Current pain and headache reports
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Curr Pain Headache Rep · Jun 2006
ReviewUpdate on pharmacotherapy guidelines for the treatment of neuropathic pain.
Neuropathic pain is a common problem in our society affecting nearly 1.5% of the US population. There currently are five medications approved by the US Food and Drug Administration (FDA) for the treatment of neuropathic pain, which include gabapentin, pregabalin, duloxetine, 5% lidocaine patch, and carbamazepine. ⋯ All of these agents, both FDA-approved and off-label, have been recommended as first-line treatments for neuropathic pain. This article discusses these agents in detail as they relate to the treatment of neuropathic pain.
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Eight measures of neuropathic pain exist that have been designed to discriminate neuropathic from non-neuropathic pain and detect treatment effects. The current paper describes these measures and summarizes the evidence supporting their validity. ⋯ However, given the lack of overlap in measures designed for this purpose, it is likely that the validity of any one measure could be improved by incorporating items from the others. The Neuropathic Pain Scale (NPS) has the most empirical support as a measure of treatment outcome, although a new measure that includes the NPS items (the Pain Quality Assessment Scale) will likely prove to be even more useful, because it includes pain descriptors common to people with neuropathic and other chronic pain conditions not included on the NPS.
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Curr Pain Headache Rep · Jun 2006
ReviewPregabalin for neuropathic pain based on recent clinical trials.
Pregabalin is a ligand for the alpha-2-delta subunit of voltage-gated calcium channels with anticonvulsant, analgesic, and anxiolytic properties. It has predictable absorption across the gastrointestinal tract, is neither metabolized nor protein-bound, and has minimal drug-drug interactions. It is effective with two or three-times daily dosing in a dose range of 150 to 600 mg daily. ⋯ The 50% responder rates for PHN and DPN compare favorably with other first-line agents for neuropathic pain. Pregabalin is well tolerated in most patients with infrequent severe adverse effects. Pregabalin is an important addition to the treatment armamentarium for neuropathic pain.
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Curr Pain Headache Rep · Jun 2006
ReviewNeuropathic pain: translational research and impact for patient care.
Neuropathic pain syndromes (ie, pain after a lesion or disease of the peripheral or central nervous system) are clinically characterized by spontaneous pain (ongoing, paroxysms) and evoked types of pain (hyperalgesia, allodynia). Different pathophysiologic mechanisms occur solitarily or combined at peripheral nociceptors, spinal cord, or in the brain, which cause a broad variety of signs and symptoms. ⋯ Therefore, a new concept was proposed in which pain is analyzed on the basis of underlying mechanisms. The increased knowledge of pain-generating mechanisms and their translation into signs and symptoms may allow for a dissection of the individual mechanisms, and it ultimately should be possible to design optimal treatments for each patient.
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The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. ⋯ A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.