Articles: neuralgia.
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Experimental neurology · May 2007
Randomized Controlled TrialReaction to topical capsaicin in spinal cord injury patients with and without central pain.
Central neuropathic pain is a debilitating and frequent complication to spinal cord injury (SCI). Excitatory input from hyperexcitable cells around the injured grey matter zone is suggested to play a role for central neuropathic pain felt below the level of a spinal cord injury. Direct evidence for this hypothesis is difficult to obtain. ⋯ Touch, punctuate stimuli, cold stimuli and topical capsaicin was applied above, at, and below injury level in 10 SCI patients with central pain below a thoracic injury, in 10 SCI patients with a thoracic injury but without neuropathic pain, and in corresponding areas in 10 healthy control subjects. The study found increased responses to touch at injury level compared to controls (p=0.033) and repetitive punctuate stimuli above and at injury level compared to controls and pain-free SCI patients (p<0.04) but not an increased response to capsaicin in patients with central pain. These results suggest that SCI patients with below-level pain have increased responses to some but not all sensory input at the level of injury.
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Randomized Controlled Trial
Lamotrigine for treatment of pain associated with diabetic neuropathy: results of two randomized, double-blind, placebo-controlled studies.
To assess the efficacy and tolerability of lamotrigine in pain associated with diabetic neuropathy, two replicate randomized, double-blind, placebo-controlled studies were conducted. Patients (n=360 per study) with painful diabetic neuropathy were randomized to receive lamotrigine 200, 300, or 400 mg daily or placebo during the 19-week treatment phase, including a 7-week dose-escalation phase and a 12-week, fixed-dose maintenance phase. The mean reduction in pain-intensity score from baseline to week 19 (primary endpoint) was greater (p < or = 0.05) in patients receiving lamotrigine 400 mg than placebo in Study 2 (observed scores, -2.7 versus -1.6 on a 0- to 10-point scale). ⋯ Adverse events were reported in 71-82% of lamotrigine-treated patients compared with 63-70% of placebo-treated patients. The most common adverse events with lamotrigine were headache and rash. Compared with placebo, lamotrigine (300 and 400 mg daily) was inconsistently effective for pain associated with diabetic neuropathy but was generally safe and well tolerated.
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Clinical therapeutics · Jan 2007
Randomized Controlled Trial Multicenter StudyDuloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies.
This post hoc analysis was aimed to summarize the efficacy and tolerability of duloxetine as represented by number needed to treat (NNT) and number needed to harm (NNH) to provide a clinically useful assessment of the position of duloxetine among current agents used to treat diabetic peripheral neuropathic pain (DPNP). ⋯ These post hoc results suggest that duloxetine was effective and well tolerated for the management of DPNP and further support the importance of duloxetine as a treatment option for clinicians and patients to assist with the management of DPNP.
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Randomized Controlled Trial
Tramadol in the treatment of neuropathic cancer pain: a double-blind, placebo-controlled study.
To assess the efficacy, safety and impact on quality of life of tramadol in the treatment of neuropathic pain in patients with cancer. ⋯ Tramadol is a therapeutic option for the control of neuropathic pain in patients with cancer, and appears to improve quality of life in these patients. The analgesic effect of tramadol is independent of changes in anxiety, depression and nervous system function.
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Acta Neurochir. Suppl. · Jan 2007
Randomized Controlled Trial Clinical TrialImplantation of surgical electrodes for spinal cord stimulation: classical midline laminotomy technique versus minimal invasive unilateral technique combined with spinal anaesthesia.
The implantation of surgical electrodes is still considered painful and invasive. Is there a possibility to diminish these disadvantages by applying a less invasive implantation procedure at the thoracic level and eventually combine this approach with a less stressful paresthesia coverage testing in the intraoperatively awake patient? In this paper, the postoperative outcome of two surgical techniques to insert surgical plate electrodes at the thoracic level is compared. In a prospective single blind study. the Classical Midline Laminotomy technique (CML) is opposed to a Minimal Invasive unilateral Technique (MIT). ⋯ In all comparisons, the MIT group scored significantly better. It can be concluded that a minimal invasive unilateral technique has some advantages over midline laminotomy. Refinements of the implantation procedure are discussed, i.e minimal invasive unilateral technique in combination with spinal (intrathecal) anaesthesia, surgical hints and the technique's use in revision surgery for migrated electrodes.