Treatment of Neuropathic Pain

Neuropathic pain is generated by disruption of normal nerve connections and/or abnormal hyperactivity at some level of the pain sensory system. Neuropathic pain syndromes due to peripheral nervous system injury are commonly encountered in clinical practice and often adversely affect patients’ quality of life. Pharmacotherapy is the mainstay of neuropathic pain management, with the majority of clinical data supporting the use of three main drug classes: (1) tricyclic antidepressants; (2) anticonvulsants; and (3) anesthetic-antiarrhythmics. Clonidine, opioids, capsaicin, nonsteroidal anti-inflammatory drugs, immunosuppressants, and the novel antidepressants may also have a role in some patient populations.

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Neuropathic pain in rheumatoid arthritis

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2020-5-60-65 ◽

2020 ◽

Vol 12 (5) ◽

pp. 60-65

Author(s):

E. S. Filatova ◽

A. M. Lila ◽

V. A. Parfenov

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Chronic Pain ◽

Nervous System ◽

Neuropathic Pain ◽

Pain Syndrome ◽

Chronic Pain Syndrome ◽

Paindetect Questionnaire ◽

Somatosensory Nervous System

Objective: to identify the signs of neuropathic pain (NP) in patients with rheumatoid arthritis (RA) on the basis of the PainDETECT questionnaire and neurological examination.Patients and methods. A total of 208 RA patients (39 men and 169 women; mean age, 47.7 years) with chronic pain syndrome were examined. The patients underwent rheumatological and neurological examinations; NP was diagnosed using the PainDETECT questionnaire; inflammation severity (DAS28 index), pain intensity (VAS), affective disorders (HADS), and quality of life (EQ-5D) were assessed.Results and discussion. 172 (82.7%) patients had moderate and high disease activity according to the DAS28. The signs of possible and highly probable NP according to the PainDETECT questionnaire were detected in 29.8 and 26.9% of patients, respectively; they were significantly more likely to be detected in patients with more severe pain syndrome, clinically significant anxiety, and worse quality of life, but were unassociated with RA activity according to the DAS28. Somatosensory nervous system injury (polyneuropathy, tunnel syndromes, and cervical myelopathy) was found in 77.6% of patients with possible NP and in 80.4% with highly probable NP. In other patients, NP might be caused by central sensitization. Conclusion. In patients with a RA exacerbation, chronic pain syndrome is caused not only by an active inflammatory process in the joint area and adjacent tissues, but also by somatosensory nervous system injury and central sensitization.

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Management issues in neuropathic pain

10.1093/med/9780199656097.003.0133 ◽

2015 ◽

Author(s):

Nanna Brix Finnerup ◽

Troels Staehelin Jensen

Keyword(s):

Nervous System ◽

Neuropathic Pain ◽

Cancer Survivors ◽

Tricyclic Antidepressants ◽

Topical Lidocaine ◽

Noradrenaline Reuptake ◽

Somatosensory Nervous System ◽

Disease Free ◽

Management Issues

Neuropathic pain is a common complication to cancer, cancer treatment, HIV, and other conditions that may affect the somatosensory nervous system. Neuropathic pain may be present in up to 40% of cancer patients and may persist independently of the cancer and affect the quality of life in disease-free cancer survivors. Particular surgical treatment and chemotherapy may cause chronic persistent neuropathic pain in cancer survivors. The diagnosis of neuropathic pain can be challenging and requires documentation of a nervous system lesion and pain in areas of sensory changes. The pharmacological treatment may include tricyclic antidepressants, selective serotonin noradrenaline reuptake inhibitors (duloxetine or venlafaxine), calcium channel α2↓ agonists (gabapentin or pregabalin), and opioids. Topical lidocaine and capsaicin, NMDA antagonists, carbamazepine, oxcarbazepine, and cannabinoids may be indicated. Due to limited efficacy or intolerable side effects at maximal doses, combination therapy is often required and careful monitoring of effect and adverse reactions is important.

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B12 as a Treatment for Peripheral Neuropathic Pain: A Systematic Review

Nutrients ◽

10.3390/nu12082221 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2221

Author(s):

Thomas Julian ◽

Rubiya Syeed ◽

Nicholas Glascow ◽

Efthalia Angelopoulou ◽

Panagiotis Zis

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Nervous System ◽

Neuropathic Pain ◽

Post Herpetic Neuralgia ◽

Peripheral Neuropathic Pain ◽

Treatment Regimens ◽

Level Ii ◽

Somatosensory Nervous System

Neuropathic pain describes a range of unpleasant sensations caused by a lesion or disease of the somatosensory nervous system. The sensations caused by neuropathic pain are debilitating and improved treatment regimens are sought in order to improve the quality of life of patients. One proposed treatment for neuropathic pain is vitamin B12, which is thought to alleviate pain by a number of mechanisms including promoting myelination, increasing nerve regeneration and decreasing ectopic nerve firing. In this paper, the evidence for B12 as a drug treatment for neuropathic pain is reviewed. Twenty four published articles were eligible for inclusion in this systematic review in which a range of treatment regimens were evaluated including both B12 monotherapy and B12 in combination with other vitamins or conventional treatments, such as gabapentinoids. Overall, this systematic review demonstrates that there is currently some evidence for the therapeutic effect of B12 in the treatment of post-herpetic neuralgia (level II evidence) and the treatment of painful peripheral neuropathy (level III evidence).

