(s):  
David J Kopsky ◽  
Jan M Keppel Hesselink
Keyword(s):  
Multiple Sclerosis ◽  
Neuropathic Pain ◽  
Case Report ◽  
Natural Compound ◽  
Stepped Care ◽  
Peroxisome Proliferator ◽  
Key Factors ◽  
Peroxisome Proliferator Activated Receptor ◽  
Central Neuropathic Pain ◽  
Care Approach

Central neuropathic pain is a common debilitating symptom in patients with multiple sclerosis. Side effects of analgesics often limit reaching therapeutic dosages. In this case report, a 61-year-old woman with chronic central neuropathic pain due to multiple sclerosis is described. Acupuncture could only partly and temporarily reduce the pain. However, after adding the natural compound palmitoylethanolamide, a glial modulator and peroxisome proliferator-activated receptor-α agonist, pain reduction was more pronounced and the interval between acupuncture sessions could be increased. A multimodal stepped care approach is demonstrated, with acupuncture and palmitoylethanolamide both influencing non-neuronal cells, such as activated glial cells, which are key factors in the development and maintenance of neuropathic pain.

Central neuropathic pain in multiple sclerosis is associated with impaired innocuous thermal pathways and neuronal hyperexcitability

Pain Medicine ◽  
2021 ◽  
Author(s):  
Michal Rivel ◽  
Anat Achiron ◽  
Mark Dolev ◽  
Yael Stern ◽  
Gaby Zeilig ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neuropathic Pain ◽  
Cross Sectional Study ◽  
Healthy Controls ◽  
Sectional Study ◽  
Sensory Testing ◽  
Cross Sectional ◽  
Central Neuropathic Pain ◽  
Body Regions ◽  
Thermal Grill Illusion

Abstract Objective About a third of patients with multiple sclerosis (MS) suffer from chronic and excruciating central neuropathic pain (CNP). The mechanism underlying CNP in MS is not clear, since previous studies are scarce and their results are inconsistent. Our aim was to determine whether CNP in MS is associated with impairment of the spinothalamic-thalamocortical pathways (STTCs) and/or increased excitability of the pain system. Design Cross sectional study Setting General hospital Subjects 47 MS patients with CNP, 42 MS patients without CNP, and 32 healthy controls. Methods Sensory testing included the measurement of temperature, pain, and touch thresholds and the thermal grill illusion (TGI) for evaluating STTCs function, and hyperpathia and allodynia as indicators of hyperexcitability. CNP was characterized using interviews and questionnaires. Results The CNP group had higher cold and warm thresholds (p < 0.01), as well as higher TGI perception thresholds (p < 0.05), especially in painful body regions compared to controls, whereas touch and pain thresholds values were normal. The CNP group also had a significantly greater prevalence of hyperpathia and allodynia. Regression analysis revealed that whereas presence of CNP was associated with a higher cold threshold, CNP intensity, and the number of painful body regions were associated with allodynia and hyperpathia, respectively. Conclusions CNP in MS is characterized by a specific impairment of STTC function; the innocuous thermal pathways, and by pain hyperexcitability. Whereas CNP presence is associated with STTC impairment, its severity and extent are associated with pain hyperexcitability. Interventions that reduce excitability level may therefore mitigate CNP severity.

scholarly journals Central Neuropathic Pain in a Patient with Multiple Sclerosis Treated Successfully with Topical Amitriptyline

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
David J. Kopsky ◽  
Remko Liebregts ◽  
Jan M. Keppel Hesselink
Keyword(s):  
Multiple Sclerosis ◽  
Neuropathic Pain ◽  
Adverse Events ◽  
Active Compound ◽  
Analgesic Effect ◽  
Tricyclic Antidepressants ◽  
Double Blind ◽  
Carryover Effect ◽  
Double Blind Placebo ◽  
Central Neuropathic Pain

Central neuropathic pain in patients with multiple sclerosis (MS) is a common debilitating symptom, which is mostly treated with tricyclic antidepressants or antiepileptics. Unfortunately, the use of these drugs is often limited due to adverse events. We investigated the analgesic effect of topical amitriptyline 5% and 10% cream in a patient with central neuropathic pain due to MS. The analgesic effect of topical amitriptyline cream on neuropathic pain was dose related. To evaluate whether this analgesic effect is due to the active compound or placebo, we conducted a double-blind placebo-controlled n-of-1 study with amitriptyline 5% cream and placebo. The instruction was to alternate the creams every week following the pattern ABAB, with an escape possibility of amitriptyline 10% cream. The result was a complete pain reduction after application of cream B, while most of the time cream A did not reduce the pain. The patient could correctly unblind both creams, determining B as active. She noted that in the week of using the active cream no allodynia was present, with a carryover effect of one day.

