Articles: neuralgia.
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Clinical Trial
Change in pulse transit time in the lower extremity after lumbar sympathetic ganglion block: an early indicator of successful block.
Objective To investigate the change in pulse transit time (PTT)-time between the electrocardiographic R wave and the highest point of the corresponding plethysmographic wave-after lumbar sympathetic ganglion block (LSGB) and evaluate PTT as an indicator of successful LSGB. Methods Sixteen cases of sympathetically mediated lower extremity neuropathic pain treated with LSGB were studied. Correlations between the changes in PTT and temperature were used to identify the cutoff point indicating successful LSGB. ⋯ The dPTT5/PTT0 ratios of the Success and Failure groups were 6.46 ± 2.81% and 2.77 ± 1.72%, respectively. The dPTT5/PTT0 cutoff indicating successful LSGB, based on receiver operating characteristic curve analysis, was 4.23%. Conclusion PTT measurement 5 min after local anesthetic injection was an early, objective indicator of successful or failed LSGB.
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Anesthesia and analgesia · Feb 2017
ReviewIntravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization.
Intravenous ketamine infusions have been used extensively to treat often-intractable neuropathic pain conditions. Because there are many widely divergent ketamine infusion protocols described in the literature, the variation in these protocols presents a challenge for direct comparison of one protocol with another and in discerning an optimal protocol. Careful examination of the published literature suggests that ketamine infusions can be useful to treat neuropathic pain and that certain characteristics of ketamine infusions may be associated with better clinical outcomes. ⋯ Therefore, despite common clinical practice, the current state of the literature leaves the use of ketamine infusions without meaningful guidance from high-quality comparative evidence. The objectives of this topical review are to (1) analyze the available clinical evidence related to ketamine infusion protocols and (2) call for clinical studies to identify optimal ketamine infusion protocols tailored for individual neuropathic pain conditions. The Oxford Center for Evidence-Based Medicine classification for levels of evidence was used to stratify the grades of clinical recommendation for each infusion variable studied.
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Postherpetic neuralgia (PHN) patients suffer debilitating chronic pain, hyperalgesia, and allodynia, as well as emotional disorders such as insomnia, anxiety, and depression. The brain structure and functional basis of PHN are still not fully understood. ⋯ For PHN patients, the local brain activity abnormality was not restricted to the pain matrix. Besides regions related to pain perception, areas in charge of affective processes, emotional activity, and pain modulation also showed abnormal local brain activity in a resting state, which may suggest complicated supraspinal function and plasticity change in PHN patients. ReHo was more closely correlated with pain intensity of PHN patients than fALFF. This work indicates that besides physical and emotional pain perception, mood disorder and pain modulation could be characteristic of PHN patients. This also supports the potential use of therapeutic interventions not only restricted to pain alleviation, but that also attempt to ameliorate the cognitive and emotional comorbidities. Key words: Postherpetic neuralgia, resting-state fMRI (rs-fMRI), mood disorder, limbic system, fractional aptitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo).
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Pharmacol. Biochem. Behav. · Feb 2017
HYP-17, a novel voltage-gated sodium channel blocker, relieves inflammatory and neuropathic pain in rats.
Clinical and experimental studies suggest that voltage-gated sodium channels (VGSCs) play a key role in the pathogenesis of neuropathic pain and that blocking agents against these channels can be potentially therapeutic. In the current study, we investigated whether a novel compound, (-)-2-Amino-1-(4-((4-chlorophenyl)(phenyl)methyl)piperazin-1-yl)-propan-1-one(HYP-17), binds to VGSCs and evaluated its inhibitory effect on Na+ currents of the rat dorsal root ganglia (DRG) sensory neurons and its analgesic effect on inflammatory and neuropathic pain. HYP-17 (10μM) reduced both the tetrodotoxin-sensitive (TTX-S) and the TTX-resistant (TTX-R) currents in DRG sensory neurons. ⋯ Electrophysiological study showed that HYP-17 significantly attenuated the hyper-responsiveness of lumbar dorsal horn neurons. In addition, HYP-17 significantly reduced the levels of pp38MAPK and p-JNK in microglia and astrocytes, respectively, in the L4-L5 spinal dorsal horn. Therefore, our results indicate that HYP-17 has potential analgesic activities against nociceptive, inflammatory and neuropathic pain.
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Randomized Controlled Trial Multicenter Study
Efficacy and Safety of 0.625% and 1.25% Capsaicin Patch in Peripheral Neuropathic Pain: Multi-Center, Randomized, and Semi-Double Blind Controlled Study.
Topical capsaicin therapy may be of benefit in providing pain relief in patients with peripheral neuropathy. ⋯ Our data indicate that the 0.625% CP may prove to be an effective and safe alternative with which to treat patients with peripheral neuropathy and could replace the high concentration (8%) CP. Further studies are now needed to definitively establish efficacy.Key words: Capsaicin, patch, CP, topical capsaicin, neuropathic pain, peripheral neuropathic pain, PNP, high concentration CPTrial Registration: ClinicalTrials.gov, NCT02228928.