The effects of a multiday (10–14 days) subanesthetic dose IV ketamine infusion in the treatment of refractory chronic pain

Aim: Ketamine is an anesthetic agent that at lower doses can be a potent analgesic. There has been an interest in the use of low dose ketamine in treatment of chronic pain syndromes. Patients & methods: We report the results of a retrospective observational study for patients diagnosed with a chronic noncancer pain syndrome receiving a 2-week continuous subanesthetic IV ketamine infusion. Results & conclusion: We conclude that a 10–14 days of subanesthetic ketamine infusion in chronic patients results in clinically significant lowering of patients' numerical pain score. Further studies looking at subanesthetic ketamine infusion in a prospective trial of multi-day IV ketamine infusion in chronic refractory chronic neuropathic pain are needed to further assess the efficacy of ketamine.

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Prospects for the Personalized Multimodal Therapy Approach to Pain Management via Action on NO and NOS

Molecules ◽

10.3390/molecules26092431 ◽

2021 ◽

Vol 26 (9) ◽

pp. 2431

Author(s):

Natalia A. Shnayder ◽

Marina M. Petrova ◽

Tatiana E. Popova ◽

Tatiana K. Davidova ◽

Olga P. Bobrova ◽

...

Keyword(s):

Chronic Pain ◽

Molecular Genetic ◽

Pain Syndrome ◽

Medical Problem ◽

Single Nucleotide Variants ◽

Genetic Studies ◽

Pain Syndromes ◽

Nos Inhibitors ◽

Peripheral Pain

Chronic pain syndromes are an important medical problem generated by various molecular, genetic, and pathophysiologic mechanisms. Back pain, neuropathic pain, and posttraumatic pain are the most important pathological processes associated with chronic pain in adults. Standard approaches to the treatment of them do not solve the problem of pain chronicity. This is the reason for the search for new personalized strategies for the prevention and treatment of chronic pain. The nitric oxide (NO) system can play one of the key roles in the development of peripheral pain and its chronicity. The purpose of the study is to review publications devoted to changes in the NO system in patients with peripheral chronical pain syndromes. We have carried out a search for the articles published in e-Library, PubMed, Oxford Press, Clinical Case, Springer, Elsevier, and Google Scholar databases. The search was carried out using keywords and their combinations. The role of NO and NO synthases (NOS) isoforms in peripheral pain development and chronicity was demonstrated primarily from animal models to humans. The most studied is the neuronal NOS (nNOS). The role of inducible NOS (iNOS) and endothelial NOS (eNOS) is still under investigation. Associative genetic studies have shown that single nucleotide variants (SNVs) of NOS1, NOS2, and NOS3 genes encoding nNOS, iNOS, and eNOS may be associated with acute and chronic peripheral pain. Prospects for the use of NOS inhibitors to modulate the effect of drugs used to treat peripheral pain syndrome are discussed. Associative genetic studies of SNVs NOS1, NOS2, and NOS3 genes are important for understanding genetic predictors of peripheral pain chronicity and development of new personalized pharmacotherapy strategies.

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How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

Journal of Opioid Management ◽

10.5055/jom.2021.0684 ◽

2021 ◽

Vol 17 (6) ◽

pp. 499-509

Author(s):

Elizabeth C. Danielson, PhD ◽

Christopher A. Harle, PhD ◽

Sarah M. Downs, MPH ◽

Laura Militello, MA ◽

Olena Mazurenko, MD, PhD

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Treatment Decisions ◽

Healthcare Organizations ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Prevention Guideline ◽

Multistep Process ◽

Primary Care Clinicians ◽

Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

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A Review of the Use of Methadone for the Treatment of Chronic Noncancer Pain

Pain Research and Management ◽

10.1155/2005/286713 ◽

2005 ◽

Vol 10 (3) ◽

pp. 133-144 ◽

Cited By ~ 33

Author(s):

Mary E Lynch

Keyword(s):

Chronic Pain ◽

Low Cost ◽

Interindividual Variation ◽

Duration Of Action ◽

Chronic Noncancer Pain ◽

Opioid Dose ◽

Long Duration ◽

Attractive Option ◽

Noncancer Pain ◽

High Bioavailability

Methadone, although having been available for approximately half a century, is now receiving increasing attention in the management of chronic pain. This is due to recent research showing that methadone exhibits at least three different mechanisms of action including potent opioid agonism, N-methyl-D-aspartate antagonism and monoaminergic effects. This, along with methadone's excellent oral and rectal absorption, high bioavailability, long duration of action and low cost, make it a very attractive option for the treatment of chronic pain. The disadvantages of significant interindividual variation in pharmacokinetics, graduated dose equivalency ratios based on prerotation opioid dose when switching from another opioid, and the requirement for special exemption for prescribing methadone make it more complicated to use. The present review is intended to educate physicians interested in adding methadone to their armamentarium for assisting patients with moderate to severe pain.

