scholarly journals Intravenous Therapies in the Management of Neuropathic Pain: A Review on the Use of Ketamine and Lidocaine in Chronic Pain Management

10.5772/36882 ◽  
2012 ◽  
Author(s):  
Harsha Shanthanna
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Chronic Pain Management

Understanding transdermal buprenorphine and a practical guide to its use for chronic cancer and non-cancer pain management

2019 ◽  
Vol 15 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Tony O’Brien, MB, FRCPI ◽  
Jin Seok Ahn, MD ◽  
Richard Chye, MBBS, FRACP, FFPMANZCA, FAChPM ◽  
Brian Le, MBBS (Hons), MPH, FRACP, FAChPM ◽  
Henry Lu, MD, DABPN, DPBPM ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Chronic Pain Management ◽  
Cancer Pain Management ◽  
Appropriate Use ◽  
Chronic Pain Conditions ◽  
Favorable Safety ◽  
Practical Recommendations

Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of action, and safety of buprenorphine. There is also limited guidance on the appropriate use of TDB for chronic pain management. This article presents an overview of TDB and also provides practical recommendations for its use as part of a multifaceted strategy in chronic cancer and non-cancer pain.

scholarly journals Gabapentinoids for treatment of neuropathic pain: a medicines usage evaluation at the Groote Schuur Hospital Chronic Pain Management Clinic

2019 ◽  
pp. 21-28 ◽  
Author(s):  
MLA Moabelo ◽  
R Parker
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Somatosensory System ◽  
Tricyclic Antidepressant ◽  
Screening Tools ◽  
Chronic Pain Management ◽  
Cross Sectional ◽  
Chronic Postsurgical Pain ◽  
Usage Evaluation

Background: Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9–10% of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods: A cross-sectional, retrospective, descriptive medicines usage evaluation (MUE) of pregabalin at Groote Schuur Hospital (GSH) Chronic Pain Management Clinic for the year 2017 was conducted. A MUE using a standardised data collection form was performed on 100 randomly selected patient folders. Data was summarised using descriptive statistics. Results: The majority of cases were women (76) with a mean age of 55.9 years (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic postsurgical pain with a neuropathic component (n = 16), followed by NP (n = 15). The most common initiating and current dose of pregabalin was 75 mg twice daily. In 56 patients, pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions: Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of pregabalin. The use of a standardised assessment document and the interdisciplinary team input at this clinic appears to optimise prescribing of pregabalin in line with practice guidelines.

Mexiletine Usage in a Chronic Pain Clinic: Indications, Tolerability, and Side Effects

2018 ◽  
Vol 1 (21;1) ◽  
pp. E573-E579 ◽  
Author(s):  
Adam Romman
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Cohort Study ◽  
Pain Management ◽  
Side Effects ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Diagnosis ◽  
Pain Clinic ◽  
Chronic Pain Management

Background: Background: Intravenous lidocaine has multiple applications in the management of acute and chronic pain. Mexiletine, an oral lidocaine analogue, has been used in a number of chronic pain conditions although its use is not well characterized. Objectives: To report our experience using mexiletine in a chronic pain population, specifically looking at tolerability, side effects, and EKG changes. Study Design: Retrospective, cohort study. Setting: Multiple pain clinic locations in an integrated multispecialty health system. Methods: All patients who had a mexiletine prescription between August 2015 and August 2016 were queried via the electronic medical record. Each chart was examined for demographics, QTc changes on EKG, length of use, and reasons for stoppage. Results:There were 74 total patients identified in the chronic pain management clinics as receiving at least 1 mexiletine prescription over the 1-year time period. Twice as many women as men received mexiletine prescriptions. Neuropathic pain was the most common primary diagnosis (64%) which included diabetic neuropathy, radiculopathy, and others. Fibromyalgia was the next most common primary diagnosis (28%). A QTc change on the EKG showed a mean decrease of 0.1 ms and median increase of 1.5 ms. At 6 months (180 days), approximately 30% of the patients remained on mexiletine therapy, and 28% remained on the therapy at 1 year (360 days). Median duration of use was 60 days and the mean was 288 days. Neurologic and gastrointestinal side effects were the most commons reason for stoppage. All side effects were mild and resolved with stoppage. After side effects, lack of response, or loss of efficacy, were the next most common reasons for stoppage. Limitations: Pain relief and outcomes were not specifically examined due to confounding factors including interventional treatments and multiple treatment modalities. This was a retrospective, cohort study limited to our specific clinic population with a relatively high loss to follow-up rate. Conclusion:Mexiletine is rarely a first line option for chronic pain management and is often used when multiple other modalities have failed. By reporting our experience, we hope other clinicians may have more familiarity with the drug’s use in a chronic pain practice. It appears reasonably tolerable, may not require frequent EKG monitoring, and can be an appropriate adjunct in the chronic pain population. More research is needed regarding efficacy and dose titration for mexiletine in chronic pain. Key Words: Chronic pain, mexiletine, IV lidocaine, pain, neuropathic pain, neuropathy, fibromyalgia, QTc, tolerability

scholarly journals P.153 Profiles and Outcomes of Workers’ Compensation Patients Undergoing Spinal Cord Stimulation for Persistent Post Surgical Pain

2021 ◽  
Vol 48 (s3) ◽  
pp. S63-S64
Author(s):  
V Varshney ◽  
R Sahjpaul ◽  
J Osborn
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Workers Compensation ◽  
Low Back ◽  
Chronic Pain Management ◽  
Surgical Pain

