Pain Catastrophizing Predicts Poor Response to Topical Analgesics in Patients with Neuropathic Pain

The prevalence of neuropathic pain approaches 10% in Canada and the United States. Given the aging population and the increasing survival rates following interventions for neuropathic pain, the prevalence of neuropathic pain conditions is expected to rise significantly over the next 20 years. Although pharmacological interventions represent the dominant treatment approach for neuropathic pain, as many as 50% of patients are partially or completely refractory to the available treatments. Pain catastrophizing has been associated with heightened pain experiences in patients with neuropathic pain conditions; however, the clinical relevance of the relationship between catastrophizing and poor treatment outcomes is, to date, unclear. Accordingly, using a numerical rating scale, this study aimed to examine this relationship in patients with varied neuropathic pain conditions who completed a measure of catastrophizing before initiating a course of topical analgesic.BACKGROUND: Previous research suggests that high levels of pain catastrophizing might predict poorer response to pharmacological interventions for neuropathic pain.OBJECTIVE: The present study sought to examine the clinical relevance of the relation between catastrophizing and analgesic response in individuals with neuropathic pain. Clinically meaningful reductions were defined in terms of the magnitude of reductions in pain through the course of treatment, and in terms of the number of patients whose end-of-treatment pain ratings were below 4/10.METHODS: Patients (n=82) with neuropathic pain conditions completed a measure of pain catastrophizing at the beginning of a three-week trial examining the efficacy of topical analgesics for neuropathic pain.RESULTS: Consistent with previous research, high scores on the measure of pain catastrophizing prospectively predicted poorer response to treatment. Fewer catastrophizers than noncatastrophizers showed moderate (≥2 points) or substantial reductions in pain ratings through the course of treatment. Fewer catastrophizers than noncatastrophizers achieved end-of-treatment pain ratings below 4/10.CONCLUSIONS: The results of the present study suggest that the development of brief interventions specifically targeting catastrophic thinking might be useful for enhancing the effects of pharmacological interventions for neuropathic pain. Furthermore, failure to account for the level of catastrophizing might contribute to null findings in clinical trials of analgesic medication.

Download Full-text

The Effect of Caudal Epidural Pulsed Radiofrequency Stimulation in Patients with Refractory Chronic Idiopathic Axonal Polyneuropathy

January 2018 - Pain Physician ◽

10.36076/ppj.2018.1.e57 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E57-E62

Author(s):

Min Cheol Chang

Keyword(s):

Neuropathic Pain ◽

Repeated Measures ◽

Rating Scale ◽

Axonal Neuropathy ◽

Pulsed Radiofrequency ◽

Oral Medications ◽

Axonal Polyneuropathy ◽

Number Of Patients ◽

Good Score ◽

Caudal Epidural

Background: Many patients with chronic idiopathic axonal polyneuropathy (CIAP) suffer from neuropathic pain, which is managed using several oral medications and modalities. However, despite these treatments, pain persists in some patients. Objective: In the clinical field, clinicians frequently meet patients with neuropathic pain caused by CIAP. The authors investigated the effect of caudal epidural pulsed radiofrequency (PRF) for the management of CIAP-induced refractory neuropathic pain. Study Design: This is a prospective study. Setting: The outpatient clinic of a single academic medical center in Korea Methods: Twenty patients with neuropathic pain and a diagnosis of refractory CIAP were recruited. For PRF stimulation, a 22-gauge cannula was inserted into the epidural space through the sacral hiatus under fluoroscopic guidance. PRF stimulation was administered once at 5 Hz with a 5-ms pulse width for 600 seconds at 55 V. The effect of stimulation was evaluated using a numeric rating scale (NRS) at 2 weeks and 1, 2, and 3 months after the procedure. Successful pain relief was defined as a reduction in the NRS score of ≥ 50% as compared with the score prior to treatment. In addition, at 3 months after treatment, patient satisfaction levels were examined; patients that reported “very good” (score = 7) or “good” (score = 6) results were considered to be satisfied with the procedure. Results: Neuropathic pain was significantly reduced at 2 weeks and at 1, 2, and 3 months followup after PRF (P < 0.001, repeated measures one-factor analysis). In addition, at 3 months post-PRF, half of the patients achieved a successful response (≥ 50% pain reduction) and were satisfied with treatment results. Limitations: A small number of patients were recruited, and we did not perform long-term follow-up. Conclusion: Caudal epidural PRF may be a good treatment option for managing neuropathic pain induced by CIAP, especially when pain is unresponsive to oral medications. Key words: Pulsed radiofrequency, chronic idiopathic axonal neuropathy, caudal epidural stimulation, neuropathic pain chronic pain, refractory pain

