Does evidence from randomized controlled trials support the use of high-concentration (8%) topical capsaicin over placebo in adults with chronic neuropathic pain?

2017 ◽  
Author(s):  
Christopher Bunt
Keyword(s):  
Neuropathic Pain ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
High Concentration ◽  
Chronic Neuropathic Pain ◽  
Randomized Controlled ◽  
Topical Capsaicin

scholarly journals Topical capsaicin (high concentration) for chronic neuropathic pain in adults

2013 ◽  
Author(s):  
Sheena Derry ◽  
Andrew S C Rice ◽  
Peter Cole ◽  
Toni Tan ◽  
R Andrew Moore
Keyword(s):  
Neuropathic Pain ◽  
High Concentration ◽  
Chronic Neuropathic Pain ◽  
Topical Capsaicin

scholarly journals Perioperative Ketamine Administration for Thoracotomy Pain

2017 ◽  
Vol 3 (20;3) ◽  
pp. 173-184 ◽  
Author(s):  
Srinivas Pyati
Keyword(s):  
Neuropathic Pain ◽  
Randomized Controlled Trials ◽  
Pain Syndrome ◽  
Route Of Administration ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Postthoracotomy Pain

Background: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia. Objective: We reviewed the evidence for the efficacy of intravenous and epidural administration of ketamine in acute post-thoracotomy pain management, and its effectiveness in reducing chronic postthoracotomy pain. Study Design: Systematic literature review and an analytic study of a data subset were performed. Methods: We searched PubMed, Embase, and Cochrane reviews using the key terms “ketamine,” “neuropathic pain,” “postoperative,” and “post-thoracotomy pain syndrome.” The search was limited to human trials and included all studies published before January 2015. Data from animal studies, abstracts, and letters were excluded. All studies not available in the English language were excluded. The manuscript bibliographies were reviewed for additional related articles. We included randomized controlled trials and retrospective studies, while excluding individual case reports. Results: This systematic literature search yielded 15 randomized control trials evaluating the efficacy of ketamine in the treatment of acute post-thoracotomy pain; fewer studies assessed its effect on attenuating chronic post-thoracotomy pain. The majority of reviewed studies demonstrated that ketamine has efficacy in reduction of acute pain, but the evidence is limited on the long-term benefits of ketamine to prevent post-thoracotomy pain syndrome, regardless of the route of administration. A nested analytical study found there is a statistically significant reduction in acute post-thoracotomy pain with IV or epidural ketamine. However currently, the evidence for a role of ketamine as a preventative agent for chronic postthoracotomy pain is insufficient due to the heterogeneity of the studies reviewed with regard to the route of administration, dosage, and outcome measures. Limitations: The evidence for a role of ketamine as a preventative agent for chronic post-thoracotomy pain is insufficient due to the heterogeneity of the studies reviewed. Conclusion: The majority of randomized controlled trials reviewed show no role for ketamine in attenuating or preventing post-thoracotomy pain syndrome at variable follow-up lengths. Therefore, additional research is warranted with consideration of risk factors and long-term follow-up for chronic post-thoracotomy pain though the evidence for benefit appears clear for acute post-thoracotomy pain. Key words: Ketamine, postoperative, thoracotomy pain, post thoracotomy pain syndrome, neuropathic pain

scholarly journals Outcome Measures in Randomized-controlled Trials of Neuropathic Pain Conditions

2015 ◽  
Vol 31 (2) ◽  
pp. 169-176 ◽  
Author(s):  
Poonam Mehta ◽  
Leica Claydon ◽  
Paul Hendrick ◽  
Stanley Winser ◽  
G. David Baxter
Keyword(s):  
Neuropathic Pain ◽  
Randomized Controlled Trials ◽  
Outcome Measures ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Nutritional Supplements for the Treatment of Neuropathic Pain

