Overview of the Pharmacological Management of Neuropathic Pain

2016 ◽  
Vol 2 (2) ◽  
pp. 114-117
Author(s):  
Virendra Yadav ◽  
Manish Singh ◽  
Manoj Shukla ◽  
Ashish Singh ◽  
Virendra Shukla
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Cost Effectiveness ◽  
Trigeminal Neuralgia ◽  
Treatment Approach ◽  
Interdisciplinary Approach ◽  
Specific Mechanism ◽  
Pharmacological Management ◽  
Somatosensory Nervous System ◽  
Neuropathic Pain Condition

Neuropathic pain refers lesions or disease affecting the somatosensory nervous system either in the periphery or centrally. Examples of neuropathic pain include painful polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and post-stroke pain. Clinically, neuropathic pain is characterized by spontaneous ongoing or shooting pain and evoked amplified pain responses after noxious or non-noxious stimuli. neuropathic pain is treated as a ‘blanket condition’ in this guideline regardless of its aetiologies, unless there is valid and robust clinical and health economics evidence that shows the clinical efficacy and cost effectiveness of a particular treatment for a specific neuropathic pain condition. Management of neuropathic pain requires an interdisciplinary approach, centered around pharmacological treatment. A better understanding of neuropathic pain and in particular of the translation of pathophysiological mechanisms into sensory signs will lead to a more effective and specific mechanism-based treatment approach.

scholarly journals Neuropathic pain in children

2013 ◽  
pp. 205-214 ◽  
Author(s):  
Suellen M. Walker
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Nerve Injuries ◽  
Diagnostic Challenge ◽  
Fabry’S Disease ◽  
Fabry's Disease ◽  
Electric Shocks ◽  
Somatosensory Nervous System ◽  
Paroxysmal Pain

Lesions or disease of the somatosensory nervous system can produce neuropathic pain (NP). Typical features include spontaneous or paroxysmal pain, often described as burning, shooting, like electric shocks, or pins and needles. NP does occur in childhood, but age at the time of injury may influence the risk of NP following traumatic nerve injuries. While conditions commonly associated with NP in adults may be less common in childhood (e.g. trigeminal neuralgia) other conditions (e.g. Fabry’s disease and erythromelalgia), may present with pain in childhood and present a diagnostic challenge for paediatric practitioners.

scholarly journals Neuropathic pain in children

2021 ◽  
pp. 214-224
Author(s):  
Madeleine A. Verriotis ◽  
Suellen M. Walker
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Nerve Injuries ◽  
Diagnostic Challenge ◽  
Fabry’S Disease ◽  
Fabry's Disease ◽  
Electric Shocks ◽  
Somatosensory Nervous System ◽  
Paroxysmal Pain

Lesions or disease of the somatosensory nervous system can produce neuropathic pain (NP). Typical features include spontaneous or paroxysmal pain, often described as burning, shooting, like electric shocks, or pins and needles. NP does occur in childhood, but age at the time of injury may influence the risk of NP following traumatic nerve injuries. Whilst conditions commonly associated with NP in adults may be less common in childhood (e.g., trigeminal neuralgia), other conditions (e.g., Fabry’s disease and erythromelalgia), may present with pain in childhood and present a diagnostic challenge for paediatric practitioners.

Rationalized Approach for The Treatment of Neuropathic Pain

2021 ◽  
pp. 2887-2895
Author(s):  
Srishti Chaudhary ◽  
Pankaj Kumar Prashar ◽  
Anamika Gautam ◽  
Ankita Sood ◽  
Sachin Kumar Singh ◽  
...  
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Good Choice ◽  
Opioid Agonist ◽  
Painful Condition ◽  
Inflammatory Drugs ◽  
Topical Glyceryl Trinitrate ◽  
Multiple Drugs ◽  
Somatosensory Nervous System ◽  
Global Population

Injury to the nerves causes alteration in normal neurobiological sequences lead to disease of somatosensory nervous system called as neuropathic pain (NP). It affects both central as well as peripheral nervous system. It is a chronic painful condition occurs due to various diseases like HIV, diabetes, lesions, infection, trauma, and metabolic insults. NP affects 7-10% of global population, hence subsequently is a major concern. Pharmacotherapy for NP remains a major clinical challenge due to its complex pathophysiology. Current treatments like Analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, tri-cyclic antidepressants, sodium channel blocker and opioid agonist administrated individually to patients of NP are providing only meager and partial relief. Furthermore, these drugs have limited efficacy as well as adverse effects. Hence instead of monotherapy, pathophysiology of NP suggests that administering multiple drugs (polypharmacy) show quick and sufficient effect in the treatment of NP. Recent updates indicate that combination of Morphine and gabapentin, Pregabalin and duloxetine, Gabapentin and nortriptyline, Amitriptyline and ketamine (topical), Doxepin and capsaicin (topical), Glyceryl trinitrate (topical) and valproate are also a good choice for the treatment of NP. Several clinical trials also established that combination pharmacotherapy showed greater efficacy than monotherapy in treating NP. Physicians, scientists working in the area of NP are not only looking for its treatment but also in resolving the issues of co-morbidities associated with it. Hence the present review focuses on rationalized approach of combination therapy for the treatment of various aspects of NP.