Background: The challenges of chronic pain management, and resulting poorer outcomes, in workers’ compensation (WCB) patients has been well established. Spinal cord stimulation (SCS) has been used for the management of low back and radicular neuropathic pain with varying effectiveness and it’s efficacy in the WCB population has been challenged. We sought to examine our experience using SCS in WCB compared to non WCB patients. Methods: A retrospective analysis of 71 WCB patients assessed and treated at the St Pauls Hospital neuromodulation program between 2016-2021 was performed. This group was compared to a cohort on non WCB patients in terms of the likelhood of being offered a trial, proceeding with trial if offered, and the likelhood of a successful trial proceeding to implant. Results: Compared to non WCB, the WCB patients were more likely to be offered a trial (86% vs 77%) and more likely to proceed with a trial if offered (82% vs 71%). Trial to implant ratios were similar in both WCB and non WCB patients (78% vs 77%). Conclusions: WCB patients were more likely to be offered a SCS trial and more likely to accept if offered, compared to non-WCB patients. However, both groups were similar in trial to implant probability.

scholarly journals Stem Cell Therapy for Chronic Pain Management: Review of Uses, Advances, and Adverse Effects

2017 ◽  
Vol 4 (20;4) ◽  
pp. 293-305 ◽  
Author(s):  
Krishnan Chakravarthy
Keyword(s):  
Stem Cells ◽  
Chronic Pain ◽  
Clinical Trials ◽  
Neuropathic Pain ◽  
Stem Cell ◽  
Pain Management ◽  
Cell Therapy ◽  
Treatment Modalities ◽  
Chronic Pain Management ◽  
Cell Based Therapy

Background: This review article outlines the recent advances, uses, and adverse effects of cell-based therapy for chronic pain management. Cell based therapies are gaining increasing ground as novel treatment modalities for a variety of pain pathologies that include, but are not limited to, neuropathic pain and degenerative disc disease. As these treatment modalities become more common practice, we have focused our review to provide pain practitioners and other practicing physicians an understanding of the technology and to summarize key clinical data and existing clinical trials that are being pursued by clinical investigators worldwide. Objective: Review of stem cell technology and applications in pain management. Study Design: Narrative review. Methods: The Pubmed NCBI and EMBASE databases was utilized to review published reports of clinical studies reported from 2000 to 2015, and ClinicalTrials.gov (www. clinicaltrials.gov/ct2/search) search function was used to document ongoing clinical trials [keywords: “chronic pain,” “disc pain,” “cell therapy,” “osteoarthritis,” “neuropathic,” “stem cell”] currently active and recruiting patients. Results: Articles were screened by title, abstract, and full article review. They were then analyzed by specific clinical indications and appropriate data were presented based on critical analysis of those articles. Limitations: More studies looking at the systematic use of stem cells in pain management will be required to draw conclusions about the benefits of the technology. Conclusion: Though the data from existing studies look promising for the use of stem cells as a novel therapeutic strategy for discogenic pain, neuropathic pain, and osteoarthritis, additional clinical studies will be needed to validate the benefit of the technology for clinical use. However, we hope that this narrative review will help guide pain physicians in making informed decisions for their patients about the potential of cell-based therapy for treating chronic pain conditions. Key words: Stem cell therapy, chronic pain, clinical trials, disc pain, neuropathic pain, mesenchymal stem cells, osteoarthritis, pain management

scholarly journals Focused Ultrasound (FUS) for Chronic Pain Management: Approved and Potential Applications

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Lazzaro di Biase ◽  
Emma Falato ◽  
Maria Letizia Caminiti ◽  
Pasquale Maria Pecoraro ◽  
Flavia Narducci ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Focused Ultrasound ◽  
Biological Effects ◽  
System Level ◽  
Tissue Ablation ◽  
Chronic Pain Management ◽  
Chronic Neuropathic Pain ◽  
Potential Applications

Chronic pain is one of the leading causes of disability and disease burden worldwide, accounting for a prevalence between 6.9% and 10% in the general population. Pharmacotherapy alone results ineffective in about 70-60% of patients in terms of a satisfactory degree of pain relief. Focused ultrasound is a promising tool for chronic pain management, being approved for thalamotomy in chronic neuropathic pain and for bone metastases-related pain treatment. FUS is a noninvasive technique for neuromodulation and for tissue ablation that can be applied to several tissues. Transcranial FUS (tFUS) can lead to opposite biological effects, depending on stimulation parameters: from reversible neural activity facilitation or suppression (low-intensity, low-frequency ultrasound, LILFUS) to irreversible tissue ablation (high-intensity focused ultrasounds, HIFU). HIFU is approved for thalamotomy in neuropathic pain at the central nervous system level and for the treatment of facet joint osteoarthritis at the peripheral level. Potential applications include HIFU at the spinal cord level for selected cases of refractory chronic neuropathic pain, knee osteoarthritis, sacroiliac joint disease, intervertebral disc nucleolysis, phantom limb, and ablation of peripheral nerves. FUS at nonablative dosage, LILFUS, has potential reversible and tissue-selective effects. FUS applications at nonablative doses currently are at a research stage. The main potential applications include targeted drug and gene delivery through the Blood-Brain Barrier, assessment of pain thresholds and study of pain, and reversible peripheral nerve conduction block. The aim of the present review is to describe the approved and potential applications of the focused ultrasound technology in the field of chronic pain management.

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