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Analgetic effect of ozone therapy: myths of reality?

Polish Annals of Medicine ◽

10.29089/2020.20.00099 ◽

2020 ◽

Author(s):

Iryna Vladimirovna Baranova ◽

Yurii A. Bezsmertnyi ◽

Halyna V. Bezsmertnaya ◽

Kateryna P. Postovitenko ◽

Iryna A. Iliuk ◽

...

Keyword(s):

Chronic Pain ◽

Musculoskeletal System ◽

Chronic Back Pain ◽

Pain Syndrome ◽

Neurological Complications ◽

Potential Effect ◽

Intervertebral Disk ◽

Ozone Therapy ◽

Pain Syndromes ◽

Innovative Techniques

Introduction: Administration of an oxygen-ozone mixture is one of the innovative techniques used in single-drug or complex therapeutic schemes for treatment of many degenerative-dystrophic pathologies of the musculoskeletal system and related neurological complications. Aim: The aim was to determine the mechanisms of physiological action of the oxygen-ozone mixture in order to substantiate its efficacy for treatment of chronic pain syndrome with underlying degenerative-dystrophic pathologies of the musculoskeletal system. Material and methods: The article covers biochemical and pathomorphological studies that explain the mechanism of the pain syndrome and the potential effect of the ozone therapy. Results and discussion: The treatment schemes and benefits of different routes of ozone administration (intramuscularly, intravenously, intradiscally and intraarticularly) were analyzed. Diverse research data demonstrated influence on the causes of chronic pain, pathophysiological phases, and possible complications. The prospects of further studies for development of the most effective techniques for treatment of various pain syndromes were assessed. Conclusions: Ozone therapy is one of the alternative rehabilitation methods with a substantial pain relieving effect. As of today, the possibility of using the oxygen-ozone mixture for treatment of chronic back pain related to intervertebral disk hernia and fibromyalgia has been substantially confirmed.

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Chronic pain syndromes

Oxford Handbook of Rheumatology ◽

10.1093/med/9780198728252.003.0022 ◽

2018 ◽

pp. 623-642

Author(s):

Gavin Clunie ◽

Nick Wilkinson ◽

Elena Nikiphorou ◽

Deepak R. Jadon

Keyword(s):

Chronic Pain ◽

General Practitioner ◽

Children And Adolescents ◽

Complex Regional Pain Syndrome ◽

Musculoskeletal Pain ◽

Pain Syndrome ◽

Pain Syndromes ◽

Pain Medications ◽

Cross Reference ◽

Chronic Pain Syndromes

The Oxford Handbook of Rheumatology 4th edition, has been extensively updated to thoroughly review aspects of musculoskeletal pain. Pain pathophysiology is reviewed. Chronic pain and fibromyalgia in adults and in children and adolescents is dealt with in detail. The reader is advised to cross reference from this chapter to Chapters 1–3 in the Handbook, where regional musculoskeletal pain conditions are listed and reviewed. In localized pain syndromes, the chapter has an overview of complex regional pain syndrome (CRPS), which is not infrequently encountered in rheumatology and musculoskeletal clinics. Included in detail for this edition, is the assessment and management of pain in children, which is a highly specialized clinical area of medicine and will be of use to the adult rheumatologist and general practitioner as well as paediatric specialists. Readers should cross reference to Chapter 23 on medications, for ‘pain medications’ in the Handbook

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Metabolic Therapy and Pain

10.1093/med/9780190497996.003.0022 ◽

2016 ◽

Author(s):

David N. Ruskin

Keyword(s):

Chronic Pain ◽

Pain Syndrome ◽

Poor Quality ◽

Fatty Acid Supplementation ◽

Pain Syndromes ◽

Drug Treatments ◽

Dietary Treatments ◽

Dietary Modifications ◽

Chronic Pain Syndromes

Chronic pain is associated strongly with poor quality of life. Drug treatments for pain can be problematic; with the understanding that chronic pain syndromes often involve derangement of homeostasis, there is an increased interest in applying nonpharmacological metabolic therapies. This chapter surveys clinical and animal research into the effects of fasting, calorie restriction, ketogenic diet, and polyunsaturated fatty acid supplementation on pain. These dietary treatments can significantly ameliorate pain in inflammatory and neuropathic disorders. The choice among these treatments might depend on the specific pain syndrome and the tolerance of the patient for particular dietary modifications. Several possible mechanisms are discussed, some of which might be in common among these treatments, and some treatments might engage multiple mechanisms. Multiple mechanisms acting together could be ideal for restoring the disordered metabolism underlying some pain syndromes.

