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Causes of painful peripheral neuropathy
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Treatment of neuropathic pain is the primary focus of management for many patients with painful peripheral neuropathies. Neuropathic pain is a common feature of many peripheral neuropathies including those associated with diabetes, uremia, HIV infection, and alcohol abuse. Pain is also present in the majority of patients with idiopathic sensory and...
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Diabetic peripheral neuropathy is a common complication of diabetes mellitus that disturb the quality of life of affected persons. Although diabetic neuropathy includes many types with different pathogeneses and clinical manifestations, the most common type is chronic sensorimotor distal symmetrical polyneuropathy. Among a variety of symptoms due t...
Diabetes associated complications are major reason for morbidity and mortality associated with this disease and is major factor causing ramifications in the life of diabetic patients. Diabetic Neuropathy is one of diabetic complication having the most common occurrence. This disorder of peripheral nerves ends up in conduction deficits, deficit in n...
Patients with chronic pain often show disturbances in their body perception. Understanding the exact role played by pain is however complex, as confounding factors can contribute to the observed deficits in these clinical populations. To address this question, acute experimental pain was used to test the effect of lateralized pain on body perceptio...
Pediatric Complex Regional Pain Syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (me...
Citations
... 84 Another advantage is the possibility of combining it with other systemic drugs in order to achieve an additive effect without systemic drug interaction or additional side effects. 85 In addition to its efficacy and safety, local treatment with lidocaine is easy to administer and displays a good patient compliance. The possibility of coupling up to three plasters or trimming the plaster to fit different body sites allows a good adaptation to the particular pain site. ...
Topical lidocaine is widely used in current practice for a variety of pain conditions. This literature review shows that its limited absorption and relative lack of systemic adverse events are an attractive analgesic option for a number of vulnerable patients. Topical lidocaine has been approved by health authorities for the treatment of post-herpetic neuralgia in a number of countries, and studies present some degree of evidence of its efficacy and safety in postsurgical pain, diabetic peripheral neuropathy, carpal tunnel syndrome, chronic lower back pain and osteoarthritis. Topical lidocaine may be a great alternative alone or in addition to systemic drugs and non-pharmacological approaches for an optimized pain management and in multimodal analgesia.
... The improved survival of persons with HIV/AIDS on HAART has seen an increase in the prevalence of neurological conditions (Ferrari et al. 2006;Mehta et al. 2011;Wolfe & Barohn 2002). The results of our study confirm that PN is prevalent amongst persons on HAART in Busia County. ...
... Evidence in support of this view shows that HIV-associated neuropathic pain is common amongst persons living with HIV (Keltner et al. 2012;Wallace et al., 2007) and is associated with pain catastrophising and poor adherence to prescribed medication (Lucey et al. 2011). Moreover, it is related to poor outcomes and problematic treatment choices and a decreased quality of life (Ellis et al. 2010;Keltner et al. 2012) partly due to inappropriate classification, increased drug prescriptions (Attal & Bouhassira 2015;Wolfe & Barohn 2002) and visits to physicians as well as the illness from the pain itself and aggravating conditions (Colloca et al. 2017). Individuals usually feel a combination of symptoms, such as electric-like and burning sensations and pain from trivial (non-noxious) stimulation such as light touch (Colloca et al. 2017). ...
Background: Despite improved immunological and viral load control, the prevalence of HIV/AIDS-related peripheral neuropathy among survivors on highly active antiretroviral therapy (HAART) is rising globally raising public health concerns.
Objectives: To determine the prevalence and clinical characteristics of peripheral neuropathy amongst persons on HAART attending Comprehensive Care Clinics in Busia County, Kenya.
Method: This cross-sectional descriptive quantitative study utilised purposive sampling and included 289 adults living with HIV/AIDS. Data collection was undertaken using the Clinical HIV Associated Neuropathy Tool (CHANT) and analysed using the Statistical Package for the Social Sciences version 25.0.
Results: Of people on HAART, 68.17% (197 amongst 289) had peripheral neuropathy. The majority were female 76.8% (n = 222), 38.1% (n = 110) were between 41 and 50, and 35% (n = 101) were widowed. The most common primary symptom was reduced right foot big toe vibration (76.8%, n = 222). There was a strong positive relationship (r = 0.621, P = 0.000) between foot vibration and illness. There was a statistically significant influence of demographic characteristics of persons on HAART on PN as they accounted for 98.5% of the variance (R2 = 0.985).
