Spinal cord stimulator for neuropathic pain in a patient with severe disability due to transverse myelitis

Transverse myelitis is an inflammatory disease of the central nervous system that disrupts nerve signals’ conduction. The illness is characterised by weakness in the lower limbs accompanied by paresthesia and urinary and bowel incontinence. The most disabling sequel is the onset of chronic neuropathic pain, which can severely limit the patient’s independence and negatively affect her quality of life. We present the case of a patient who received a spinal neurostimulator after a failure of conventional medical treatment. Masking pain through paresthesia, a mechanism provided by the device significantly reduces pain perception. The treatment success in our patient represents an advance in pain therapy.

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Peripheral straightjacket (α2δ Ca 2+ channel subunit) expression is required for neuropathic sensitization in Drosophila

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2019.0287 ◽

2019 ◽

Vol 374 (1785) ◽

pp. 20190287 ◽

Cited By ~ 4

Author(s):

Thang M. Khuong ◽

Zina Hamoudi ◽

John Manion ◽

Lipin Loo ◽

Arjun Muralidharan ◽

...

Keyword(s):

Neuropathic Pain ◽

Nerve Injury ◽

Pain Perception ◽

Analgesic Drug ◽

Chronic Neuropathic Pain ◽

Thermal Pain ◽

Subunit Expression ◽

Central Inhibition ◽

Maladaptive Response

Nerve injury leads to devastating and often untreatable neuropathic pain. While acute noxious sensation (nociception) is a crucial survival mechanism and is conserved across phyla, chronic neuropathic pain is considered a maladaptive response owing to its devastating impact on a patient's quality of life. We have recently shown that a neuropathic pain-like response occurs in adult Drosophila . However, the mechanisms underlying this phenomenon are largely unknown. Previous studies have shown that the α2δ peripheral calcium channel subunit straightjacket ( stj ) is a conserved factor required for thermal pain perception. We demonstrate here that stj is required in peripheral ppk+ sensory neurons for acute thermal responses and that it mediates nociceptive hypersensitivity in an adult Drosophila model of neuropathic pain-like disease. Given that calcium channels are the main targets of gabapentinoids (pregabalin and gabapentin), we assessed if these drugs can alleviate nociceptive hypersensitivity. Our findings suggest that gabapentinoids may prevent nociceptive hypersensitivity by preserving central inhibition after nerve injury. Together, our data further highlight the similarity of some mechanisms for pain-like conditions across phyla and validates the scientific use of Drosophila neuropathic sensitization models for analgesic drug discovery. This article is part of the Theo Murphy meeting issue ‘Evolution of mechanisms and behaviour important for pain’.

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The Comparison of Gabapentin and Amitriptilin Effectivity as Pain Therapy in Herniated Nucleus Pulposus

International Journal of Public Health Science (IJPHS) ◽

10.11591/ijphs.v4i3.4738 ◽

2015 ◽

Vol 4 (3) ◽

pp. 225

Author(s):

Indriastuti Cahyaningsih ◽

Rina Handayani ◽

Setyaningsih Setyaningsih

Keyword(s):

Neuropathic Pain ◽

Nucleus Pulposus ◽

Statistical Difference ◽

Pain Therapy ◽

P Value ◽

Analog Scale ◽

Peripheral Neuropathic Pain ◽

Quasi Experimental ◽

Herniated Nucleus Pulposus

Herniated nucleus pulposus (HNP) is one of peripheral neuropathic pain. Although concensus guidelines for the treatment of neuropathic pain are based on the results of the RCT studies, there are still gaps in the literatures. This study aimed to compare the effectiveness and quality of life of gabapentin and amitriptyline for the treatment of pain in HNP. The method used a quasi experimental with consequtive sampling. This study included 30 patients in the gabapentin group and 26 patients in the amitriptyline group, and each group was evaluated for 1 month. Effectiveness was assessed using Visual Analogue Scale (VAS) every 2 weeks then analized by independent and paired sample t test. The results showed that the use of gabapentin and amitriptilin in 4 weeks showed the decrease of pain score measured by visual analog scale 3.70 ± 0.349 and 3.500 ± 0.34 although there was no statistical difference (p value = 0.704). To sum up, effectiveness of gabapentin and amitriptyline in the treatment of neuropathic pain did not have statistical difference.

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The nature and prevalence of chronic pain in homeless persons: an observational study

F1000Research ◽

10.12688/f1000research.2-164.v1 ◽

2013 ◽

Vol 2 ◽

pp. 164 ◽

Cited By ~ 10

Author(s):

Rebecca Fisher ◽

Judith Ewing ◽

Alice Garrett ◽

E Katherine Harrison ◽

Kimberly KT Lwin ◽

...