Download Full-text

Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain

The Journal of Knee Surgery ◽

10.1055/s-0038-1675415 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1020-1023 ◽

Cited By ~ 1

Author(s):

Masahiro Hasegawa ◽

Shine Tone ◽

Yohei Naito ◽

Hiroki Wakabayashi ◽

Akihiro Sudo

Keyword(s):

Total Knee Arthroplasty ◽

Neuropathic Pain ◽

Knee Arthroplasty ◽

Severe Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Number Of Patients ◽

Numerical Rating ◽

Total Knee ◽

The Impact

AbstractThe present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires. Risk factors for these types of pain were determined. The ratio of patients with moderate-to-severe pain was 28% (62 knees). Thirteen patients (21 knees; 9%) experienced unclear pain. Patients with moderate-to-severe or unclear pain had malalignment and lower Knee Society knee scores. In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain.

Download Full-text

Neuroprotective Propensity of 4-Allylpyrocatechol Derivatives against Oxaliplatin Induced Peripheral Neuropathy

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i24a31436 ◽

2021 ◽

pp. 92-100

Author(s):

Tirupathi Rao Annavarapu ◽

Sujana Kamepalli ◽

Vijay Kotra ◽

G. Venkata Rao

Keyword(s):

Neuropathic Pain ◽

Peripheral Neuropathy ◽

Thermal Hyperalgesia ◽

The Body ◽

Protective Effects ◽

Biochemical Alterations ◽

Functional Deficits ◽

Growing Cell ◽

End Of Treatment ◽

Number Of Patients

Chemotherapy is used for the treatment of rapidly growing cell diseases in the body. It is most used for the treatment of different kinds of tumors. It can develop neuropathic pain due to damage of peripheral nerve cells and it is called Chemotherapy-Induced Peripheral Neuropathy (CIPN). In this study, we have reported the protective effects of 4-allyl pyrocatechol (4-APC) and its derivatives from biochemical and functional deficits associated with oxaliplatin (OP) induced neuropathy. The animals were submitted to mechanical and thermal hyperalgesia tests, after treatment with OP three times weekly at 0.20 mg/kg and 4-APC and derivatives (10 mg/kg & 30 mg/kg). The pain parameters were evaluated during the treatment period and at the end of treatment. 4-APC significantly prevented the mice from behavioural and biochemical alterations associated with OP-induced neuropathy. Thus, we conclude from this study, the use of 4-APC and its derivatives with OP might reduce the number of patients who develop painful peripheral neuropathy.

Download Full-text

8% Capsaicin Patch in Treatment of Peripheral Neuropathic Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/e541 ◽

2020 ◽

Vol 5;23 (9;5) ◽

pp. E541-E548

Author(s):

Décia Gonçalves

Keyword(s):

Neuropathic Pain ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Syndrome ◽

Peripheral Neuropathic Pain ◽

Patch Application ◽

Analgesic Therapy ◽

Number Of Patients ◽

Painful Area

Background: Neuropathic pain is a complex condition that is difficult to control and has a high impact on quality of life. 8% Capsaicin patch can be a therapeutic strategy in the treatment of peripheral neuropathic pain. Objectives: This study aims to (1) evaluate clinical efficacy and (2) tolerability of 8% capsaicin patch in a Pain Unit. Study Design: Retrospective observational study Setting: Portuguese Pain Unit Methods: A sample of 120 patients diagnosed with peripheral neuropathic pain, underwent treatment with the 8% capsaicin patch between February 2011 and February 2019 in a Portuguese Pain Unit. Patients were included in one of the following groups according to the etiology of pain: postherpetic neuralgia (PHN), chronic post-surgical pain (CPSP), post traumatic neuropathic pain (PTNP), diabetic neuropathy (DN), regional pain syndrome. complex I and II (CRPS I / II), HIVassociated neuropathy (HIVN), lumbar neuropathic pain (LNP), trigeminal neuralgia (TN) and other neuropathies (O). The evaluated parameters were: pain intensity according to unit protocol (numerical rating scale), pain characteristics, location, size of the painful area. The evolution of pain intensity after treatment (patients were considered as responders to therapy if the decrease in NRS was equal to or greater than 30%; patients with a decrease in NRS of 50% or more were also analyzed), the area of pain and the need for adjuvant analgesic therapy, as well as the tolerability to treatment and the identification of eventual predictors of its efficacy were evaluated, at 15 days, 8 weeks and 12 weeks after 8% capsaicin patch. Results: Of the 120 patients in the sample, 40.8% had a ≥ 30% decrease in basal pain intensity 15 days after treatment, 43.3% after 8 weeks and 45.0% after 12 weeks. 30.8% of patients had ≥ 50% decreased basal pain intensity 15 days after treatment, 27.5% after 8 weeks and 30.0% after 12 weeks. Pain area decreased in 36.7% of patients and 18.3% reduced chronic analgesic therapy within 12 weeks after 8% capsaicin patch application. There was only one case of intolerance to the treatment. Limitations: This study has the limitations inherent to a retrospective study. The study period was only 12 weeks and some diagnostic groups included a small number of patients. Conclusion: Treatment of peripheral neuropathic pain with 8% capsaicin patch seem to be effective in the short and medium term, both in decreasing pain intensity and in reducing the painful area. Its application is tolerated by most patients. Key words: 8% capsaicin patch, peripheral neuropathic pain, pain intensity, painful area

