Pain management
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SUMMARY Pregabalin is the only US FDA-approved drug to date for neuropathic pain in spinal cord injured patients. Pregabalin is a novel GABA analog whose primary mechanism of action involves binding at the α2-δ subunit of voltage-sensitive calcium channels. Efficacy is noted within the first several days of administration. ⋯ Dosing can be increased gradually to a recommended maximum of 600 mg per day in divided dosing. Adverse events include somnolence, dizziness and dry mouth, and typically manifest within the first 2 weeks of treatment. Pregabalin is generally safe to use in combination with other pain medications or antidepressants, but safety in pregnant patients has not been established.
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SUMMARY The treatment of chronic pelvic pain in both females and males is a challenge for pain clinicians. Standard therapies are multimodal in nature with use of behavioral, medical and procedural therapeutics. ⋯ This review briefly examines newly employed therapeutic options, while restating currently utilized options. The current state-of-the-art treatment includes focal therapies for identified pathologies and empiric trials of other options for care when precise sources of the chronic pelvic pain are ill defined.
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SUMMARY Neuropathic pain is typically caused by a lesion or dysfunction in the nervous system that results in both negative (i.e., reduced sensitivity) and positive symptoms (i.e., paraesthesia, spontaneous ongoing pain with shooting, electric shock-like sensations and abnormal responses to evoked pain). Intriguingly, chronic pain disorders manifest profound alterations in brain structure and function, and thus, modern nuclear magnetic resonance (NMR) techniques have allowed us to begin to dissect the complexities of how neuropathic pain affects the brain. NMR approaches can be used as an independent measure to improve our understanding of key changes in brain structure, function and chemistry in chronic neuropathic pain. ⋯ Additionally, although at an early stage, NMR methods can also be useful to define clinical metrics to predict chronification of neuropathic pain and responses to drugs. This article provides a review of NMR techniques and their capacity to study spontaneous pain and evoked pain, as well as structural, functional and neurochemical alterations that have repeatedly been associated with chronic neuropathic pain. Finally, the importance for quantifying disease state and treatment efficacy in neuropathic pain using NMR techniques is discussed.