Articles: neuralgia.
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Physical exercise is a low-cost, safe, and efficient intervention for the reduction of neuropathic chronic pain in humans. However, the underlying mechanisms for how exercise reduces neuropathic pain are not yet well understood. Central monoaminergic systems play a critical role in endogenous analgesia leading us to hypothesize that the analgesic effect of low-intensity exercise occurs through activation of monoaminergic neurotransmission in descending inhibitory systems. ⋯ Finally, PNI-induced increase in inflammatory cytokines, tumor necrosis factor-alpha, and interleukin-1 beta, in the brainstem, was reversed by 2 weeks of exercise. These findings provide new evidence indicating that low-intensity aerobic treadmill exercise suppresses pain-like behaviors in animals with neuropathic pain by enhancing brainstem 5-HT neurotransmission. These data provide a rationale for the analgesia produced by exercise to provide an alternative approach to the treatment of chronic neuropathic pain.
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Randomized Controlled Trial
Treatment of Postherpetic Neuralgia with Gastroretentive Gabapentin: Interaction of Patient Demographics, Disease Characteristics, and Efficacy Outcomes.
To understand how patient demographics and patient-reported disease characteristics relate to successful management of postherpetic neuralgia (PHN), integrated data from phase 3 and phase 4 studies of patients with PHN (n = 546) who received once-daily gastroretentive gabapentin (G-GR, 1800 mg) were analyzed. There were widespread, networked, positive correlations among efficacy end points--pain qualities on the visual analog scale (VAS) and Brief Pain Inventory (BPI), measures of pain interference on the BPI, and Patient Global Impression of Change (PGIC)--most likely characterized by positive feedback loops, in which pain interferes with patient functioning, and poor functioning enhances pain. VAS scores at baseline or at week 2 were the strongest predictors of being "much" or "very much" improved on the PGIC; BPI sleep interference scores were the strongest predictors of percent changes in BPI pain qualities and in the average of BPI interference scores, whereas age, sex, and race were not important predictors. In addition to VAS, BPI sleep interference and PGIC assessments appeared to be key co-strategic factors important for successful treatment outcomes, and should be considered as co-primary end points in future clinical trials of PHN. This could improve detection of true positive efficacy responses and guide successful transition to real-world clinical practice. ⋯ This study describes complex relationships among measures of pain intensity, pain interference with daily activities, and demographics of patients with PHN treated with G-GR. Such comprehensive characterization provides important insight into how different variables contribute to successful treatment, and may lead to better management of neuropathic pain.
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Case Reports Comparative Study
[Topical ambroxol for the treatment of neuropathic pain : A first clinical observation. German version].
Neuropathic pain is difficult to treat and available options are frequently not sufficient. The expectorant ambroxol also works as a strong local anesthetic and blocks sodium channels about 40 times more potently than lidocaine. Ambroxol preferentially inhibits the channel subtype Nav 1.8, which is expressed particularly in nociceptive C fibers. Due to the low toxicity, topical ambroxol seemed to represent a reasonable therapeutic attempt for treatment of neuropathic pain resistant to other standard options. ⋯ Ambroxol acts as a strong local anesthetic and preferentially inhibits the nociceptive-relevant sodium channel subtype Nav 1.8. For the first time, we report relevant pain reduction following topical Ambroxol 20% cream in patients with neuropathic pain. Regarding the advantageous profile with rare side effects, the clinical benefit for pain patients should be further investigated.
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The rise in the global burden of diabetes is spurring an increase in the prevalence of its complications. Diabetic peripheral neuropathy (DPN) is a common and devastating complication of diabetes, with multiple clinical manifestations. The most common is a symmetrical length-dependent dysfunction and damage of peripheral nerves. ⋯ For painful diabetic neuropathy, clinical guidelines recommend: atypical analgesics for pain relief, including duloxetine and amitriptyline; the γ-aminobutyric acid analogues gabapentin and pregabalin; opioids, including Tapentadol; and topical agents such as lidocaine and capsaicin. No single effective treatment exists for painful DPN, highlighting a growing need for studies to evaluate more potent and targeted drugs, as well as combinations. A number of novel potential candidates, including erythropoietin analogues and angiotensin II type 2 receptor anatagonists are currently being evaluated in phase II clinical trials.
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To compare psychological difficulties experienced during the initial acute hospitalization and the last follow up visit for children with electrical injuries (EI) and children without electrical injuries (non-EI). We hypothesized that children with electrical burns would have different psychological outcomes. ⋯ Some differences were evident between the groups immediately after injury; however, long term outcomes were similar.