scholarly journals Therapeutic Approaches for Peripheral and Central Neuropathic Pain

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Délia Szok ◽  
János Tajti ◽  
Aliz Nyári ◽  
László Vécsei ◽  
Luigi Trojano
Keyword(s):  
Neuropathic Pain ◽  
Tricyclic Antidepressants ◽  
Treatment Options ◽  
Somatosensory System ◽  
Therapeutic Approaches ◽  
Chronic Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Psychological Therapies ◽  
First Choice ◽  
Pubmed Search

Neuropathic pain is a chronic secondary pain condition, which is a consequence of peripheral or central nervous (somatosensory) system lesions or diseases. It is a devastating condition, which affects around 7% of the general population. Numerous etiological factors contribute to the development of chronic neuropathic pain. It can originate from the peripheral part of the nervous system such as in the case of trigeminal or postherpetic neuralgia, peripheral nerve injury, painful polyneuropathies, or radiculopathies. Central chronic neuropathic pain can develop as a result of spinal cord or brain injury, stroke, or multiple sclerosis. As first-line pharmacological treatment options, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids are recommended. In trigeminal neuralgia, carbamazepine and oxcarbazepine are the first-choice drugs. In drug-refractory cases, interventional, physical, and psychological therapies are available. This review was structured based on a PubMed search of papers published in the field from 2010 until May 2019.

Review of antidepressants in the treatment of neuropathic pain

2015 ◽  
Vol 5 (3) ◽  
pp. 123-133 ◽  
Author(s):  
Elizabeth P. Baltenberger ◽  
Whitney M. Buterbaugh ◽  
B. Shane Martin ◽  
Christopher J. Thomas
Keyword(s):  
Neuropathic Pain ◽  
Adverse Effects ◽  
Tricyclic Antidepressants ◽  
Randomized Clinical Trials ◽  
Treatment Options ◽  
Comparable Efficacy ◽  
Chemotherapy Treatment ◽  
Pubmed Search ◽  
Pathological Pain ◽  
Meta Analyses

Abstract Introduction Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. Trials indicate that venlafaxine, duloxetine, and tricyclic antidepressants (TCAs) have comparable efficacy, but TCAs have a higher incidence of adverse effects. Other antidepressants, such as citalopram, paroxetine, and bupropion have limited evidence supporting their use in neuropathy. Discussion Based on the evidence reviewed, venlafaxine and duloxetine should be used as first-line agents. TCAs should be used as second-line agents, due to higher incidence of adverse effects. Other treatment options include citalopram, paroxetine, and bupropion, but data supporting their efficacy is limited.

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 What do general neurologists need to know about neuropathic pain?

2009 ◽  
Vol 67 (3a) ◽  
pp. 741-749 ◽  
Author(s):  
Pedro Schestatsky ◽  
Osvaldo José M. Nascimento
Keyword(s):  
Neuropathic Pain ◽  
Somatosensory System ◽  
Relevant Information ◽  
Diagnostic Tools ◽  
Post Herpetic Neuralgia ◽  
Therapeutic Approaches ◽  
Pain Syndromes ◽  
Cord Injury ◽  
Common Causes ◽  
Nociceptive Pathway

Neuropathic pain (NP) is defined as pain caused by lesion or dysfunction of the somatosensory system, as a result of abnormal activation of the nociceptive pathway (small fibers and spinothalamic tracts). The most common causes of this syndrome are the following: diabetes, post-herpetic neuralgia, trigeminal neuralgia, stroke, multiple sclerosis, spinal cord injury, HIV infection, cancer. In the last few years, the NP has been receiving special attention for two main reasons: (1) therapeutical refractoriness of a variety of pain syndromes with predominant neuropathic characteristics and (2) the development of diagnostic tools for neuropathic pain complaints. The present review article provides relevant information on the understanding and recognition of NP, as well as evidence-based therapeutic approaches.

scholarly journals Psychiatric Underpinnings of Chronic Diabetic Neuropathic Pain