Conclusion: Peripheral neuropathy is prevalent and is significantly influenced by socio-demographic characteristics of persons on HAART-PN. Early diagnosis and exercise guidance by physiotherapists is key in forestalling severe symptoms, disability and poor quality of life.
Clinical implications: There is need to screen persons living with HIV on HAART for PN to establish their medical, physiotherapy and rehabilitation needs. Early diagnosis will encourage healthcare workers to start interventions to prevent progression of impairment, onset of disability and decrease in quality of life. Therefore, adaptation of PN screening tools and physiotherapeutic interventions should be considered.
... 9 The advantage of local anesthesia is the possibility of its combination with systemic treatment so as to achieve an additive or synergistic effect without systemic drug interaction or additional side effects. 18 In addition to its efficacy and safety, local anesthesia with lidocaine cream is simple and easy to administer and shows good patient compliance. With injected local anesthetic, copyright. ...
Background and objectives
Pain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved patient outcomes, chest tube removal could be distressful experience for many patients. The aim of this trial was to test whether the addition of lidocaine cream would have a significant impact on the pain treatment during chest tube removal from patients who had undergone VATS for lung cancer.
Methods
This clinical trial was a double-blind randomized study. Forty patients with histologically confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled. All patients had standard perioperative care. Patients were randomly assigned to receive either epidural anesthesia plus placebo cream (placebo, Group P) or epidural anesthesia plus 7% lidocaine cream cutaneously around the chest tube insertion site and on the skin over the tube’s course 20 min (Group L) before chest drain removal.
Results
Visual analog scale (VAS) scores were higher in Group P (median 5, IQR, 3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured using a PainVision system were also higher in Group P (median 296.7, IQR, 216.9–563.5) than Group L (median 41.2, IQR, 11.8–97.0). VAS scores and the pain intensity associated with chest drain removal were significantly lower in Group L than Group P (p=0.0002 vs p<0.0001).
Conclusion
Analgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS.
Trial registration number
UMIN000013824.
... Peripheral neuropathy can affect sensory, motor or autonomic functions, either alone or in combination, which causes the loss of the sense of heat and burning pains. The nature of neuropathic pain can be sharp and deadly mode or ambiguous and difficult to localization (1), for instance burning and all referral pain, compressive and colic pains are used for paresthesia as well as dysphonia is also related to exaggerated levels of pain (hyperpathy) which is called neuropathy (2). Some studies have reported similar findings in terms of estimated prevalence of neuropathic pain, so that through clinical examination (visit in clinic by specialist) it was reported as 9.8%, using Berger criteria 3% and the S-LANSS (Leeds assessment of neuropathic symptoms and signs) 8.8%, and based on self-reporting, was 12.4% (3)(4)(5). ...
Background
Neuropathic pain is one of the most common complaints of neurologic clinics. Neuropathic pain is common and important and has inappropriate complications, and despite their importance, there is no effective treatment for them.
Objective
Because of the importance of neuropathic pain and safe and effective treatment, in this study, we determined the effect of topiramate versus gabapentin in patients with neuropathic pain.
Methods
In this randomized clinical trial, 30 patients with pain attributed to neuropathy who had at least one month of neuropathic pain in one area, were randomized to receive either gabapentin, titrated from 300 mg/day to a maximum of 900 mg/day or topiramate, titrated from 50 mg/day to a maximum of 100 mg/day after a 4-week period in the neurology clinic of Imam Khomeini Hospital of Urmia city, Iran in 2015. Complication, drug tolerance rate and pain were investigated. The pain was measured on visual analog scale (VAS). The data were analyzed by SPSS version 18, and using descriptive statistics, t-test, and ANOVA.
Results
In patients treated by gabapentin, the primary pain score was 74.33±10.29, this score decreased to 49.46±11.41 and 29.93±11.92 in the second and fourth week after intervention with gabapentin. In topiramate treated patients, the primary score was 76.00±9.69. It decreased to 54.33±10.31 and 34.20±6.09 at the same time. There were no significant differences between both groups in terms of average reduction of pain intensity [gabapentin group (59.73%) compared with topiramate (55%) (p=0.48)]. In the present study, the only complication reported in patients treated by gabapentin was drowsiness, but other uncommon side effects were nausea and dizziness.