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Multiple Sclerosis and Pain: A Medical Focus

International Journal of MS Care ◽

10.7224/1537-2073-2.3.40 ◽

2000 ◽

Vol 2 (3) ◽

pp. 40-47 ◽

Cited By ~ 13

Author(s):

Marilyn Kassirer

Keyword(s):

Multiple Sclerosis ◽

Chronic Pain ◽

Joint Pain ◽

Pain Syndrome ◽

Surgical Interventions ◽

Alternative Interventions ◽

Pain Syndromes ◽

Drug Treatments ◽

Patients Experience ◽

Iatrogenic Pain

Abstract About 65% of multiple sclerosis (MS) patients experience a broad range of both acute and subacute painful syndromes. Acute conditions (eg, trigeminal neuralgia and Lhermitte's syndrome) cause intense, unrelenting pain that may worsen with age and disease progression. Chronic pain (eg, joint pain) is also a component of MS. Pain syndromes, including optic neuritis, complex regional pain syndrome (CRPS), and other less well-known syndromes, may respond to a variety of pharmacologic, surgical, or alternative interventions. MS patients may also experience iatrogenic pain. Some successful drug treatments for pain that are used in combination or alone include anticonvulsants, tricyclics, methylprednisolone, and narcotics. Surgical interventions, percutaneous compression-balloons, and radiofrequency ablation are other viable options for some pain syndromes.

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The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis

American Journal of Men s Health ◽

10.1177/1557988316672396 ◽

2016 ◽

Vol 11 (4) ◽

pp. 1208-1213 ◽

Cited By ~ 15

Author(s):

Omer A. Raheem ◽

Sunil H. Patel ◽

David Sisul ◽

Tim J. Furnish ◽

Tung-Chin Hsieh

Keyword(s):

Chronic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Opioid Therapy ◽

Total Testosterone ◽

Chronic Noncancer Pain ◽

Numerical Rating ◽

Noncancer Pain ◽

Supplemental Therapy

Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups ( p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group ( p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.

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Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain

Pain Research and Management ◽

10.1155/2017/1365910 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Élise Roy ◽

Richard J. Côté ◽

Denis Hamel ◽

Pierre-André Dubé ◽

Éric Langlois ◽

...

Keyword(s):

Online Survey ◽

Family Physicians ◽

Training Needs ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescription ◽

Chronic Noncancer Pain ◽

Pain Syndromes ◽

Noncancer Pain ◽

And Training

Aim. To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP). Methodology. An online survey was carried out in 2016. Results. Of 636 respondents (43.0% men; 54.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree), dependence (73.2%), and lack of support (75.4%) were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7%) had recently (last five years) taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training. Conclusions. This study provides insights into Québec family physicians’ concerns, practices, and needs with respect to the management of CNCP. Physicians’ difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.

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Neuropathic pain

Innovative medicine of Kuban ◽

10.35401/2500-0268-2021-22-2-58-64 ◽

2021 ◽

pp. 58-64

Author(s):

V. A. Koriachkin ◽

A. P. Spasova ◽

V. V. Khinovker

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Correct Diagnosis ◽

Epidemiological Studies ◽

Chronic Neuropathic Pain ◽

Official Document ◽

Adequate Treatment ◽

Pain Syndromes ◽

Recent Classification

Background Chronic neuropathic pain is a common occurrence, its prevalence ranges from 7 to 10% of the total population. Currently, the only official document that includes neuropathic pain is the International Classification of Headaches Disorders (ICHD-3), in which this type of pain is associated with traumatic brain injury and neuralgia. Until now, there has been no generally accepted terminology and classification of chronic neuropathic pain.Objective To provide the current terminology, classification and additional characteristics of neuropathic chronic pain.Results The review of modern terminology and classification of neuropathic chronic pain describes the terms included in the concept of chronic peripheral and central neuropathic pain, identifies pain subtypes, as well as its additional characteristics such as the intensity of neuropathic pain, the severity of suffering and disability.Conclusions Thus, the presented recent classification of chronic neuropathic pain is an exhaustive list of the most common neuropathic pain syndromes. The inclusion of classification into clinical practice will help to draw attention to the problem of treatment of chronic neuropathic pain by WHO members, carrying out epidemiological studies and making a correct diagnosis, and therefore the appointment of adequate treatment methods.

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