scholarly journals ALIAmides Update: Palmitoylethanolamide and Its Formulations on Management of Peripheral Neuropathic Pain

2020 ◽  
Vol 21 (15) ◽  
pp. 5330 ◽  
Author(s):  
Ramona D’Amico ◽  
Daniela Impellizzeri ◽  
Salvatore Cuzzocrea ◽  
Rosanna Di Paola
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Mast Cells ◽  
Inflammatory Responses ◽  
Bioactive Lipids ◽  
Peripheral Neuropathic Pain ◽  
Novel Approach ◽  
Preclinical And Clinical Studies ◽  
Somatosensory Nervous System

Neuropathic pain results from lesions or diseases of the somatosensory nervous system and it remains largely difficult to treat. Peripheral neuropathic pain originates from injury to the peripheral nervous system (PNS) and manifests as a series of symptoms and complications, including allodynia and hyperalgesia. The aim of this review is to discuss a novel approach on neuropathic pain management, which is based on the knowledge of processes that underlie the development of peripheral neuropathic pain; in particular highlights the role of glia and mast cells in pain and neuroinflammation. ALIAmides (autacoid local injury antagonist amides) represent a group of endogenous bioactive lipids, including palmitoylethanolamide (PEA), which play a central role in numerous biological processes, including pain, inflammation, and lipid metabolism. These compounds are emerging thanks to their anti-inflammatory and anti-hyperalgesic effects, due to the down-regulation of activation of mast cells. Collectively, preclinical and clinical studies support the idea that ALIAmides merit further consideration as therapeutic approach for controlling inflammatory responses, pain, and related peripheral neuropathic pain.

Neuropathic Pain During Common Lumboradiculalgia in Subsaharian Africa: Bicentric Study About 409 Patients.

2020 ◽  
Author(s):  
Fulgence Kaboré ◽  
Baly Ouattara ◽  
Stéphanie Wendlassida Joelle Tiendrébéogo ◽  
Mohamed Diomandé ◽  
Charles Sougué ◽  
...  
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Statistical Analysis ◽  
Sex Ratio ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Somatosensory Nervous System ◽  
Age Over 60

Abstract Background: Neuropathic pain is defined as pain caused by injury or disease of the somatosensory nervous system. Our purpose was to study the frequency of neuropathic pain among common lumboradiculalgia patients in subsaharian Africa patients. Methods: This was a bicentric cross-sectional study from February 2015 to 30 July 2015 in the first center and then from February 2017 to 30 July 2017 in the second center, i.e. a duration of 6 months for each study site. All patients with a common lomboradiculalgie were included. DN4 questionnaire was used for the diagnosis of neuropathic pain.Results : Four hundred and nine patients with common lumboradiculalgia were included. There were 278 females (67.97%) and 131 males (32.03%), for a sex ratio of 0.47. The average age was 51.75 ± 13.84 years with extremes of 16 and 88 years. One hundred and seventy-five patients ( 42.8%) had NP. Statistical analysis showed a statistically significant association between the existence of NP and age over 60 years and the existence of radiculalgia. Conclusions: Our study confirms the high frequency of neuropathic pain during common lumboradiculalgia. Age over 60 years and Poorly systematized radiculalgia were associated to NP.

Trigeminal Neuralgia

2018 ◽  
pp. 257-266
Author(s):  
Radhika Grandhe ◽  
Eli Johnson Harris ◽  
Eugene Koshkin
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Clinical Diagnosis ◽  
Facial Pain ◽  
Pharmacological Therapy ◽  
Surgical Decompression ◽  
Facial Movements ◽  
Classical Trigeminal Neuralgia ◽  
Neuropathic Pain Condition ◽  
Secondary Causes

Trigeminal neuralgia is a rare neuropathic pain condition but can be very disabling. The hallmark is brief episodes of intense, radiating pain within the territory of trigeminal nerve distribution. It is typically unilateral, often accompanied by facial spasms and can be triggered by facial movements in a majority of patients. Microvascular compression of trigeminal ganglion is the etiology for most patients with classical trigeminal neuralgia. Some patients can have continuous facial pain in addition to paroxysms of pain. Trigeminal neuralgia is a clinical diagnosis, but MRI is done to rule out secondary causes or to detect microvascular compression. Pharmacological therapy with first-line agents—carbamazepine or oxcarbazepine—is the preferred treatment. Patients with failed pharmacological therapy are considered for surgical decompression, ablation procedures, or Gamma Knife surgery.