2016 ◽  
Vol 30 (1&2) ◽  
pp. 37
Author(s):  
Syed H. Shabbir
Keyword(s):  
Neuropathic Pain ◽  
Diabetic Neuropathy ◽  
Psychiatric Illness ◽  
Treatment Options ◽  
Diabetic Polyneuropathy ◽  
Therapeutic Approaches ◽  
Diabetic Neuropathic Pain ◽  
Psychiatric Illnesses ◽  
Axis I

There is increasing evidence that psychosocial factors may be involved in the pathophysiology of chronic diabetic neuropathic pain. Individuals with diabetic polyneuropathy exhibit significantly higher rates of axis I psychiatric disorders, and worsening neuropathic symptoms correlate with worsened psychiatric illness. This association exists even when social-support and quality-of-life measures are controlled. Aberrant supraspinal structures and neuronal networks in diabetic neuropathy mimic those found in other psychiatric illnesses. Response to standard medications and therapeutic approaches remains unsatisfactory, and antidepressants continue to serve as first-line treatment for diabetic neuropathy. The exact interplay between neuropathic pain and psychiatric illness remains unclear and may have a common pathophysiological focus. This area of study needs to be revisited and psychological interventions must be explored as possible treatment options for diabetic neuropathy. 

Practicalities of using TENS for specific conditions and situations

2014 ◽  
Keyword(s):  
Neuropathic Pain ◽  
Back Pain ◽  
Good Practice ◽  
Labour Pain ◽  
The Elderly ◽  
Chronic Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pattern Frequency ◽  
Post Operative Pain ◽  
Principles Of Good Practice

Research studies have failed to evaluate different TENS techniques for specific conditions. Safe and appropriate TENS technique is based on the use of conventional TENS delivered at a strong, non-painful intensity at the site of pain in the first instance with patients selecting pulse pattern, frequency, and duration for reasons of comfort. In practice, it is necessary to adapt this approach for specific painful conditions. The purpose of this chapter is to demonstrate how the general principles of good practice are applied when using TENS to manage various painful conditions. The chapter discusses acute pain, including post-operative pain and labour pain, chronic musculoskeletal pain, including back pain and osteoarthritis, chronic neuropathic pain, including peripheral and central neuropathic pain, cancer pain, and TENS for children and the elderly.

scholarly journals The Neuropeptide Cortistatin Alleviates Neuropathic Pain in Experimental Models of Peripheral Nerve Injury

Pharmaceutics ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 947
Author(s):  
Clara P. Falo ◽  
Raquel Benitez ◽  
Marta Caro ◽  
Maria Morell ◽  
Irene Forte-Lago ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Clinical Manifestations ◽  
Somatosensory System ◽  
Experimental Models ◽  
Protective Capacity ◽  
Chronic Neuropathic Pain ◽  
Inflammatory Conditions

Neuropathic pain is one of the most severe forms of chronic pain caused by the direct injury of the somatosensory system. The current drugs for treating neuropathies have limited efficacies or show important side effects, and the development of analgesics with novel modes of action is critical. The identification of endogenous anti-nociceptive factors has emerged as an attractive strategy for designing new pharmacological approaches to treat neuropathic pain. Cortistatin is a neuropeptide with potent anti-inflammatory activity, recently identified as a natural analgesic peptide in several models of pain evoked by inflammatory conditions. Here, we investigated the potential analgesic effect of cortistatin in neuropathic pain using a variety of experimental models of peripheral nerve injury caused by chronic constriction or partial transection of the sciatic nerve or by diabetic neuropathy. We found that the peripheral and central injection of cortistatin ameliorated hyperalgesia and allodynia, two of the dominant clinical manifestations of chronic neuropathic pain. Cortistatin-induced analgesia was multitargeted, as it regulated the nerve damage-induced hypersensitization of primary nociceptors, inhibited neuroinflammatory responses, and enhanced the production of neurotrophic factors both at the peripheral and central levels. We also demonstrated the neuroregenerative/protective capacity of cortistatin in a model of severe peripheral nerve transection. Interestingly, the nociceptive system responded to nerve injury by secreting cortistatin, and a deficiency in cortistatin exacerbated the neuropathic pain responses and peripheral nerve dysfunction. Therefore, cortistatin-based therapies emerge as attractive alternatives for treating chronic neuropathic pain of different etiologies.

