Articles: neuropathic-pain.
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Expert Rev Clin Pharmacol · Nov 2008
Transdermal buprenorphine in chronic pain: indications and clinical experience.
Transdermal buprenorphine has been shown to be effective in managing moderate-to-severe cancer pain and severe pain that is unresponsive to nonopioid analgesics. In clinical trials, it provided better pain relief than placebo, despite a higher consumption of rescue analgesia by placebo patients. Analgesia was rated as satisfactory or better by 90% of patients in a long-term follow-up study and 94.6% considered the buprenorphine matrix patch to be user friendly. ⋯ No problems have been encountered when switching from another opioid to transdermal buprenorphine, or in combining the buprenorphine patch with intravenous morphine or tramadol for breakthrough pain. There is a growing body of evidence that transdermal buprenorphine may be particularly useful for managing neuropathic pain. Most notably, it appears to be effective in treating hyperalgesic states and syndromes characterized by pronounced central sensitization.
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Neuropathic facial pain often is a very difficult problem to treat. We describe three cases of intractable neuropathic facial pain which were successfully treated with peripheral stimulation. These three cases review trialing, operative considerations, including cosmetic considerations, and provide some insight into the pathophysiology of these pain syndromes.
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Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods. Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. ⋯ No predictive value of pain etiology was observed. Conclusions. Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surgery syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.
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Subcutaneous targeted neuromodulation is one part of the wider new peripheral neuromodulation development in the treatment of neuropathic pain. Although it has not received wider acceptance, there are many reports in the literature of successful use of this technique.