The Diversity of Neuropathic Pain

2018 ◽  
pp. 658-678
Author(s):  
Nanna Brix Finnerup ◽  
Nadine Attal
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Recent Progress ◽  
Surgical Trauma ◽  
System Disease ◽  
Cord Injury ◽  
Current Classification ◽  
History Of ◽  
Somatosensory Nervous System ◽  
Pain Distribution

This article presents an update of the current classification, diagnosis, assessment, mechanisms, and treatment of neuropathic pain. Neuropathic pain, which is defined as pain associated with a lesion or disease of the somatosensory nervous system, may be caused by a variety of conditions, such as diabetic neuropathy, herpes zoster, surgical trauma, spinal cord injury, and stroke. The diagnostic criteria for neuropathic pain are a history of a nervous system disease or lesion and pain distribution and sensory signs in a neuroanatomically plausible distribution. The treatment of neuropathic pain is often multidisciplinary and involves specific drugs. Recent progress in the diagnosis, assessment, and understanding of its mechanisms offers the perspective of a more rational therapeutic management, which should result in better therapeutic outcome.

scholarly journals Neuropathic pain: mechanisms of development, principles of diagnostics and treatment

Pain medicine ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 4-32
Author(s):  
Dmytro Dmytriiev ◽  
Pylyp Prudius ◽  
Olesia Zaletskaya ◽  
Yevhen Lisak ◽  
Yurii Rudnitsky ◽  
...  
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Pain Syndrome ◽  
Diabetic Polyneuropathy ◽  
Pain Mechanisms ◽  
Peripheral Neuropathic Pain ◽  
Pain Pathways ◽  
Mechanisms Of Development ◽  
Somatosensory Nervous System ◽  
Cause Of Pain

Neuropathic pain is a pain caused by a disease or focal damage to the somatosensory nervous system. The prevalence of chronic pain with neuropathic features in different countries is estimated at 7–10 %. Damages to the nervous system can occur at the level of peripheral nerves, plexus and dorsal roots (peripheral neuropathic pain) or spinal cord and brain (central neuropathic pain). Neuropathic pain is based on pathological activation of pain pathways. Neuropathic pain occurs with diabetic polyneuropathy more often than with all polyneuropathies of another etiology. Hyperglycemia is the major cause of chronic diabetes mellitus and its progression. Since the cause of pain can rarely be cured, treatment is usually symptomatic. Neuropathic pain is generally poorly controlled by analgesics. NB management is started with conservative pharmacotherapy before applying invasive analgesia. Although there are many drugs that can be used in patients with DPN, monotherapy can not always stop pain syndrome. In addition, the patient may not tolerate the full therapeutic dose of the drug. All this dictates the need for combination therapy.

scholarly journals The Rehabilitation of Oncological Patients Presenting Neuropathies

2014 ◽  
Vol 87 (2) ◽  
pp. 67-72
Author(s):  
Elena Claudia Micu ◽  
Laszlo Irsay
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
International Association ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Morbidity Rate ◽  
Oncological Patients ◽  
Somatosensory Nervous System

The International Association for the Study of Pain (IASP 2011) defines neuropathic pain as “the pain caused by an injury or disease of the somatosensory portion of the nervous system”. The central neuropathic pain is defined as “the pain caused by an injury or disease of the central somatosensory central nervous system”, whereas the peripheral neuropathic pain is defined as “the pain caused by an injury or disease of the peripheral somatosensory nervous system”. The peripheral neuropathy describes any affection of the peripheral nervous system. The etiology is vast, there being a number of over 100 possible causes, which causes the global morbidity rate to reach approximately 2.4%. The chronic nature of the pain superposes the everyday routine and leads to the high intake of medication for pain alleviation. The number of cases of neuroplasia has always increased today. This disturbing diagnosis which can potentiate the signs and symptoms of peripheral neuropathy as well as reduce and limit the treatment options associated with neuropathies. The treatment presupposes a multidisciplinary approach, while the solution to prevent complications involves the control of risk factors and pathophysiological treatment.  Chemotherapy-induced peripheral neuropathy (CPIN) is a significant disabling symptom that is tightly connected to the administration of neurotoxic cytostatic agents used for the treatment of neoplasia. CPIN compromises the quality of life and produces pain or discomfort. I have sought to produce a presentation of the medicated and physical-kinetic treatment options that have proved their effectiveness during clinical studies or random trials and can be applied to cancer patients presenting with symptoms associated with peripheral neuropathy, namely with neuropathic pain, and support it with arguments

scholarly journals Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes

2022 ◽  
Vol 12 ◽  
Author(s):  
Michael K. Racke ◽  
Elliot M. Frohman ◽  
Teresa Frohman
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Disease Course ◽  
Central Neuropathic Pain ◽  
Muscular Pain ◽  
Clinical Vignettes ◽  
Pain Syndromes

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

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