Conclusion
This study showed that both gabapentin and topiramate reduce pain. Topiramate can also be a good alternative choice, if gabapentin has side effects for patients and it cannot be tolerated, topiramate can be a good replacement.
Trial registration
The trial was registered at the Thai Registry of Clinical Trials (http://www.clinicaltrials.in.th) with the TCTR ID: TCTR20170615001.
Funding
This research has been financially supported by Research Council of Urmia University of Medical Sciences.
... Localized neuropathic pain: an expert consensus Another advantage of topical administration is the possibility of combination with other pharmacologic agents acting systemically, so as to achieve an additive or synergistic effect without systemic drug interaction or additional side effects. 94 In addition to its efficacy and safety, local treatment with lidocaine is easy to administer and shows good patient compliance. The possibility of coupling up to three plasters or trimming the plaster to fit different body sites allows good adaptation to the particular pain site. ...
Background
Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments.
Materials and methods
Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice.
Results
Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously.
Conclusion
Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug–drug interactions.
... Coping skills, management of stress, and relaxation as well as biofeedback approaches are examples of lifestyles modification that can be considered beneficial. [26] As a large group of patients with diabetes have neuropathic pain, maintaining a balanced diet as well as glycemic control is highly recommended. [27] Other than lifestyle modification, many clinical trials and pharmacological investigations have been carried out to control and manage the complications related to neuropathy. ...
One of the most frequent problems in medical care is the management of patient presenting with chronic pain. Neuropathic pain is related to the injury or disorders affecting peripheral and central nervous systems and is resistant to over-the-counter analgesics and conventional treatment methods. The estimated prevalence for patients presenting classical symptoms of neuropathic pain is eventually reported to be 6%–8%. Several mechanisms have been considered and proposed for this disorder. The involvement of small and large sensory fibers as well as motor fibers is a reason for the presence of neuropathic pain. In addition to the lifestyle modification, a number of different therapeutic approaches and treatment protocols have been applied to control the neuropathic pain. However, management is still unsatisfactory. Comorbidities such as depression, anxiety, and sleep disorders are associated with this disorder and should be previously considered and eliminated. Analgesics, tricyclic antidepressants, anticonvulsant, serotonin– norepinephrine reuptake inhibitors, and local anesthetic agent as well as opioid analgesics and herbal medicaments such as capsaicin are known treatment lines for the management of neuropathic pain. Regarding the unsuccessfulness of single therapy, poly-pharmacy or combination therapy of two or more agents with synergistic mechanisms and different modes of action seems necessary.
... Twenty million people are affected with neuropathy in the United States. About 70% of these can be classified based on the etiology with diabetic neuropathy being the most common and approximately 30% of the peripheral neuropathies remain unclassified [2][3][4]. A Mayo clinic evaluation of 205 cases of neuropathy revealed 42% inherited disorders, 21% inflammatory demyelinating polyradiculopathy, 13% other acquired neuropathies and 24% remained undiagnosed [5]. ...
... The other proposed causes of neuropathy include other metabolic disorders, infections, inflammatory conditions, hereditary, toxins and cancer. Some series report that about 25% of the neuropathy patients do not have any known cause identified and are categorized as cryptogenic or idiopathic [4]. There have been studies previously looking at the etiology of neuropathies at various sites individually [2,3,5]. ...
... Approximately the same numbers of patients were seen in the North American and South American clinics during this period. The percentage of patients with cryptogenic neuropathy in North America and South America is similar to that mentioned in literature [4]. This is an important and largely underdiagnosed and neglected category of neuropathy. ...
