scholarly journals Ketamine for Non-Neuropathic Pain

2021 ◽  
Author(s):  
Subbulakshmi Sundaram ◽  
Ashok Swaminathan Govindarajan
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
Antinociceptive Effect ◽  
Pain Syndrome ◽  
Well Being ◽  
Pain Mechanisms ◽  
Cardiovascular Side Effects ◽  
Chronic Pain Conditions ◽  
Rescue Agent

Chronic pain is one of the leading causes of years lost to disability, as most of the time it is refractory to conventional treatment. Recent advances in understanding the pain mechanisms have favored the use of ketamine as a rescue agent in refractory chronic pain conditions, as it has potential modulating effect on both sensory-discriminative and affective motivational components of pain. Preclinical studies also suggested the antinociceptive effect of sub anesthetic dose of ketamine against central and peripheral neuropathic pain conditions and non-neuropathic pain conditions such as inflammatory and nociceptive pain states. Subanesthetic infusion of ketamine along with adjuvants such as midazolam and clonidine is found to reduce the psychomimetic and cardiovascular side effects of ketamine. Even though the consensus guidelines for intravenous use of ketamine for chronic pain advocate the use of ketamine only for complex regional pain syndrome, various other clinical studies suggested its role in other refractory painful conditions. Hence the present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc. Many studies had shown that ketamine not only reduces the pain scores but also the analgesic medications, which further improves the well-being and quality of life.

Ketamine Infusions for Complex Regional Pain Syndrome

2016 ◽  
Author(s):  
Roy K. Esaki
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Hepatic Dysfunction ◽  
Case Reports ◽  
Pain Syndrome ◽  
Nmda Receptor Antagonist ◽  
Treatment Resistant ◽  
Urinary Tract Symptoms ◽  
Chronic Pain Conditions ◽  
Lower Urinary

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction. 

Neuropathic pain in patients with haemophilia, that is the question

2015 ◽  
Vol 35 (S 01) ◽  
pp. S5-S9 ◽  
Author(s):  
S. Krüger ◽  
T. Hilberg
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Pain Management ◽  
Pain Mechanisms ◽  
Number Of Patients ◽  
Paindetect Questionnaire ◽  
Chronic Disorders ◽  
Chronic Pain Conditions

SummaryChronic pain caused by recurrent joint bleedings affects a large number of patients with haemophilia (PwH). The basis of this pain, nociceptive or neuropathic, has not been investigated so far. In other pain-related chronic disorders such as osteoarthritis or rheumatoid arthritis, initial studies showed nociceptive but also neuropathic pain features. 137 PwH and 33 controls (C) completed the painDETECT-questionnaire (pDq), which identifies neuropathic components in a person´s pain profile. Based on the pDq results, a neuropathic pain component is classified as positive, negative or unclear. A positive neuropathic pain component was found in nine PwH, but not in C. In 20 PwH an unclear pDq result was observed. In comparison to C the allocation of pDq results is statistically significant (p≤0.001). Despite various pDq results in PwH and C a similar appraisal pain quality, but on a different level, was determined. Summarising the results, there is a potential risk to misunderstand underlying pain mechanisms in PwH. In chronic pain conditions based on haemophilic arthopathy, a differential diagnosis seems to be unalterable for comprehensive and individualised pain management in PwH.

scholarly journals Spinal NGF Restores Opioid Sensitivity in Neuropathic Rats: Possible Role of NGF as a Regulator of CCK-Induced Anti-Opioid Effects

2000 ◽  
Vol 5 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Catherine M Cahill ◽  
Terence J Coderre
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Nerve Injury ◽  
Postnatal Period ◽  
Spontaneous Pain ◽  
Pain Mechanisms ◽  
Nociceptive Neurons ◽  
Nociceptive Transmission ◽  
Chronic Pain Conditions ◽  
Injury Models

The breadth of peripheral effects produced by nerve growth factor (NGF) in nociceptive processing has been well documented. However, less is known about the functional significance of central NGF in nociceptive transmission. The effect of NGF on the nervous system is dependent on the developmental stage. During the prenatal developmental period, NGF is critical for survival of nociceptors; in the postnatal period it regulates the expression of nociceptor phenotype, and in the adult it contributes to pain following an inflammatory insult. The implications for central NGF in the expression and regulation of spinal neuropeptides that are involved in pain mechanisms are reviewed. Knowledge has been gained by studies using peripheral nerve injury models that cause a deprivation of central NGF. These models also give rise to the development of pain syndromes, which encompass spontaneous pain, hyperalgesia and allodynia, routinely referred to as neuropathic pain. These models provide an approach for examining the contribution of central NGF to nociceptive transmission. Chronic pain emanating from a nerve injury is typically refractory to traditional analgesics such as opioids. Recent evidence suggests that supplementation of spinal NGF restores morphine-induced antinociception in an animal model of neuropathic pain. This effect appears to be mediated by alterations in spinal levels of cholecystokinin. The authors hypothesize that NGF is critical in maintaining neurochemical homeostasis in the spinal cord of nociceptive neurons, and that supplementation may be beneficial in restoring and/or maintaining opioid analgesia in chronic pain conditions resulting from traumatic nerve injury.

Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS)

2017 ◽  
Vol 15 (1) ◽  
pp. 104-105 ◽  
Author(s):  
Harald Breivik ◽  
Stephen Butler
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Muscle Pain ◽  
Scandinavian Journal ◽  
Young Patients ◽  
Pain Syndrome ◽  
Rehabilitation Team ◽  
Multidisciplinary Rehabilitation ◽  
Chronic Pain Conditions ◽  
Depth Interviews

AbstractIn this issue of the Scandinavian Journal of Pain Kari Sørensen and Bjørg Christiansen publish their report on in depth interviews of young patients suffering from CRPS or from severe muscle pain [1]. These patients were recovering from their chronic pain conditions after treatment by a multidisciplinary rehabilitation team.

Chronic postsurgical pain and complex regional pain syndrome

2021 ◽  
pp. 289-291
Author(s):  
Lesley A. Colvin ◽  
Sebastian Bourn
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
International Association ◽  
Emotional Experience ◽  
Adult Population ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. Acute pain is predictable following surgical intervention; chronic pain is less so. Chronic pain, persisting for longer than 3 months, or beyond expected wound healing, is a worldwide problem affecting around 20% of the adult population. Chronic postsurgical pain is multifactorial, although it often involves some form of nerve damage, with clinical signs consistent with this. Neuropathic pain may have a greater impact on quality of life than other chronic pain syndromes. It is important, therefore, to identify neuropathic pain as early as possible, in order to initiate appropriate management and reduce longer-term impact. This chapter focuses on two types of neuropathic pain: chronic postsurgical pain and complex regional pain syndrome.

Classification of Neuropathic Pain

2018 ◽  
pp. 11-16
Author(s):  
Abdullah Kandil ◽  
Danielle Perret
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Phantom Limb ◽  
Charcot Marie Tooth Disease ◽  
Amputation Stump ◽  
Stump Pain ◽  
Chronic Pain Conditions

Neuropathic pain encompasses a category of chronic pain conditions that are caused by disease or lesion of the somatosensory nervous system. Depending on the location of the lesion or disease, neuropathic pain can be categorized as peripheral, central, or mixed. Peripheral neuropathic pain includes such common pain conditions as painful diabetic neuropathy, postherpetic neuralgia, radiculopathies, post-amputation stump pain, various nerve entrapment syndromes, and neuropathies due to immune, hereditary, metabolic, and toxic factors. Central neuropathic pain is pain caused by stroke, spinal cord injury, spinal infarction, syringomyelia, multiple sclerosis, Parkinson disease, and phantom limb pain. In contrast, some conditions may cause pain through both central and peripheral mechanisms, such spinal stenosis, complex regional pain syndrome type II, Charcot-Marie-Tooth disease, fibromyalgia, and cancer pain. Classification of neuropathic may not only help guide the diagnosis and treatment of these chronic pain conditions but may also provide the framework for research of the mechanisms of generation of neuropathic pain.

scholarly journals Neuropsychological Changes in Complex Regional Pain Syndrome (CRPS)

2020 ◽  
Vol 2020 ◽  
pp. 1-30 ◽  
Author(s):  
Monika Halicka ◽  
Axel D. Vittersø ◽  
Michael J. Proulx ◽  
Janet H. Bultitude
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Cognitive Functions ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Body Representation ◽  
Neuropsychological Changes ◽  
Neuropsychological Functions ◽  
Higher Cognitive Functions ◽  
Chronic Pain Conditions

Complex Regional Pain Syndrome (CRPS) is a poorly understood chronic pain condition of multifactorial origin. CRPS involves sensory, motor, and autonomic symptoms primarily affecting one extremity. Patients can also present with neuropsychological changes such as reduced attention to the CRPS-affected extremity, reminiscent of hemispatial neglect, yet in the absence of any brain lesions. However, this “neglect-like” framework is not sufficient to characterise the range of higher cognitive functions that can be altered in CRPS. This comprehensive literature review synthesises evidence of neuropsychological changes in CRPS in the context of potential central mechanisms of the disorder. The affected neuropsychological functions constitute three distinct but not independent groups: distorted body representation, deficits in lateralised spatial cognition, and impairment of non-spatially-lateralised higher cognitive functions. We suggest that many of these symptoms appear to be consistent with a broader disruption to parietal function beyond merely what could be considered “neglect-like.” Moreover, the extent of neuropsychological symptoms might be related to the clinical signs of CRPS, and rehabilitation methods that target the neuropsychological changes can improve clinical outcomes in CRPS and other chronic pain conditions. Based on the limitations and gaps in the reviewed literature, we provide several suggestions to improve further research on neuropsychological changes in chronic pain.

Chronic pain syndromes

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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