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Short Form ◽

Homeless People ◽

Brief Pain Inventory ◽

Homeless Persons ◽

Lower Limbs ◽

Mcgill Pain Questionnaire ◽

Wide Range

Background: Homeless people are known to suffer disproportionately with health problems that reduce physical functioning and quality of life, and shorten life expectancy. They suffer from a wide range of diseases that are known to be painful, but little information is available about the nature and prevalence of chronic pain in this vulnerable group. This study aimed to estimate the prevalence of chronic pain among homeless people, and to examine its location, effect on activities of daily living, and relationship with alcohol and drugs.Methods: We conducted face-to-face interviews with users of homeless shelters in four major cities in the United Kingdom, in the winters of 2009-11. Participants completed the Brief Pain Inventory, Short Form McGill Pain questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and detailed their intake of prescribed and unprescribed medications and alcohol. We also recorded each participant’s reasons for homelessness, and whether they slept rough or in shelters.Findings: Of 168 shelter users approached, 150 (89.3%) participated: 93 participants (63%) reported experiencing pain lasting longer than three months; the mean duration of pain experienced was 82.2 months. The lower limbs were most frequently affected. Opioids appeared to afford a degree of analgesia for some, but whilst many reported symptoms suggestive of neuropathic pain, very few were taking anti-neuropathic drugs.Interpretation: The prevalence of chronic pain in the homeless appears to be substantially higher than the general population, is poorly controlled, and adversely affects general activity, walking and sleeping. It is hard to discern whether chronic pain is a cause or effect of homelessness, or both. Pain is a symptom, but in this challenging group it might not always be possible to treat the underlying cause. Exploring the diagnosis and treatment of neuropathic pain may offer a means of improving the quality of these vulnerable people’s lives.

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Contemporary treatment neuropathic pain

Medicinski pregled ◽

10.2298/mpns1110443c ◽

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.

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Neuromodulation Management of Chronic Neuropathic Pain in the Central Nervous System

Advanced Functional Materials ◽

10.1002/adfm.201908999 ◽

2020 ◽

Vol 30 (37) ◽

pp. 1908999

Author(s):

Kai Yu ◽

Xiaodan Niu ◽

Bin He

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Neuropathic Pain ◽

Chronic Neuropathic Pain ◽

The Central Nervous System

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Dorsal Root Ganglion (DRG) and Chronic Pain

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113020 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Amnon A. Berger ◽

Yao Liu ◽

HarLee Possoit ◽

Anna C. Rogers ◽

Warner Moore ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Dorsal Root ◽

Randomized Trials ◽

Pain Treatment ◽

Common Condition ◽

Significant Morbidity ◽

Chronic Neuropathic Pain

Context: Chronic neuropathic pain is a common condition, and up to 11.9% of the population have been reported to suffer from uncontrolled neuropathic pain. Chronic pain leads to significant morbidity, lowered quality of life, and loss of workdays, and thus carries a significant price tag in healthcare costs and lost productivity. dorsal root ganglia (DRG) stimulation has been recently increasingly reported and shows promising results in the alleviation of chronic pain. This paper reviews the background of DRG stimulation, anatomical, and clinical consideration and reviews the clinical evidence to support its use. Evidence Acquisition: The DRG span the length of the spinal cord and house the neurons responsible for sensation from the periphery. They may become irritated by direct compression or local inflammation. Glial cells in the DRG respond to nerve injury, producing inflammatory markers and contribute to the development of chronic pain, even after the resolution of the original insult. While the underlying mechanism is still being explored, recent studies explored the efficacy of DRG stimulation and neuromodulation for chronic pain treatment. Results: Several reported cases and a small number of randomized trials were published in recent years, describing different methods of DRG stimulation and neuromodulation with promising results. Though evidence quality is mostly low, these results provide evidence to support the utilization of this technique. Conclusions: Chronic neuropathic pain is a common condition and carries significant morbidity and impact on the quality of life. Recent evidence supports the use of DRG neuromodulation as an effective technique to control chronic pain. Though studies are still emerging, the evidence appears to support this technique. Further studies, including large randomized trials evaluating DRG modulation versus other interventional and non-interventional techniques, are needed to further elucidate the efficacy of this method. These studies are also likely to inform the patient selection and the course of treatment.

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Interrelationship of Neurogenic Obesity and Chronic Neuropathic Pain in Persons With Spinal Cord Injury

Topics in Spinal Cord Injury Rehabilitation ◽

10.46292/sci20-00062 ◽

2021 ◽

Vol 27 (1) ◽

pp. 75-83

Author(s):

Elizabeth R. Felix ◽

David R. Gater

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Negative Impact ◽

Chronic Neuropathic Pain ◽

Excess Adiposity ◽

Cord Injury ◽

Significant Negative Impact ◽

Prevalence Of Obesity

The prevalence of obesity and of neuropathic pain are both estimated at above 50% in the population of people with chronic spinal cord injury (SCI). These secondary consequences of SCI have significant negative impact on physical functioning, activities of daily living, and quality of life. Investigations of relationships between weight or body composition and chronic neuropathic pain in people with SCI are lacking, but investigations in non-SCI cohorts suggest an association between obesity and the presence and severity of neuropathic pain conditions. In the present article, we present a review of the literature linking obesity and neuropathic pain and summarize findings suggesting that metabolic syndrome and chronic, systemic inflammation due to excess adiposity increase the risk for neuropathic pain after an SCI.

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Botulinum toxin type A in chronic neuropathic pain in refractory leprosy

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190053 ◽

2019 ◽

Vol 77 (5) ◽

pp. 346-351 ◽

Cited By ~ 1

Author(s):

Emanuel de Jesus Soares de Sousa ◽

Gustavo Celeira de Sousa ◽

Vitor Ferreira Baia ◽

Danusa Neves Somensi ◽

Marília Brasil Xavier

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Botulinum Toxin ◽

Therapeutic Option ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Chronic Neuropathic Pain ◽

Specific Protocol

ABSTRACT Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. Objective: To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. Methods: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Results: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. Conclusion: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

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