Breakthrough pain in opioid-treated patients with neuropathic pain

2006 ◽  
Vol 2 (6) ◽  
pp. 347 ◽  
Author(s):  
Steve Simon, MD, RPh ◽  
Daniel S. Bennett, MD ◽  
Richard Rauck, MD ◽  
Donald Taylor, MD ◽  
Steven Shoemaker, MD
Keyword(s):  
Neuropathic Pain ◽  
Breakthrough Pain ◽  
Median Number ◽  
Rapid Onset ◽  
Maximum Intensity ◽  
Chronic Neuropathic Pain ◽  
Chronic Noncancer Pain ◽  
Study Population ◽  
Noncancer Pain ◽  
Pain Patients

Objective: This report aims to describe the prevalence and characteristics of breakthrough pain in patients with neuropathic pain.Methods: The study represents data from a subset of patients from a larger survey of 228 patients with chronic noncancer pain. Patients were identified from nine pain programs and were administered a telephone questionnaire. The study population comprised 45 chronic noncancer pain patients with primary neuropathic pain diagnoses who were being treated with opioids.Results: Pain had been present for a median of six years. Medications used for pain in addition to opioids included nonsteroidal anti-inflammatory agents (29 percent), antidepressants (60 percent), and anticonvulsants (53 percent). Thirty-five of the patients (78 percent) described a total of 42 distinct types of breakthrough pain. The median number of episodes per day was two; the median time to maximum intensity was 10 minutes, and the median duration of pain was 60 minutes. Patients could identify a precipitant for 62 percent of the pains, and 88 percent of the precipitants were activity related. The onset of breakthrough pain could not be predicted for 48 percent of the pains and could only sometimes be predicted for 29 percent of the pains.Conclusion: Breakthrough pain is common in opioidtreated patients with chronic neuropathic pain. Such pain often has a rapid onset and a relatively short duration, and it is frequently difficult to predict, similar to breakthrough pain in cancer patients.

Prevalence and Characteristics of Breakthrough Pain in Opioid-Treated Patients With Chronic Noncancer Pain

2006 ◽  
Vol 7 (8) ◽  
pp. 583-591 ◽  
Author(s):  
R PORTENOY ◽  
D BENNETT ◽  
R RAUCK ◽  
S SIMON ◽  
D TAYLOR ◽  
...  
Keyword(s):  
Breakthrough Pain ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

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

2021 ◽  
Author(s):  
Amokrane Chebini ◽  
Sina Marzoughi ◽  
Jason Randhawa ◽  
Daphne Guh ◽  
Stephen Wiseman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Prospective Trial ◽  
Pain Syndrome ◽  
Chronic Patients ◽  
Chronic Neuropathic Pain ◽  
Chronic Noncancer Pain ◽  
Ketamine Infusion ◽  
Pain Syndromes ◽  
Clinically Significant ◽  
Noncancer 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.

scholarly journals Efficacy and Practicality of Opioid Therapy in Japanese Chronic Noncancer Pain Patients

2019 ◽  
Vol 20 (3) ◽  
pp. 222-231 ◽  
Author(s):  
Yukari Shindo ◽  
Soushi Iwasaki ◽  
Michiaki Yamakage
Keyword(s):  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Pain Patients

scholarly journals Health care resource use and cost differences by opioid therapy type among chronic noncancer pain patients

2017 ◽  
Vol Volume 10 ◽  
pp. 1713-1722 ◽  
Author(s):  
Pamela Landsman-Blumberg ◽  
Nathaniel Katz ◽  
Kavita Gajria ◽  
Anna D’Souza ◽  
Sham L Chaudhari ◽  
...  
Keyword(s):  
Health Care ◽  
Resource Use ◽  
Opioid Therapy ◽  
Health Care Resource ◽  
Chronic Noncancer Pain ◽  
Health Care Resource Use ◽  
Noncancer Pain ◽  
Pain Patients ◽  
Cost Differences

The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities

2020 ◽  
Vol 21 (5) ◽  
pp. 390-402 ◽  
Author(s):  
Dixon H. Xu ◽  
Benjamin D. Cullen ◽  
Meng Tang ◽  
Yujiang Fang
Keyword(s):  
Neuropathic Pain ◽  
Placebo Group ◽  
Peripheral Neuropathy ◽  
Symptomatic Relief ◽  
Symptom Relief ◽  
Treatment Algorithm ◽  
Pain Scale ◽  
Current Treatment ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

Background: Peripheral neuropathy can significantly impact the quality of life for those who are affected, as therapies from the current treatment algorithm often fail to deliver adequate symptom relief. There has, however, been an increasing body of evidence for the use of cannabinoids in the treatment of chronic, noncancer pain. The efficacy of a topically delivered cannabidiol (CBD) oil in the management of neuropathic pain was examined in this four-week, randomized and placebocontrolled trial. Methods: In total, 29 patients with symptomatic peripheral neuropathy were recruited and enrolled. 15 patients were randomized to the CBD group with the treatment product containing 250 mg CBD/3 fl. oz, and 14 patients were randomized to the placebo group. After four weeks, the placebo group was allowed to crossover into the treatment group. The Neuropathic Pain Scale (NPS) was administered biweekly to assess the mean change from baseline to the end of the treatment period. Results: The study population included 62.1% males and 37.9% females with a mean age of 68 years. There was a statistically significant reduction in intense pain, sharp pain, cold and itchy sensations in the CBD group when compared to the placebo group. No adverse events were reported in this study. Conclusions: Our findings demonstrate that the transdermal application of CBD oil can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy. The treatment product was well tolerated and may provide a more effective alternative compared to other current therapies in the treatment of peripheral neuropathy.