scholarly journals An overview of analgesics - anticonvulsants, antidepressants, and other medications (Part 3)

2019 ◽  
Vol 61 (3) ◽  
pp. 59-63
Author(s):  
R. Van Rensburg ◽  
H. Reuter
Keyword(s):  
Chronic Pain ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Tissue Damage ◽  
Tricyclic Antidepressants ◽  
Treatment Options ◽  
First Line ◽  
Patient Profile ◽  
Noradrenaline Reuptake ◽  
Associated Conditions

Pain is classified by various descriptions. Chronic pain has been described as being neuropathic (due to nervous system lesions), nociceptive (due to tissue damage), or mixed (a combination of neuropathic and nociceptive). The addition of the term nociplastic pain is used to describe patients who experience chronic pain without tissue damage or nervous system lesions. Chronic pain is often difficult to manage, particularly neuropathic pain. Evidence-based pharmacological treatment options include anticonvulsants and antidepressants. The choice of medication will depend on various factors, including patient profile, type of pain, and associated conditions. Medications with the best evidence of efficacy for first-line use in neuropathic pain are the gabapentinoids, carbamazepine, the tricyclic antidepressants, and the serotonin-noradrenaline reuptake inhibitors duloxetine and venlafaxine. The cannabinoids and ketamine are being actively investigated for use in chronic pain. Currently the cannabinoids’ potential benefit is outweighed by the adverse effects, and recommendations for the use of ketamine is limited by its parenteral route of administration and low evidence of efficacy in chronic pain.

scholarly journals Non-invasive brain stimulation interventions for management of chronic central neuropathic pain: a scoping review protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016002 ◽  
Author(s):  
Mei Lin Chen ◽  
Lin Yao ◽  
Jennifer Boger ◽  
Kathryn Mercer ◽  
Benjamin Thompson ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Brain Stimulation ◽  
Scoping Review ◽  
Somatosensory System ◽  
Primary Data ◽  
Original Research ◽  
Plain Language ◽  
Central Neuropathic Pain ◽  
Non Invasive ◽  
Cord Injury

IntroductionPain can affect people regardless of age, gender or ethnicity. Chronic central neuropathic pain (CCNP) is a debilitating condition that affects populations such as stroke survivors, amputees, spinal cord injury patients and patients with multiple sclerosis, with prevalence rates between 30% and 80%. This condition can be caused by a lesion or disease affecting the somatosensory system. CCNP is notoriously drug resistant, and few effective CCNP treatment or management strategies exist. The emergence of non-invasive brain stimulation and neuromodulation techniques provide novel avenues for managing chronic central neuropathic pain. This scoping review aims to systematically identify the methods and effectiveness of non-invasive brain stimulation techniques for treating and managing chronic central neuropathic pain.Methods and analysisThe following databases will be searched systematically: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Institute of Electric and Electronic Engineers (IEEE), Association of Computing Machinary (ACM) and Scopus. Additional literature will be identified by searching the reference lists of identified studies. Studies will include reviews and original research in both published and grey literatures. Two reviewers will independently screen identified studies for final inclusion. A quantitative analysis on the intervention type, application and efficacy will be synthesised along with a qualitative analysis to describe the effectiveness of each intervention.Ethics and disseminationNo primary data will be collected and hence formal ethics review is not required. The results of the scoping review will be presented at relevant national and international conferences, published in a peer-reviewed journal and provided to the stakeholders with plain language to be posted on their websites. This scoping review will provide a foundation to guide the development of future primary research on non-invasive brain stimulation and CCNP.

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