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 674
Author(s):  
Khaled M. Abdelrahman ◽  
Kevin V. Hackshaw
Keyword(s):  
Neuropathic Pain ◽  
Randomized Controlled Trials ◽  
Tricyclic Antidepressants ◽  
Nutritional Supplements ◽  
Herbal Remedies ◽  
Controlled Trials ◽  
Vitamin B ◽  
Randomized Controlled ◽  
Noradrenaline Reuptake ◽  
Preclinical Animal Models

Neuropathic pain affects 7–10% of the population and is often ineffectively and incompletely treated. Although the gold standard for treatment of neuropathic pain includes tricyclic antidepressants (TCAs), serotonin-noradrenaline reuptake inhibitors, and anticonvulsants, patients suffering from neuropathic pain are increasingly turning to nonpharmacologic treatments, including nutritional supplements for analgesia. So-called “nutraceuticals” have garnered significant interest among patients seeking to self-treat their neuropathic pain with readily available supplements. The supplements most often used by patients include vitamins such as vitamin B and vitamin D, trace minerals zinc and magnesium, and herbal remedies such as curcumin and St. John’s Wort. However, evidence surrounding the efficacy and mechanisms of these supplements in neuropathic pain is limited, and the scientific literature consists primarily of preclinical animal models, case studies, and small randomized controlled trials (RCTs). Further exploration into large randomized controlled trials is needed to fully inform patients and physicians on the utility of these supplements in neuropathic pain. In this review, we explore the basis behind using several nutritional supplements commonly used by patients with neuropathic pain seen in rheumatology clinics.

Antineuropathic medication combination therapy

2018 ◽  
Author(s):  
Mick G. Serpell
Keyword(s):  
Neuropathic Pain ◽  
Side Effects ◽  
Combination Therapy ◽  
Diabetic Neuropathy ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Post Herpetic Neuralgia ◽  
Combination Drug ◽  
Seminal Paper ◽  
Randomized Controlled

The landmark paper discussed in this chapter is ‘Morphine, gabapentin, or their combination for neuropathic pain’, published by Gilron et al. in 2005. Although combination drug therapies for neuropathic pain had long been suggested, this seminal paper provided the first evidence for efficacy of combination therapy of mechanistically distinct medications in analgesia, using morphine in combination with gabapentin in post-herpetic neuralgia or diabetic neuropathy. Combination therapy had greater efficacy than gabapentin alone and was equally effective as morphine alone but with a lower dose of morphine; however, this did not seem to translate into reduced side effects. To this day, precious little is known about what are the most effective combinations for neuropathic pain, and the need for large randomized controlled trials in this area is still as pressing it was back in 2005.

scholarly journals A Qualitative Systematic Review of Head-to-Head Randomized Controlled Trials of Oral Analgesics in Neuropathic Pain

2010 ◽  
Vol 15 (3) ◽  
pp. 147-157 ◽  
Author(s):  
C Peter N Watson ◽  
Ian Gilron ◽  
Jana Sawynok
Keyword(s):  
Systematic Review ◽  
Neuropathic Pain ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Relative Efficacy ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Jadad Scale ◽  
Qualitative Systematic Review ◽  
Comparative Trials

BACKGROUND: Neuropathic pain (NP) encompasses many difficult-to-treat disorders. There are few head-to-head, comparative, randomized controlled trials (RCTs) of drugs for NP in different analgesic categories, or of different drugs within a category, despite many placebo-controlled RCTs for individual agents. Well-designed head-to-head comparative trials are an effective way to determine the relative efficacy and safety of a new drug.OBJECTIVE: To perform a systematic review of head-to-head RCTs of oral analgesics in NP.METHODS: A systematic review of RCTs involving NP patients was performed, of which head-to-head comparative trials were selected. Reference lists from published systematic reviews were searched. These studies were rated according to the Jadad scale for quality.RESULTS AND CONCLUSIONS: Twenty-seven such trials were identified. Seventeen were comparisons of different analgesics, and 10 were of different drugs within an analgesic class. Important information was obtained about the relative efficacy and safety of drugs in different categories and within a category. Some significant differences between active treatments were reported. Trial inadequacies were identified. More and improved head-to-head RCTs are needed to inform clinical choices.

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