Assessing Cognitive and Psychomotor Performance Under Long-Term Treatment with Transdermal Buprenorphine in Chronic Noncancer Pain Patients

2007 ◽  
Vol 105 (5) ◽  
pp. 1442-1448 ◽  
Author(s):  
Oguzhan Dagtekin ◽  
Hans J. Gerbershagen ◽  
Werner Wagner ◽  
Frank Petzke ◽  
Lukas Radbruch ◽  
...  
Keyword(s):  
Psychomotor Performance ◽  
Term Treatment ◽  
Chronic Noncancer Pain ◽  
Long Term Treatment ◽  
Noncancer Pain ◽  
Pain Patients

Cathepsin S is increased in cerebrospinal fluid from patients with neuropathic pain—A support of the microglia hypothesis in humans

2014 ◽  
Vol 5 (3) ◽  
pp. 208-209
Author(s):  
Torsten Gordh ◽  
Anne-Li Lind ◽  
Constantin Bodolea ◽  
Ellen Hewitt ◽  
Anders Larsson
Keyword(s):  
Cerebrospinal Fluid ◽  
Neuropathic Pain ◽  
Microglial Activation ◽  
Animal Experiments ◽  
Cathepsin S ◽  
Control Group ◽  
Chronic Neuropathic Pain ◽  
Potential Biomarker ◽  
New Treatment ◽  
Pain Patients

AbstractAimsCathepsin S has been reported to be a biomarker of spinal microglial activation, a process suggested to be involved in the pathophysiology of chronic neuropathic pain. So far this has been shown only in animal experiments. The aim of this study was to investigate the concentrations of cathepsin S in human cerebrospinal fluid (CSF) samples from a well-defined patient cohort suffering from neuropathic pain as compared to controls.MethodsCSF samples from patients suffering from chronic neuropathic pain (n = 14) were analyzed for cathepsin S levels using commercial sandwich ELISAs (DY1183, R&D Systems, Minneapolis, MN, USA). Control CSF was sampled from patients undergoing minor urological surgical procedures under spinal anaesthesia (n = 70), having no obvious pain suffering.ResultsThe neuropathic pain group had significantly higher levels of CSF cathepsin S (median 15189 pg/mL, range 3213–40,040), than the control group (median 5911 pg/mL, range 1909–17,188) (p < 0.005, Mann–Whitney U-test).ConclusionThe results support the existence of microglial activation in chronic neuropathic pain patients. CSF Cathepsin S may serve as a potential biomarker for this specific mechanism linked to neuropathic pain. In the future, Cathepsin S inhibiting drugs might become a new treatment alternative for neurophatic pain.

Tramadol Use and Dependence in Chronic Noncancer Pain Patients

2004 ◽  
Vol 37 (4) ◽  
pp. 191-192 ◽  
Author(s):  
M. Soyka ◽  
M. Backmund ◽  
S. Hasemann
Keyword(s):  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Pain Patients

Cerebrospinal fluid levels of substance P (SP) N-terminal fragment SP1–7 in patients with neuropathic pain

2015 ◽  
Vol 8 (1) ◽  
pp. 51-51
Author(s):  
A. Jonsson ◽  
A.-L. Lind ◽  
M. Hallberg ◽  
F. Nyberg ◽  
T. Gordh
Keyword(s):  
Cerebrospinal Fluid ◽  
Neuropathic Pain ◽  
Substance P ◽  
Chronic Neuropathic Pain ◽  
Painful Condition ◽  
Mechanical Hypersensitivity ◽  
Terminal Fragment ◽  
Minor Surgery ◽  
Fluid Levels ◽  
Pain Patients

Abstract Aims Neuropathic pain is a complex and painful condition, which is difficult to treat and causes a lot of suffering. The substance P (SP) system is well known to be involved in nociceptive signaling and it has previously been shown that the cerebrospinal fluid (CSF) level of SP is decreased in neuropathic pain. In this study we analyzed CSF from chronic neuropathic pain patients for the levels of SP1–7, an N-terminal fragment of SP with the ability to alleviate thermal as well as mechanical hypersensitivity in different animal models of chronic neuropathic pain, e.g. [1,2]. Methods CSF was collected from 11 neuropathic pain patients, treated with SCS, who had refrained from using their spinal cord stimulator for 48h. Control CSF was collected from 11 patients without any known neurological disorder, who underwent minor surgery under spinal anesthesia. The CSF samples were analyzed for the levels of SP1–7 using radioimmunoassay. Results The results revealed a decrease in the level of SP1–7 compared to controls. We believe that the lower level ofSP1–7 most likely is a consequence of reduced amount of its precursor SP in the neuropathic pain patients. Conclusions Our results indicate that the SP system is changed in patients with neuropathic pain and that SP-related peptides, including SP1–7, might serve as biological markers for the patho-physiology of chronic neuropathic pain.

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