scholarly journals The Ala/Ala genotype of PPARY Pro12 Ala polymorphism is associated with late onset of multiple sclerosis

2013 ◽  
Vol 65 (2) ◽  
pp. 447-453
Author(s):  
N. Lukic ◽  
A. Stankovic ◽  
E. Dincic ◽  
M. Bundalo ◽  
Z. Krsmanovic ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Late Onset ◽  
Age At Onset ◽  
Peroxisome Proliferator ◽  
Pro12ala Polymorphism ◽  
Peroxisome Proliferator Activated Receptor ◽  
Post Hoc ◽  
Genotype And Allele Frequencies

The function of peroxisome proliferator-activated receptor ? (PPAR?) in immune regulation, as well as in antiinflammatory and anti-proliferative actions towards T lymphocytes, has been reported. A potential role of PPARs in multiple sclerosis (MS) was suggested. The aim of this study was to investigate if there is an association of PPAR?-2 Pro12Ala polymorphism with MS in 361 patients from Serbia. The genotype and allele frequencies of Pro12Ala polymorphism were not significantly different between controls and patients, or between females and males. In contrast to controls, we detected a rare Ala/Ala genotype in patients with MS. We found that there is a significant association of Ala/Ala genotype with older age at onset (ANOVA, p=0.07; LSD post-hoc, Ala/Ala vs. Pro/Ala, p=0.03, Ala/Ala vs. Pro/Pro p=0.02). It would be useful to validate our results in other populations, as well as to perform follow-up of the disease progression in regard to PPAR? genotypes.

Whole‐body reversible neuropathic pain associated with right parieto‐temporal operculum single inflammatory lesion in a patient with multiple sclerosis: A case report

2019 ◽  
Vol 23 (10) ◽  
pp. 1763-1766 ◽  
Author(s):  
Louis Poncet‐Megemont ◽  
Radhouane Dallel ◽  
Carine Chassain ◽  
Antoine Perrey ◽  
Sophie Mathais ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neuropathic Pain ◽  
Case Report ◽  
Inflammatory Lesion ◽  
Whole Body

scholarly journals PPARα Agonist WY-14643 Relieves Neuropathic Pain through SIRT1-Mediated Deacetylation of NF-κB

PPAR Research ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wanshun Wen ◽  
Jinlin Wang ◽  
Biyu Zhang ◽  
Jun Wang
Keyword(s):  
Neuropathic Pain ◽  
Chronic Constriction Injury ◽  
Peroxisome Proliferator ◽  
Peroxisome Proliferator Activated Receptor ◽  
Sirt1 Expression ◽  
Therapy Option ◽  
Anti Inflammation ◽  
Pparα Agonist

Inflammation caused by neuropathy contributes to the development of neuropathic pain (NP), but the exact mechanism still needs to be understood. Peroxisome proliferator-activated receptor α (PPARα), an important inflammation regulator, might participate in the inflammation in NP. To explore the role of PPARα in NP, the effects of PPARα agonist WY-14643 on chronic constriction injury (CCI) rats were evaluated. The results showed that WY-14643 stimulation could decrease inflammation and relieve neuropathic pain, which was relative with the activation of PPARα. In addition, we also found that the SIRT1/NF-κB pathway was involved in the WY-14643-induced anti-inflammation in NP, and activation of PPARα increased SIRT1 expression, thus reducing the proinflammatory function of NF-κB. These data suggested that WY-14643 might serve as an inflammation mediator, which may be a potential therapy option for NP.

scholarly journals Reduction of central neuropathic pain with ketamine infusion in a patient with Ehlers–Danlos syndrome: a case report

2016 ◽  
Vol Volume 9 ◽  
pp. 683-687 ◽  
Author(s):  
Tony Chung Tung Lo ◽  
Stephen Yeung ◽  
Sujin Lee ◽  
Kira Skavinski ◽  
Solomon Liao
Keyword(s):  
Neuropathic Pain ◽  
Case Report ◽  
Ketamine Infusion ◽  
Central Neuropathic Pain ◽  
Danlos Syndrome
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