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ДИАГНОСТИКА ХРОНИЧЕСКИХ ИНДУЦИРОВАННЫХ КРАПИВНИЦ

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/raj.2019.2.41457 ◽

2019 ◽

pp. 5-13

Author(s):

E.Yu. Borzova

Keyword(s):

Quality Of Life ◽

Biological Therapy ◽

Treatment Algorithm ◽

The Novel ◽

International Guidelines ◽

Systemic Reactions ◽

Significant Impairment ◽

Challenge Tests

Хронические индуцированные крапивницы имеют важное социальноэкономическое значение вследствие риска развития системных реакций и значительного снижения качества жизни пациентов. Диагностика хронических индуцированных крапивниц основывается на анамнестических данных и проведении провокационных тестов. Современный протокол ведения больных хронической крапивницей включает применение неседативных антигистаминных препаратов. Международные согласительные документы по лечению крапивницы рекомендуют 4кратное увеличение суточной дозы неседативных антигистаминных препаратов при их неэффективности в стандартных дозах. Данные метаанализа указывают на эффективность омализумаба при хронических индуцированных крапивницах. В перспективе ожидается расширение арсенала генноинженерной биологической терапии хронических индуцированных крапивниц.Chronic inducible urticarias are characterized by the risks of systemic reactions and a significant impairment of patients quality of life. The diagnosis of chronic inducible urticarias relies on the patients history and the challenge tests. A treatment algorithm for the management of chronic inducible urticarias includes nonsedating antihistamines as a firstline treatment. The international guidelines for the management of chronic inducible urticarias recommend updosing of nonsedating antihistamines up to four fold if standard doses are not effective. The metaanalysis suggests the efficacy of omalizumab in chronic inducible urticarias. In the prospect, the novel options of biological therapy for chronic inducible urticarias are expected.

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QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION

Neuro-Oncology ◽

10.1093/neuonc/noaa222.695 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii438-iii438

Author(s):

Kathleen Dorris ◽

Jessica Channell ◽

Ashley Mettetal ◽

Molly Hemenway ◽

Natalie Briones ◽

...

Keyword(s):

Quality Of Life ◽

Central Nervous System ◽

Nervous System ◽

Cell Activity ◽

Cns Tumors ◽

Low Grade ◽

Tumor Type ◽

Central Nervous System Tumor ◽

The Impact

Abstract BACKGROUND Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population. METHODS A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected. RESULTS Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy. CONCLUSIONS Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.

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Health-related quality of life and neuropathic pain in sickle cell disease in Jamaica

Disability and Health Journal ◽

10.1016/j.dhjo.2021.101107 ◽

2021 ◽

pp. 101107

Author(s):

Rachel Bartlett ◽

Zachary Ramsay ◽

Amza Ali ◽

Justin Grant ◽

Angela Rankine-Mullings ◽

...

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Health Related Quality ◽

Cell Disease ◽

Related Quality ◽

Health Related

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Buprenorphine: Far Beyond the “Ceiling”

Biomolecules ◽

10.3390/biom11060816 ◽

2021 ◽

Vol 11 (6) ◽

pp. 816

Author(s):

Rosmara Infantino ◽

Consalvo Mattia ◽

Pamela Locarini ◽

Antonio Luigi Pastore ◽

Sabatino Maione ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Drug Abuse ◽

Side Effects ◽

National Health System ◽

Analgesic Drugs ◽

Third Line ◽

Dynamic Profile

Chronic pain, including neuropathic pain, represents an untreated disease with important repercussions on the quality of life and huge costs on the national health system. It is well known that opioids are the most powerful analgesic drugs, but they represent the second or third line in neuropathic pain, that remain difficult to manage. Moreover, these drugs show several side effects that limit their use. In addition, opioids possess addictive properties that are associated with misuse and drug abuse. Among available opioids compounds, buprenorphine has been suggested advantageous for a series of clinical reasons, including the effectiveness in neuropathic pain. Some properties are partly explained by its unique pharmacological characteristics. However, questions on the dynamic profile remain to be answered. Pharmacokinetics optimization strategies, and additional potentialities, are still to be explored. In this paper, we attempt to conceptualize the potential undiscovered dynamic profile of buprenorphine.

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