scholarly journals Pharmacological Management of Chronic Neuropathic Pain: Revised Consensus Statement from the Canadian Pain Society

2014 ◽  
Vol 19 (6) ◽  
pp. 328-335 ◽  
Author(s):  
DE Moulin ◽  
A Boulanger ◽  
AJ Clark ◽  
H Clarke ◽  
T Dao ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Systematic Reviews ◽  
Consensus Statement ◽  
Somatosensory System ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Ease Of Use ◽  
Control Group ◽  
Pharmacological Management ◽  
Analgesic Agents

BACKGROUND: Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians.OBJECTIVE: To review the randomized controlled trials (RCTs) and systematic reviews related to the pharmacological management of NeP to develop a revised evidence-based consensus statement on its management.METHODS: RCTs, systematic reviews and existing guidelines on the pharmacological management of NeP were evaluated at a consensus meeting in May 2012 and updated until September 2013. Medications were recommended in the consensus statement if their analgesic efficacy was supported by at least one methodologically sound RCT (class I or class II) showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment were based on the degree of evidence of analgesic efficacy, safety and ease of use.RESULTS: Analgesic agents recommended for first-line treatments are gabapentinoids (gabapentin and pregabalin), tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors. Tramadol and controlled-release opioid analgesics are recommended as second-line treatments for moderate to severe pain. Cannabinoids are now recommended as third-line treatments. Recommended fourth-line treatments include methadone, anticonvulsants with lesser evidence of efficacy (eg, lamotrigine, lacos-amide), tapentadol and botulinum toxin. There is support for some analgesic combinations in selected NeP conditions.CONCLUSIONS: These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Additional studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes and treatment of pediatric, geriatric and central NeP.

scholarly journals Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

2007 ◽  
Vol 12 (1) ◽  
pp. 13-21 ◽  
Author(s):  
DE Moulin ◽  
AJ Clark ◽  
I Gilron ◽  
MA Ware ◽  
CPN Watson ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Ease Of Use ◽  
Control Group ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Analgesic Agents ◽  
Third Line

Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

Drugs for neuropathic pain

2021 ◽  
pp. 500-510
Author(s):  
Sachin Rastogi ◽  
Fiona Campbell
Keyword(s):  
Neuropathic Pain ◽  
Drug Therapy ◽  
Side Effects ◽  
Randomized Controlled Trials ◽  
Tissue Injury ◽  
Somatosensory System ◽  
Pain Syndrome ◽  
Direct Consequence ◽  
Controlled Trials ◽  
Pharmacological Management

Neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” It is often contrasted with nociceptive pain, which is associated with tissue injury or inflammation. Neuropathic pain conditions in children are qualitatively different from those common in adults and include complex regional pain syndrome, postoperative neuropathic pain, and autoimmune and degenerative neuropathies. Few randomized controlled trials in pediatrics means that evidence from adult studies is extrapolated to guide pharmacological management in children, which is problematic as the etiologies and mechanisms are different. An algorithm for drug therapy is proposed based on the best-available evidence, clinical experience, and the safety of these drugs in pediatric practice. A step-wise approach should be tried methodically according to effectiveness and side effects. Neuropathic pain in children, if identified and treated in a timely manner as part of an interprofessional framework, can be managed effectively.

scholarly journals Bilateral ultrasound-guided abdominal peripheral block in tap plane, tap - block

2020 ◽  
Vol 18 (4) ◽  
pp. 344-349
Author(s):  
M. Sekulovski ◽  
B. Simonska ◽  
G. Mutafov ◽  
V. Alexandrov ◽  
L. Spassov
Keyword(s):  
General Anesthesia ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Abdominal Muscle ◽  
Control Group ◽  
Tap Block ◽  
Ultrasound Guided ◽  
Group I ◽  
Group Ii ◽  
Peripheral Block

INTRODUCTION: Bilateral ultrasound-guided peripheral block (TAP - block) in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle – TAP plane, is a regional anesthesia technique by infiltration of a local anesthetic, provides analgesia for operations involving the anterior abdominal wall. The analgesic effectiveness of the block decreases the consumption of opioid analgesics and non-steroidal anti-inflammatory drugs. AIM: In this study, we evaluated the intraoperative analgesic efficacy of bilateral TAP - block and the consumption of opioid analgesics in patients undergoing bilateral laparoscopic inguinal hernia repair. METHODS: The study was conducted with 35 patients, who were randomized into two groups. In the control group (group I), there are patients who received general anesthesia (GA), and experimental group (group II), were patients who have received general anesthesia and a bilateral tap block (GA + TAP). RESULTS: Patients with TAP-block (group II) have significantly lower fentanyl consumption compared to group I. CONCLUSION: Multimodal approach for the simultaneous administration of general anesthesia with a TAP block provides effective intraoperative analgesia and significantly reduces the perioperative consumption of opioid analgesics.

