Articles: neuralgia.
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Randomized Controlled Trial
Efficacy and safety of EMA401 in peripheral neuropathic pain: results of two randomised, double-blind, phase 2 studies in patients with postherpetic neuralgia and painful diabetic neuropathy.
The analgesic efficacy and safety of 2 phase 2b studies of EMA401 (a highly selective angiotensin II type 2 receptor antagonist) in patients with postherpetic neuralgia (EMPHENE) and painful diabetic neuropathy (EMPADINE) were reported. These were multicentre, randomised, double-blind treatment studies conducted in participants with postherpetic neuralgia or type I/II diabetes mellitus with painful distal symmetrical sensorimotor neuropathy. Participants were randomised 1:1:1 to either placebo, EMA401 25 mg, or 100 mg twice daily (b.i.d) in the EMPHENE and 1:1 to placebo or EMA401 100 mg b.i.d. in the EMPADINE. ⋯ Out of the planned participants, a total of 129/360 (EMPHENE) and 137/400 (EMPADINE) participants were enrolled. The least square mean reduction in numeric rating scale pain score was numerically in favour of EMA401 100 mg arm in both EMPHENE (treatment difference: -0.5 [95% confidence interval: -1.6 to 0.6; P value: 0.35]) and EMPADINE (treatment difference: -0.6 [95% confidence interval: -1.4 to 0.1; P value: 0.10]) at the end of week 12. However, as the studies were terminated prematurely, no firm conclusion could be drawn but the consistent clinical improvement in pain intensity reduction across these 2 studies in 2 different populations is worth noting.
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Mechanical hyperalgesia and allodynia incidence varies considerably amongst neuropathic pain patients. This study explored whether sensory or psychological factors associate with mechanical hyperalgesia and brush allodynia in a human experimental model. ⋯ We evaluated differential relationships of psychological and perceptual sensitivity to the development of capsaicin-induced mechanical allodynia and hyperalgesia. Fifty percent of healthy volunteers failed to develop mechanical allodynia. Baseline pain sensitivity was greater in those developing allodynia and was related to the magnitude and area of hyperalgesia. State psychological factors, whilst unrelated to allodynia, were related to mechanical hyperalgesia. This supports that the intensity of peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, whilst psychological factors play a lesser role.
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This study aimed to investigate the effects of popliteal sciatic nerve block (PSNB) in the treatment of postinjection sciatic neuropathy (PISN) resistant to conservative treatments. ⋯ The outcome of this research proved the effectiveness of PSNB with methylprednisolone in the management of PISN, especially in patients whose pain was located below the knee. EPSs findings and loss of muscle strength indicated the severity of the nerve damage affect the success of PSNB in pain management, but the length of time that elapsed after the nerve injury did not.
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Since 2017, the diagnosis of patients with orofacial pain at the University Center for Dental Medicine Basel has been supplemented by using standardized image graphics (Dolografie® [Affolter/Rüfenacht, Bern, Switzerland]). For this purpose, patients select from a set of 34 cards those that visually best match their pain and then explain the reason for their choice. ⋯ The use of standardized image cards as a "visual communication tool" has proven to be a time-efficient procedure in the context of history taking, which helps to obtain clinically relevant information not previously expressed by the patient.