Central neuropathic pain: syndromes, pathophysiology, and treatments

2008 ◽  
pp. 374-387 ◽  
Author(s):  
James C Watson
Keyword(s):  
Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes

Ketamine for acute and subacute pain in opioid-tolerant patients

2018 ◽  
Vol 4 (3) ◽  
pp. 173 ◽  
Author(s):  
Shoshana Chazan, RN ◽  
Margaret P. Ekstein, MD ◽  
Nissim Marouani, MD ◽  
Avi A. Weinbroum, MD
Keyword(s):  
Neuropathic Pain ◽  
Epidural Analgesia ◽  
Severe Pain ◽  
Bone Pain ◽  
Phantom Pain ◽  
Chronic Ischemia ◽  
Central Neuropathic Pain ◽  
Pain Syndromes ◽  
Metastatic Bone Pain ◽  
New Onset

Prolonged acute pain, especially that of oncologic neurological origin, is at times difficult to control; it is seldom entirely alleviated by opioids. We report eight patients with severe pain, three of whom suffered from new onset oncologic metastatic bone pain, others had previous pain syndromes and presented with exacerbation of pain. Pain was associated with hyperalgesia and allodynia phenomena in two patients and with phantom pain in a third one. Tolerance to opioids had developed, and high IV doses of morphine, meperidine or fentanyl, and patient-controlled intravenous and epidural analgesia were insufficient. Several patients became dependent on opioids and could not be weaned from assisted ventilation.Pain was controlled with decreasing adjunct doses of ketamine. Within 5-10 days of ketamine and opioid protocols, pain was controlled and after an additional 5-7 days, ketamine could be stopped and pain controlled on oral regimens compatible with outpatient care.Ketamine is an efficient adjuvant analgesic for intractable severe pain, caused by metastasis, trauma, chronic ischemia, or central neuropathic pain. It is effective even when mega doses of IV, epidural, or oral opioids prove ineffective and when signs of tolerance have developed.

Effects of Gabapentin on the Different Components of Peripheral and Central Neuropathic Pain Syndromes: A Pilot Study

1998 ◽  
Vol 40 (4) ◽  
pp. 191-200 ◽  
Author(s):  
Nadine Attal ◽  
Louis Brasseur ◽  
Fabrice Parker ◽  
Marcel Chauvin ◽  
Didier Bouhassira
Keyword(s):  
Neuropathic Pain ◽  
Pilot Study ◽  
Central Neuropathic Pain ◽  
Pain Syndromes

scholarly journals Central Neuropathic Pain Syndromes

2016 ◽  
Vol 91 (3) ◽  
pp. 372-385 ◽  
Author(s):  
James C. Watson ◽  
Paola Sandroni
Keyword(s):  
Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes

Neuropathic pain

2016 ◽  
Author(s):  
Sathiji Nageshwaran ◽  
Heather C Wilson ◽  
Anthony Dickenson ◽  
David Ledingham
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Diabetic Neuropathy ◽  
Clinical Features ◽  
Phantom Pain ◽  
Evidence Based ◽  
Post Herpetic Neuralgia ◽  
Central Neuropathic Pain ◽  
Pain Syndromes

This chapter on neuropathic pain discusses the classification, clinical features, and evidence-based management of major neuropathic pain syndromes (painful polyneuropathy, diabetic neuropathy, post-herpetic neuralgia, HIV neuropathy, cancer neuropathic pain, phantom pain, traumatic neuropathic pain, chronic radiculopathy, central neuropathic pain, and trigeminal neuralgia).

scholarly journals Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes

2022 ◽  
Vol 12 ◽  
Author(s):  
Michael K. Racke ◽  
Elliot M. Frohman ◽  
Teresa Frohman
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Disease Course ◽  
Central Neuropathic Pain ◽  
Muscular Pain ◽  
Clinical Vignettes ◽  
Pain Syndromes

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

Peripheral and central neuropathic pain syndromes

2000 ◽  
Vol 57 (11) ◽  
pp. 698-703
Author(s):  
Rodic ◽  
Cavigelli
Keyword(s):  
Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes

Ein bedeutender Teil der rückenmarkgeschädigten Patienten leidet an chronischen Schmerzen. Besonders belastend und invalidisierend ist das neuropathische Schmerzsyndrom. Der Schmerz hat hier nicht mehr die Funktion eines protektiven Warnsignals, sondern stellt sich als dominierendes Symptom der Rückenmarkläsion dar. Es ist nicht selten mit einer erheblichen Beeinträchtigung der Lebensqualität verbunden. Der Weg zur Diagnose und die zur Verfügung stehenden therapeutischen Maßnahmen werden aufgezeichnet.

scholarly journals A.02 Long-term outcomes in the management of central neuropathic pain syndromes

2018 ◽  
Vol 45 (s2) ◽  
pp. S9-S9
Author(s):  
MD Staudt ◽  
AJ Clark ◽  
AS Gordon ◽  
ME Lynch ◽  
PK Morley-Forster ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Primary Outcome ◽  
Pain Interference ◽  
Peripheral Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes ◽  
Cord Injury ◽  
Patient Reported

Background: Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, spinal cord injury, or multiple sclerosis. These syndromes are much less common than peripheral etiologies, with less known regarding optimal treatment. The objective of this study was to determine the long-term clinical effectiveness of the management of central relative to peripheral neuropathic pain at tertiary pain centers. Methods: Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified from a prospective observational cohort from seven Canadian tertiary centers. Data regarding patient -characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome was the composite of reduced average pain intensity and pain interference. Secondary outcomes included assessments of function, mood, and quality-of-life. Results: At 12-month follow-up, 13.5% (95%CI,5.6-25.8) of patients achieved ≥30% reduction in pain, whereas 38.5% (95%CI,25.3-53.0) achieved a ≥1 point reduction in pain interference; 9.6% (95%CI,3.2-21.0) of patients achieving both these measures. Patients with peripheral neuropathic pain were more likely to achieve this primary outcome at 12-months (25.3% of patients; 95%CI,21.4-29.5) (p=.012). Conclusions: Patients with central neuropathic pain were less likely to achieve a meaningful improvement in pain and function compared to patients with peripheral neuropathic pain at 12-month follow-up.

scholarly journals Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study

2018 ◽  
Vol 45 (5) ◽  
pp. 545-552 ◽  
Author(s):  
Michael D. Staudt ◽  
Alexander John Clark ◽  
Allan S. Gordon ◽  
Mary E. Lynch ◽  
Pat K. Morley-Forster ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Primary Outcome ◽  
Data Sets ◽  
Long Term Outcomes ◽  
Peripheral Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes ◽  
Observational Cohort

AbstractBackground:Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers.Methods:Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction.Results:At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012).Conclusion:Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.

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