Download Full-text

Effectiveness of Pulsed Radiofrequency with Multifunctional Epidural Electrode in Chronic Lumbosacral Radicular Pain with Neuropathic Features

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/477 ◽

2014 ◽

Vol 6;17 (6;12) ◽

pp. 477-486 ◽

Cited By ~ 2

Author(s):

Simone Vigneri

Keyword(s):

Neuropathic Pain ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Rating Scale ◽

Radicular Pain ◽

Pain Intensity Score ◽

Pulsed Radiofrequency ◽

Number Of Patients ◽

Pre Treatment

Background: Lumbosacral radicular pain is a common clinical finding with a statistical prevalence ranging from 9.9% to 25% in the general population. Objective: To investigate the effectiveness of dorsal root ganglion pulsed radiofrequency (PRF) in patients with chronic lumbosacral radicular pain and neuropathic features. Study Design: Prospective case series clinical outcome study. Methods: We evaluated 34 patients with lumbosacral neuropathic pain who underwent PRF at the corresponding level of radicular symptoms distribution (ranging from L3 to S1). Each patient suffered a single leg-radiating pain with probable neuropathic features (assessed with clinical grading) lasting for > 6 months and unresponsive to previous treatments. A multifunctional PASHA-electrode® was introduced with trans-sacral access through a hollow needle, placed under fluoroscopic guidance into the lumbosacral epidural space and its active tip moved close to the dorsal root ganglion responsible of the clinical symptoms. After connecting the electrode to a generator, stimulation tests were performed and PRF was started and applied for 240 seconds at a frequency of 2Hz, amplitude of 45 V and a tip temperature between 40 – 42°C. If the pain involved more than a single nerve root, the electrode was placed at a different segment and the procedure repeated. Outcome measures included the pain intensity score on a 0 – 10 numeric rating scale (NRS) and the Italian Pain Questionnaire (QUID) at pre-treatment, one and 6 months post-treatment. P values < 0.05 were considered statistically significant. Results: In comparison with pre-treatment, a significant reduction in pain score was observed in mean NRS either at one and 6 months (P < 0.001). The QUID - Pain Rating Index rank displayed a parallel trend at the first (P < 0.001) and last follow-up (P = 0.01). Moreover, a direct correlation between the 2 scales occurred, showing a parallel score decreasing (P < 0.001). Eighteen (52.9%) and 17 (50%) of 34 patients showed pain reduction in NRS > 2 points and > 30%, at one and 6 months, respectively. Limitations: The non-controlled design of the study, the patients were heterogeneous, the small number of patients, and the duration of follow-up was limited to 6 months. Conclusions: PRF of dorsal root ganglion performed with a multifunctional electrode for > 240 seconds appears to be safe and might be more effective than the classic 120 seconds needlemediated approach. Therefore, it may be considered as a valuable tool for the treatment of lumbosacral radicular pain with neuropathic features. Key words: PRF, radicular pain, neuropathic pain, DRG, NRS, PRIr-T, multifunctional electrode

Download Full-text

Scrambler therapy improves pain in neuromyelitis optica

Neurology ◽

10.1212/wnl.0000000000009370 ◽

2020 ◽

Vol 94 (18) ◽

pp. e1900-e1907 ◽

Cited By ~ 1

Author(s):

Maureen A. Mealy ◽

Sharon L. Kozachik ◽

Lawrence J. Cook ◽

Lauren Totonis ◽

Ruth Andrea Salazar ◽

...