Drugs for neuropathic pain

2013 ◽  
pp. 495-507
Author(s):  
Sachin Rastogi ◽  
Fiona Campbell
Keyword(s):  
Neuropathic Pain ◽  
Tissue Injury ◽  
Somatosensory System ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Direct Consequence ◽  
Phantom Limb ◽  
Nociceptive Pain ◽  
Pharmacological Management ◽  
Charcot Marie Tooth Disease

Neuropathic pain is defined as ‘pain arising as a direct consequence of a lesion or disease affecting the somatosensory system’. It is often contrasted with nociceptive pain which is associated with tissue injury or inflammation. Neuropathic pain exhibits certain clinical features that differentiate it from nociceptive pain. Neuropathic pain conditions in children are different from those in adults and include complex regional pain syndrome (CRPS), phantom limb pain, postoperative and post-traumatic neuropathic pain, and autoimmune and degenerative neuropathies, e.g. Guillain–Barré syndrome, Charcot–Marie–Tooth disease. However, a lack of randomized controlled trials in children means that evidence from adult studies guides pharmacological management of neuropathic pain in children, which is problematic as the aetiologies and mechanisms are different. In this chapter we propose an algorithm for drug therapy for neuropathic pain in children based on best available evidence, our clinical experience, and the safety of these drugs in paediatric practice. We suggest a step-wise approach incorporating first-, second-, third-, and fourth-line therapies that should be tried methodically according to effectiveness and side effects. Neuropathic pain in children, if identified and treated in a timely manner as part of an interdisciplinary framework, using multimodal strategies can be managed effectively.

scholarly journals Evaluation of the Effect of Duration on the Efficacy of Pulsed Radiofrequency in an Animal Model of Neuropathic Pain

2018 ◽  
Vol 1 (21;1) ◽  
pp. 191-198
Author(s):  
Khaled I. Khalil
Keyword(s):  
Animal Model ◽  
Neuropathic Pain ◽  
Sciatic Nerve ◽  
Tissue Injury ◽  
Statistical Significance ◽  
Analgesic Efficacy ◽  
Control Group ◽  
Pulsed Radiofrequency ◽  
Tnf Α ◽  
Histopathological Evaluation

Background: Pulsed radiofrequency (PRF) is increasingly used in clinical practice, especially in neuropathic pain disorders. Although PRF is not new to clinical use, there are significant gaps in knowledge regarding its effectiveness. Objectives: The current study was conducted to evaluate the effect of duration of application of PRF on its analgesic efficacy in improvement of neuropathic pain. Study Design: A randomized experimental trial. Setting: An animal research facility at the College of Veterinary Medicine at Mansoura University in Egypt. Methods: Chronic constriction of the sciatic nerve of 36 male Sprague-Dawley rats was performed to induce neuropathic pain. The rats were divided into 6 groups (6 rats each) in which PRF was applied for 2, 4, 6, or 8 minutes or not at all. In one group, RF cannula was applied without performing PRF intervention. The pain was assessed through observation of resting paw posture (RPP) at 3, 10, and 21 days. Nerve damage was assessed by histopathological evaluation of the sciatic nerve. Immunohistochemical localization of proinflammatory cytokines (interleukin 6 [IL-6] and tumor necrosis factor alpha [TNF-α]) was also done. Results: RPP was improved in rats treated with PRF. This improvement was significant only in rats treated for 8 minutes. Increased duration for PRF application was associated with a significant decrease in IL-6 and TNF-α contents in all groups when compared with the control group. Histopathological evaluation of the constricted sciatic nerve revealed no statistical significance among the different study groups. Limitations: The study was limited by the lack of measurement of other inflammatory markers that may help elucidate other relevant mechanisms. Conclusions: Increased duration of PRF application resulted in better analgesic efficacy without any increase in tissue injury in an animal model of neuropathic pain. This effect may be attributed to decreased production of pro-inflammatory cytokines. Key words: Pulsed radiofrequency, analgesic, rats, sciatic nerve, duration, neuropathic pain

scholarly journals Oxycodone versus other opioid analgesics after laparoscopic surgery: a meta-analysis

