Expert review of neurotherapeutics
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Expert Rev Neurother · Nov 2008
ReviewCurrent challenges and future prospects in management of neuropathic pain.
Management of neuropathic pain is a challenge, as the currently available drugs usually do not target the multiple underlying mechanisms. This article will briefly review the currently available therapies for neuropathic pain as an introduction to those in clinical trials. The two most common conditions in clinical trials of neuropathic pain are diabetic neuropathy and postherpetic neuralgia. ⋯ Some of the novel targets for developing therapies for neuropathic pain include chemokine receptors, glial cells and cytokines. The review includes various suggestions for management of neuropathic pain, including multidisciplinary and personalized approaches. Considerable improvements are anticipated in the management of neuropathic pain in the next 5 years, although it is difficult to predict the chances of success of any particular product in development, considering the high rate of failures of previous trials.
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Expert Rev Neurother · Nov 2008
Review Meta AnalysisExtended-release epidural morphine (DepoDur): review and safety analysis.
Extended-release epidural morphine (EREM) provides effective postoperative analgesia for 48 h following injection. It is administered as a single bolus into the lumbar epidural space, and is indicated for lower abdominal and lower extremity surgery associated with moderate-to-severe pain. While its efficacy has been well documented in randomized controlled trials, the safety and clinically appropriate dosing are less well defined. ⋯ Vomiting was also increased with EREM 15 mg or greater compared with placebo (odds ratio: 0.40; 95% CI: 0.18-0.89; p = 0.02; NNT = 5). A multimodal analgesic regime is recommended to permit the use of lower EREM doses, thus reducing the risk for adverse effects including respiratory depression. Prophylactic time-contingent antiemetics are also recommended when EREM is used.
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Expert Rev Neurother · Nov 2008
ReviewApplications of virtual reality for pain management in burn-injured patients.
The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance - often on a daily basis for weeks to months - of painful and anxiety-provoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by potent pharmacologic analgesics (e.g., opioids), but is necessarily complemented by nonpharmacologic techniques, including distraction or hypnosis. ⋯ Initial reports from these groups are consistent in suggesting that immersive virtual reality is logistically feasible, safe and effective in ameliorating the pain and anxiety experienced in various settings of post-burn pain. Furthermore, the technique appears applicable to a wide age range of patients and may be particularly well-adapted for use in children, one of the most challenging populations of burn victims to treat. However, confirmation and extension of these results in larger numbers of patients in various types of burn-related pain is necessary to more clearly define the specific benefits and limitations of virtual reality analgesia in the burn care setting.
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Lacosamide is a novel chemical entity with anticonvulsant and analgesic properties that is being developed to treat epilepsy and neuropathic pain conditions. Lacosamide has shown efficacy in many animal models of chronic pain and in several short- and long-term Phase II/III clinical trials in humans with diabetic neuropathic pain. The mechanism of action of lacosamide differs from other drugs used to treat neuropathic pain in that it selectively enhances sodium channel slow inactivation without affecting fast inactivation, and may modulate collapsin-response mediator protein 2. The pharmacokinetic properties of lacosamide include a fast rate of absorption, little or no interaction with cytochrome P450 isoenzymes, limited effect of age and gender on plasma levels and low potential for drug-drug interactions.
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Expert Rev Neurother · Nov 2008
ReviewA new tr(i)p to sense pain: TRPA1 channel as a target for novel analgesics.
Pain sensation occurs at multiple levels of the nervous system, involving a myriad of molecules and signaling pathways that contribute to the detection of noxious stimuli, and the modulation, initiation and propagation of electrical activity in nociceptors, a subset of primary sensory neurons. The fact that several types of ion channels or their splice variants are highly expressed in nociceptors and are critical for pain transduction has prompted scientists to examine their physiological roles in order to better understand the neuromolecular mechanisms of the pain pathway. Recent reports have demonstrated that TRPA1, a member of the mammalian transient receptor potential cation channel family, acts as a key chemical nocisensor in response to diverse chemical stimuli. The TRPA1 channel represents a new target for novel analgesics to specifically eliminate pain sensation of various stimuli.