Articles: neuralgia.
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Journal of anesthesia · Dec 2019
Association between treatment-related early changes in psychological factors and development of postherpetic neuralgia.
To examine the association between catastrophizing and pain intensity with acute herpes zoster, and the association of treatment-related early changes in depressive symptoms, anxiety, and catastrophizing with postherpetic neuralgia (PHN) development, independent of acute pain intensity. ⋯ Catastrophizing was associated with acute pain intensity, and lower pain-related catastrophizing among patients with acute herpes zoster was associated with less risk of PHN development, independent of acute pain intensity.
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Expert Opin Drug Metab Toxicol · Dec 2019
ReviewPharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature.
Introduction: Chronic neuropathic pain (NP) is an incapacitating illness caused by a lesion of the somatosensory nervous system and is associated with several diseases or syndromes. Since current treatment options lack adequate efficacy in the majority of patients, ketamine is often administered to treat refractory NP. Areas covered: This review gives an overview of new ketamine pharmacokinetic data including data on intranasal and inhaled ketamine. ⋯ Expert opinion: Proof of sustained, large effects of ketamine in the treatment of NP from randomized controlled clinical trials is lacking, although we cannot exclude selective ketamine efficacy in patients with central sensitization, opioid-induced hyperalgesia or opioid tolerance. Interestingly, data from observational trials and case series do suggest the efficacy of ketamine in producing effective pain relief in NP with positive patient-related outcome measures. Additional randomized trials in often ill-defined groups of chronic pain patients are not useful and we suggest to conduct future studies in NP patients with central sensitization and/or with opioid refractory severe NP.
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Neuropathic pain is defined as pain caused by a lesion or a disease affecting the somatosensory nervous system. Development of neuropathic pain is induced by many pathophysiological mechanisms affecting pain pathways. Neuropathic pain has diverse origins, making its management difficult, hence, many patients with neuropathic pain do not receive appropriate treatment. ⋯ Capsaicin and lidocaine patches are second line treatments, tramadol and strong opioids are third line treatments. This work also highlighted molecules with inconclusive recommendations or non-recommended pharmacological treatments based on a low quality of evidence, a lack of efficacy or a bad safety profile. The objective of this paper is to present the different treatments and to detail their mechanisms of action.
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About half of patients with spinal cord injury (SCI) develop debilitating central neuropathic pain (CNP), with no effective treatments. Thus, effective, safe, and novel therapies are needed urgently. Previously, docosahexaenoic acid (DHA) was reported to confer neuroprotection in preclinical SCI models. ⋯ Spinal microgliosis, a known hallmark associated with neuropathic pain behaviours, was reduced by DHA treatments. Finally, we revealed novel potential roles of peroxisome proliferator-activated and retinoid X receptors and docosahexaenoyl ethanolamide (DHA's metabolite) in mediating DHA's effects on microglial activation. Our findings, coupled with the excellent long-term clinical safety of DHA even in surgical and critically ill patients, suggest that systemic DHA treatment is a translatable, effective, safe, and novel approach for preventing and managing SCI-CNP.
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Transverse myelitis (TM) is a rare neurologic disorder of acute inflammation resulting in spinal cord injury. Chronic pain in TM is a significant detriment to quality of life. ⋯ He reported 70% improvement during the trial and was subsequently implanted with an SCS. He continues to experience significant pain relief and functional improvement (>80%) with conventional paresthesia programming at the 9-month follow-up.