Rationalized Approach for The Treatment of Neuropathic Pain

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.

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

International Journal of Molecular Sciences ◽

10.3390/ijms21155330 ◽

2020 ◽

Vol 21 (15) ◽

pp. 5330 ◽

Cited By ~ 2

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.

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

10.21203/rs.3.rs-27534/v1 ◽

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.

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The Diversity of Neuropathic Pain

The Oxford Handbook of the Neurobiology of Pain ◽

10.1093/oxfordhb/9780190860509.013.22 ◽

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.

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

Pain medicine ◽

10.31636/pmjua.v4i2.1 ◽

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.

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The Rehabilitation of Oncological Patients Presenting Neuropathies

Medicine and Pharmacy Reports ◽

10.15386/cjmed-278 ◽

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

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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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Case Report: Scrambler Therapy for Treatment-Resistant Central Neuropathic Pain in a Patient with Transverse Myelitis

International Journal of MS Care ◽

10.7224/1537-2073.2017-083 ◽

2019 ◽

Vol 21 (2) ◽

pp. 76-80 ◽

Cited By ~ 3

Author(s):

Maureen A. Mealy ◽

Scott D. Newsome ◽

Sharon L. Kozachik ◽

Michael Levy ◽

Thomas J. Smith

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Neuropathic Pain ◽

Peripheral Neuropathy ◽

Transverse Myelitis ◽

Central Neuropathic Pain ◽

The Central Nervous System ◽

Scrambler Therapy ◽

Multiple Drugs ◽

Favorable Safety

Abstract Central neuropathic pain is a severely disabling consequence of conditions that cause tissue damage in the central nervous system. It is often refractory to treatments commonly used for peripheral neuropathy. Scrambler therapy is an emerging noninvasive pain-modifying technique that uses transcutaneous electrical stimulation of nociceptive fibers with the intent of reorganizing maladaptive signaling pathways. It has been examined for the treatment of peripheral neuropathy with favorable safety and efficacy outcomes, but its application to central neuropathic pain has not been reported in transverse myelitis. We describe the use of Scrambler therapy in a patient with persistent central neuropathic pain due to transverse myelitis. The patient had tried multiple drugs for treatment of the pain, but they were not effective or caused adverse effects. After a course of Scrambler therapy, pain scores improved considerably more than what was reported with previous pharmacologic and nonpharmacologic interventions. This case supports further investigation of Scrambler therapy in multiple sclerosis, neuromyelitis optica spectrum disorder, and other immune-mediated disorders that damage the central nervous system.

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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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Neuropathic pain in children

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0021 ◽

2013 ◽

pp. 205-214 ◽

Cited By ~ 1

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.

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