Opioids as a Treatment Option for MS Patients with Chronic Pain

2005 ◽  
Vol 7 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Anthony H. Guarino ◽  
Martha Cornell
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Treatment Option ◽  
Opioid Therapy ◽  
Term Therapy ◽  
Drug Category ◽  
Pain Syndromes ◽  
Long Term Therapy ◽  
Addictive Potential

Neuropathic and nociceptive pain are commonly observed in patients with MS. Among the analgesic options available for treating pain in MS, opioids may be too often avoided because of concerns about prescribing restrictions and addictive potential. However, when these fears are misplaced, they deny the patient of a powerful and potentially effective pain reduction option. Proper screening and management can help select appropriate patients for opioid therapy and maintain patients on long-term therapy while monitoring for signs of behaviors such as addiction or diversion. One such method involves entering into a “contract” with the patient with guidelines for renewing prescriptions. Although the literature contains few studies on opioids specific to MS patients, a number of studies support the use of this drug category in patients experiencing neuropathic pain syndromes.

scholarly journals Deep brain stimulation for the treatment of various chronic pain syndromes

2006 ◽  
Vol 21 (6) ◽  
pp. 1-8 ◽  
Author(s):  
Dirk Rasche ◽  
Patricia C. Rinaldi ◽  
Ronald F. Young ◽  
Volker M. Tronnier
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Long Term Results ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes ◽  
Deep Brain

Object Electrical intracerebral stimulation (also referred to as deep brain stimulation [DBS]) is a tool for the treatment of chronic pain states that do not respond to less invasive or conservative treatment options. Careful patient selection, accurate target localization, and identification with intraoperative neurophysiological techniques and blinded test evaluation are the key requirements for success and good long-term results. The authors present their experience with DBS for the treatment of various chronic pain syndromes. Methods In this study 56 patients with different forms of neuropathic and mixed nociceptive/neuropathic pain syndromes were treated with DBS according to a rigorous protocol. The postoperative follow-up duration ranged from 1 to 8 years, with a mean of 3.5 years. Electrodes were implanted in the somatosensory thalamus and the periventricular gray region. Before implantation of the stimulation device, a double-blinded evaluation was carefully performed to test the effect of each electrode on its own as well as combined stimulation with different parameter settings. The best long-term results were attained in patients with chronic low-back and leg pain, for example, in so-called failed–back surgery syndrome. Patients with neuropathic pain of peripheral origin (such as complex regional pain syndrome Type II) also responded well to DBS. Disappointing results were documented in patients with central pain syndromes, such as pain due to spinal cord injury and poststroke pain. Possible reasons for the therapeutic failures are discussed; these include central reorganization and neuroplastic changes of the pain-transmitting pathways and pain modulation centers after brain and spinal cord lesions. Conclusions The authors found that, in carefully selected patients with chronic pain syndromes, DBS can be helpful and can add to the quality of life.

scholarly journals Safety and tolerability of high doses of intrathecal fentanyl for the treatment of chronic pain

2006 ◽  
Vol 2 (6) ◽  
pp. 365 ◽  
Author(s):  
Sulane Do Ouro, MD ◽  
Santiago Esteban, BS ◽  
Una Sibirceva, MD ◽  
Beverly Whittenberg, MD ◽  
Russell Portenoy, MD ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Dose Escalation ◽  
Scope Of Practice ◽  
Dose Titration ◽  
Term Therapy ◽  
High Dose ◽  
High Doses ◽  
Long Term Therapy

Fentanyl is commonly used systemically or neuraxially for the management of chronic pain. It can be administered intrathecally via implanted pump, but it is generally considered only after trials of intrathecal (IT) morphine and hydromorphone have proven ineffective. Published experience with IT fentanyl is limited, and long-term therapy at relatively high doses has not been described previously. We describe four patients who were treated with IT fentanyl after other analgesic approaches had failed and who gradually underwent dose escalation to levels as high as 20 times those previously reported. Safety and tolerability were maintained during dose titration. Our experience highlights an expanding scope of practice in the use of IT opioids in general and fentanyl specifically and suggests that high-dose fentanyl can be used safely in highly selected patients.

scholarly journals A Virus-Like Particle-Based Anti-Nerve Growth Factor Vaccine Reduces Inflammatory Hyperalgesia: Potential Long-Term Therapy for Chronic Pain

2010 ◽  
Vol 186 (3) ◽  
pp. 1769-1780 ◽  
Author(s):  
Till A. Röhn ◽  
William T. Ralvenius ◽  
Jolly Paul ◽  
Petra Borter ◽  
Marcela Hernandez ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Nerve Growth Factor ◽  
Growth Factor ◽  
Term Therapy ◽  
Inflammatory Hyperalgesia ◽  
Nerve Growth ◽  
Virus Like Particle ◽  
Long Term Therapy

Antithrombotic Therapy for DVT/PE

1997 ◽  
Vol 17 (03) ◽  
pp. 161-162
Author(s):  
Thomas Hyers
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Therapeutic Agents ◽  
Great Promise ◽  
Term Therapy ◽  
Low Molecular Weight ◽  
Long Term Therapy

SummaryProblems with unfractionated heparin as an antithrombotic have led to the development of new therapeutic agents. Of these, low molecular weight heparin shows great promise and has led to out-patient therapy of DVT/PE in selected patients. Oral anticoagulants remain the choice for long-term therapy. More cost-effective ways to give oral anticoagulants are needed.

Office-based post-marketing surveillance study on the influence of long term therapy with aripiprazole in patients with schizophrenia

2007 ◽  
Vol 40 (05) ◽  
Author(s):  
M Kungel ◽  
A Engelhardt ◽  
T Spevakné-Göröcs ◽  
M Ebrecht ◽  
C Werner ◽  
...  
Keyword(s):  
Surveillance Study ◽  
Term Therapy ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
Long Term Therapy

scholarly journals The Safety and Effect of Local Botulinumtoxin A Injections for Long-Term Management of Chronic Pain in Post-Herpetic Neuralgia: Literature Review and Cases Report Treated with Incobotulinumtoxin A

2021 ◽  
Vol 11 (8) ◽  
pp. 758
Author(s):  
Songjin Ri ◽  
Anatol Kivi ◽  
Jörg Wissel
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Adverse Events ◽  
Case Reports ◽  
Pain Reduction ◽  
Post Herpetic Neuralgia ◽  
Botulinumtoxin A ◽  
Incobotulinumtoxin A ◽  
Term Management

There are few reports on the safety and effectiveness of long-term botulinumtoxin A (BoNT A) therapy in severe chronic pain of post-herpetic neuralgia (PHN). The literature was searched with the term “neuropathic pain” and “botulinum” on PubMed (up to 29 February 2020). Pain was assessed with the Visual Analogue Scale (VAS) before and after BoNT A therapy. A total of 10 clinical trials and six case reports including 251 patients with PHN were presented. They showed that BoNT A therapy had significant pain reduction (up to 30–50%) and improvement in quality of life. The effect duration seems to be correlated with BoNT A doses injected per injection site. Intervals between BoNT A injections were 10–14 weeks. No adverse events were reported in cases and clinical studies, even in the two pregnant women, whose babies were healthy. The repeated (≥6 times) intra/subcutaneous injections of incobotulinumtoxin A (Xeomin®, Merz Pharmaceuticals, Germany) over the two years of our three cases showed marked pain reduction and no adverse events. Adjunctive local BoNT A injection is a promising option for severe PHN, as a safe and effective therapy in long-term management for chronic neuropathic pain. Its effect size and -duration seem to be depended on the dose of BoNT A injected per each point.

Sign in / Sign up

Export Citation Format

Share Document