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Yan Li ◽  
Zhi Dou ◽  
Liqiang Yang ◽  
Qi Wang ◽  
Jiaxiang Ni ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Laparoscopic Surgery ◽  
Adverse Effects ◽  
Adverse Events ◽  
Systematic Reviews ◽  
Visceral Pain ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Significant Difference

Abstract Background Intravenous opioids are administered for the management of visceral pain after laparoscopic surgery. Whether oxycodone has advantages over other opioids in the treatment of visceral pain is not yet clear. Methods In this study, the analgesic efficiency and adverse events of oxycodone and other opioids, including alfentanil, sufentanil, fentanyl, and morphine, in treating post-laparoscopic surgery visceral pain were evaluated. This review was conducted according to the methodological standards described in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The PubMed, Embase, and Cochrane databases were searched in December 2019. Results Ten studies were included in this review. The sample size was 695 participants. The results showed that compared with morphine and fentanyl, oxycodone had a more potent analgesic efficacy on the first day after laparoscopic surgery, especially during the first 0.5 h. There was no significant difference in sedation between the two groups. Compared to morphine and fentanyl, oxycodone was more likely to lead to dizziness and drowsiness. Overall, patient satisfaction did not differ significantly between oxycodone and other opioids. Conclusions Oxycodone is superior to other analgesics within 24 h after laparoscopic surgery, but its adverse effects should be carefully considered.

Transmodulation of Dopaminergic Signaling to Mitigate Hypodopminergia and Pharmaceutical Opioid-induced Hyperalgesia

2020 ◽  
Vol 9 (3) ◽  
pp. 164-184
Author(s):  
Raymond Brewer ◽  
Kenneth Blum ◽  
Abdalla Bowirrat ◽  
Edward J. Modestino ◽  
David Baron ◽  
...  
Keyword(s):  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Well Being ◽  
Deficiency Syndrome ◽  
Pain Tolerance ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Analgesic Agents ◽  
Opioid Induced Hyperalgesia ◽  
Intensive Investigation

Neuroscientists and psychiatrists working in the areas of “pain and addiction” are asked in this perspective article to reconsider the current use of dopaminergic blockade (like chronic opioid agonist therapy), and instead to consider induction of dopamine homeostasis by putative pro-dopamine regulation. Pro-dopamine regulation could help pharmaceutical opioid analgesic agents to mitigate hypodopaminergia-induced hyperalgesia by inducing transmodulation of dopaminergic signaling. An optimistic view is that early predisposition to diagnosis based on genetic testing, (pharmacogenetic/pharmacogenomic monitoring), combined with appropriate urine drug screening, and treatment with pro-dopamine regulators, could conceivably reduce stress, craving, relapse, enhance well-being and attenuate unwanted hyperalgesia. These concepts require intensive investigation. However, based on the rationale provided herein, there is a good chance that combining opioid analgesics with genetically directed pro-dopamine-regulation using KB220 (supported by 43 clinical studies). This prodopamine regulator may become a front-line technology with the potential to overcome, in part, the current heightened rates of chronic opioid-induced hyperalgesia and concomitant Reward Deficiency Syndrome (RDS) behaviors. Current research does support the hypothesis that low or hypodopaminergic function in the brain may predispose individuals to low pain tolerance or hyperalgesia.

Effectiveness of mobile applications on healthy lifestyles aimed at diabetic patients: review of systematic reviews. (Preprint)

2019 ◽  
Author(s):  
Francisco Jesús Represas Carrera Sr ◽  
Ángel Alfredo Martínez Ques Sr ◽  
Ana Clavería Fontán Sr
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Systematic Reviews ◽  
Mobile Applications ◽  
Control Group ◽  
Diabetic Patients ◽  
Healthy Lifestyles ◽  
Major Public Health Problem