Keyword(s):

Neuropathic Pain ◽

Neuromyelitis Optica ◽

Rating Scale ◽

Controlled Trial ◽

Numeric Rating Scale ◽

Central Neuropathic Pain ◽

End Of Treatment ◽

Scrambler Therapy ◽

Anxiety Depression

ObjectiveTo determine whether Scrambler therapy is an effective, acceptable, and feasible treatment of persistent central neuropathic pain in patients with neuromyelitis optica spectrum disorder (NMOSD) and to explore the effect of Scrambler therapy on co-occurring symptoms.MethodsWe conducted a randomized single-blind, sham-controlled trial in patients with NMOSD who have central neuropathic pain using Scrambler therapy for 10 consecutive weekdays. Pain severity, pain interference, anxiety, depression, and sleep disturbance were assessed at baseline, at the end of treatment, and at the 30- and 60-day follow-up.ResultsTwenty-two patients (11 per arm) were enrolled in and completed this trial. The median baseline numeric rating scale (NRS) pain score decreased from 5.0 to 1.5 after 10 days of treatment with Scrambler therapy, whereas the median NRS score did not significantly decrease in the sham arm. Depression was also reduced in the treatment arm, and anxiety was decreased in a subset of patients who responded to treatment. These symptoms were not affected in the sham arm. The safety profiles were similar between groups.ConclusionsScrambler therapy is an effective, feasible, and safe intervention for central neuropathic pain in patients with NMOSD. Decreasing pain with Scrambler therapy may additionally improve depression and anxiety.Clinicaltrials.gov identifierNCT03452176.Classification of evidenceThis study provides Class II evidence that Scrambler therapy significantly reduces pain in patients with NMOSD and persistent central neuropathic pain.

Download Full-text

The incidence of neuropathic pain symptoms in patients with knee osteoarthritis

Medicinski pregled ◽

10.2298/mpns2010291i ◽

2020 ◽

Vol 73 (9-10) ◽

pp. 291-294

Author(s):

Josip Ivacic ◽

Enis Garipi ◽

Aleksandar Knezevic ◽

Nikola Boskovic

Keyword(s):

Neuropathic Pain ◽

Knee Osteoarthritis ◽

Rating Scale ◽

Common Symptom ◽

Number Of Patients ◽

Significant Difference ◽

Maximum Pain ◽

Average Pain ◽

Numeric Pain Rating Scale ◽

Pain Symptoms

Introduction. Pain is the most common symptom of knee osteoarthritis. Until recently, this pain was referred to as nociceptive pain. However, the difficulties of pain management in knee osteoarthritis indicate the possible presence of a neuropathic component. The objective of this study was to determine how often neuropathic component is part of chronic pain in knee osteoarthritis. Material and Methods. The study included 417 patients with knee osteoarthritis. The patients were tested using the Neuropathic Pain (Douleur Neuropathique) 4 Questions and a Numeric Pain Rating Scale. Patients were divided into 2 groups. The first group included patients with a Neuropathic Pain 4 Questions score ? 4, and the second group with a score < 4. Results. The majority of patients included in this study were females (301, 72.2%), and most of the patients scored less than 4 in the questionnaire (231, 55.4%). Among the patients with a score ? 4, 144 (77.4%) were female, which is significantly higher compared to the group of patients who scored < 4, 157 (68%) (p = 0.037). There was no statistically significant difference in age between the two groups (p = 0.231). The current pain intensity, average pain, and maximum pain during the last 4 weeks were significantly higher in the group with a score ? 4 (p < 0.001). Conclusion. A significant number of patients with knee osteoarthritis had a neuropathic component of pain. There were significantly more women in the group with score ? 4, and this group also reported significantly higher current, as well as average and maximum pain during last 4 weeks than the other group.

Download Full-text

Neuromodulation for Chronic Pelvic Pain: A Single-Institution Experience With a Collaborative Team

Neurosurgery ◽

10.1093/neuros/nyaa537 ◽

2020 ◽

Author(s):

Cheyanne Bridger ◽

Tarun Prabhala ◽

Rachael Dawson ◽

Olga Khazen ◽

Jacquelyn MacDonell ◽

...

Keyword(s):

Neuropathic Pain ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Catastrophizing ◽

Pain Catastrophizing Scale ◽

Pain Disability ◽

Numerical Rating

Abstract BACKGROUND Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. OBJECTIVE To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients. METHODS A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale. RESULTS Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043). CONCLUSION Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.

Download Full-text

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200009 ◽

2020 ◽

Vol 41 (3) ◽

pp. 192-197

Author(s):

Sherry S. Zhou ◽

Alan P. Baptist

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Electronic Cigarettes ◽

The United States ◽

Fisher Exact Test ◽

Exact Test ◽

Knowledge And Beliefs ◽

Tobacco Cigarette ◽

Number Of Patients ◽

Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

Download Full-text

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

Download Full-text