BACKGROUND Diabetes mellitus is currently a major public health problem worldwide. It is traditionally approached in a clinical inpatient relationship between the patient and the healthcare professional. However, the rise of new technologies, particularly mobile applications, is revolutionizing the traditional healthcare model through the introduction of telehealthcare. OBJECTIVE (1) To assess the effects of mobile applications for improving healthy lifestyles on the quality of life and metabolic control of diabetes mellitus in adult patients. (2) To describe the characteristics of the mobile applications used, identify the healthy lifestyles they target, and describe any adverse effects their use may have. METHODS Review of systematic reviews and meta-analysis, following the guidelines of the Cochrane Collaboration and the Joanna Briggs Institute. We included studies that used any mobile application aimed at helping patients improve self-management of diabetes mellitus by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care without the use of mobile devices. In May 2018, a search was conducted in Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct, updated in May 2019. The methodological quality of the studies was assessed using the Amstar-2 tool. RESULTS Seven systematic reviews of 798 articles were initially selected for analysis. The interventions had a duration of between 1 and 12 months. Mobile applications focused singly or simultaneously on different lifestyles aspects (diet, physical exercise, motivation, blood glucose levels, etc.). There are significant changes in HbA1c values, body weight and BMI, although in others, such as lipid profile, quality of life, or blood pressure, there is no clear improvement. CONCLUSIONS There is clear evidence that the use of mobile applications improves glycemic control in diabetic patients in the short term. There is a lack of evidence in its long-term benefits. It is thus necessary to carry out further studies to learn about the long-term effectiveness of mobile applications aimed at promoting the healthy lifestyles of diabetic patients. CLINICALTRIAL PROSPERO Register: CRD42019133685

scholarly journals Chatbot to improve learning punctuation in Spanish and to enhance open and flexible learning environments

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Esteban Vázquez-Cano ◽  
Santiago Mengual-Andrés ◽  
Eloy López-Meneses
Keyword(s):  
Learning Process ◽  
Latent Dirichlet Allocation ◽  
Distance Matrix ◽  
Ease Of Use ◽  
Three Dimensions ◽  
Pairwise Distance ◽  
Control Group ◽  
Quantitative Methodology ◽  
Quasi Experimental ◽  
Experimental Group

AbstractThe objective of this article is to analyze the didactic functionality of a chatbot to improve the results of the students of the National University of Distance Education (UNED / Spain) in accessing the university in the subject of Spanish Language. For this, a quasi-experimental experiment was designed, and a quantitative methodology was used through pretest and posttest in a control and experimental group in which the effectiveness of two teaching models was compared, one more traditional based on exercises written on paper and another based on interaction with a chatbot. Subsequently, the perception of the experimental group in an academic forum about the educational use of the chatbot was analyzed through text mining with tests of Latent Dirichlet Allocation (LDA), pairwise distance matrix and bigrams. The quantitative results showed that the students in the experimental group substantially improved the results compared to the students with a more traditional methodology (experimental group / mean: 32.1346 / control group / mean: 28.4706). Punctuation correctness has been improved mainly in the usage of comma, colon and periods in different syntactic patterns. Furthermore, the perception of the students in the experimental group showed that they positively value chatbots in their teaching–learning process in three dimensions: greater “support” and companionship in the learning process, as they perceive greater interactivity due to their conversational nature; greater “feedback” and interaction compared to the more traditional methodology and, lastly, they especially value the ease of use and the possibility of interacting and learning anywhere and anytime.

scholarly journals Effects of Curcumin and Its Different Formulations in Preclinical and Clinical Studies of Peripheral Neuropathic and Postoperative Pain: A Comprehensive Review

2021 ◽  
Vol 22 (9) ◽  
pp. 4666
Author(s):  
Paramita Basu ◽  
Camelia Maier ◽  
Arpita Basu
Keyword(s):  
Neuropathic Pain ◽  
Postoperative Pain ◽  
Clinical Studies ◽  
Curcuma Longa ◽  
Somatosensory System ◽  
Positive Outcomes ◽  
Negative Effects ◽  
Acute Postoperative Pain ◽  
Peripheral Neuropathic Pain ◽  
Preclinical And Clinical Studies

Lesion or disease of the somatosensory system leads to the development of neuropathic pain. Peripheral neuropathic pain encompasses damage or injury of the peripheral nervous system. On the other hand, 10–15% of individuals suffer from acute postoperative pain followed by persistent pain after undergoing surgeries. Antidepressants, anticonvulsants, baclofen, and clonidine are used to treat peripheral neuropathy, whereas opioids are used to treat postoperative pain. The negative effects associated with these drugs emphasize the search for alternative therapeutics with better efficacy and fewer side effects. Curcumin, a polyphenol isolated from the roots of Curcuma longa, possesses antibacterial, antioxidant, and anti-inflammatory properties. Furthermore, the low bioavailability and fast metabolism of curcumin have led to the advent of various curcumin formulations. The present review provides a comprehensive analysis on the effects of curcumin and its formulations in preclinical and clinical studies of neuropathic and postoperative pain. Based on the positive outcomes from both preclinical and clinical studies, curcumin holds the promise of mitigating or preventing neuropathic and postoperative pain conditions. However, more clinical studies with improved curcumin formulations are required to involve its use as adjuvant to neuropathic and postoperative drugs.

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