Abstract Peripheral neuropathy is a common neurological disorder. There may be important differences and similarities in the diagnosis of peripheral neuropathy between North America (NA) and South America (SA). Neuromuscular databases were searched for neuropathy diagnosis at two North American sites, University of Kansas Medical Center and University of Texas Southwestern Medical Center; and one South American site, Federal Fluminense University in Brazil. All patients were included into one of six major categories: immune-mediated, diabetic, hereditary, infectious/inflammatory, systemic/metabolic /toxic (not diabetic), and cryptogenic. A comparison of the number of patients in each category was made between North America and South America databases. Total number of cases in North America was 1090 and in South America was 1034. Immune-mediated: NA 215 (19.7%), SA 191(18%); Diabetic: NA 148 (13.5%), SA 236 (23%); Hereditary: NA 292 (26.7%), SA103 (10%); Infectious/inflammatory: NA 53(4.8%), SA 141 (14%); Systemic/metabolic/toxic: NA 71(6.5%), SA 124(12%); Cryptogenic: NA 311(28.5%), SA 239 (23%). Some specific neuropathy comparisons were: hereditary neuropathies (Charcot Marie Tooth cases) in NA 246/292 (84.2%) and SA 60/103 (58%); familial amyloid neuropathy in SA 31/103(30%) and none in NA. Among infectious neuropathies, HTLV-1 neuropathy in SA were 36/141(25%), Chagas disease in SA 13/141(9%) and none for either in NA; Neuropathy due to leprosy -NA 26/53 (49%) and SA 39/141(28%). South America tertiary care centers are more likely to see patients with infectious, diabetic and hereditary disorders such as familial amyloid neuropathies. North America tertiary centers are more likely to see patients with CMT. Immune neuropathies and cryptogenic neuropathies were seen equally in North America and South America.
... The heterogeneity (eg, ethnicity, age, sex) and complexity (eg, disease processes, underlying mechanisms) of the chronic pain population, including DPN patients, is well recognized and may partly explain the large variability in the response to pharmacological treatment. 15,16 In the current study a mathematical pharmacodynamic model was developed, considering the time course of response, to quantify the magnitude and onset/offset times of the effect of capsaicin 8% patch in the treatment of DPN. In addition, a mixture model was applied to objectively match patterns in pain-associated behavior (NPRS). ...
Treatment of chronic pain is associated with high variability in the response to pharmacological interventions. A mathematical pharmacodynamic model was developed to quantify the magnitude and onset/offset times of effect of a single capsaicin 8% patch application in the treatment of painful diabetic peripheral neuropathy in 91 patients. In addition, a mixture model was applied to objectively match patterns in pain-associated behavior. The model identified four distinct subgroups that responded differently to treatment: 3.3% of patients (subgroup 1) showed worsening of pain; 31% (subgroup 2) showed no change; 32% (subgroup 3) showed a quick reduction in pain that reached a nadir in week 3, followed by a slow return towards baseline (16% ± 6% pain reduction in week 12); 34% (subgroup 4) showed a quick reduction in pain that persisted (70% ± 5% reduction in week 12). The estimate of the response-onset rate constant, obtained for subgroups 1, 3, and 4, was 0.76 ± 0.12 week⁻¹ (median ± SE), indicating that every 0.91 weeks the pain score reduces or increases by 50% relative to the score of the previous week (= t½). The response-offset rate constant could be determined for subgroup 3 only and was 0.09 ± 0.04 week⁻¹ (t½ 7.8 weeks). The analysis allowed separation of a heterogeneous neuropathic pain population into four homogenous subgroups with distinct behaviors in response to treatment with capsaicin. It is argued that this model-based approach may have added value in analyzing longitudinal chronic pain data and allows optimization of treatment algorithms for patients suffering from chronic pain conditions.
... Tricyclic antidepressants (TCAs), though often the first choice treatment in most patients, have significant side effects including sedation and various cardiovascular issues, and they often require several days of treatment prior to producing positive effects [7,16,18]. Anticonvulsants, like the TCAs, are only partially effective in the majority of patients suffering from chemotherapy induced pain [2,18]. Opioids, though often prescribed for moderate to severe pain, are sometimes avoided because of their potential for dependence and tolerance, scheduling issues and side effects [5,10]. ...
Painful peripheral neuropathy is a common side effect of cancer chemotherapy. in some cases, the pain diminishes within days or weeks after treatment, while in other cases is long-lasting. Since several different mechanisms are supposed to be involved in neuropathic pain, we evaluated the effect of dextromethorphan, gabapentin, amitriptyline and tramadol on vincristine-induced peripheral neuropathy. In the experiment we used adult male NMRI mice (25 35 g; N = 72) divided in six groups: control group (C), vincristine group (VCR), dextromethorphan and vincristine group (DMV), gabapentine and vincristine group (GBV), amitriptyline and vincristine group (AMV), tramadol and vincristine group (TRV). Vincristine (100 mu g/kg-bw) was administered intraperitoneally daily for 11 days. Dextromethorpan (20 mg/kg-bw), gabapentin (150 mg/kg-bw), amitriptyline (25 mg/kg-bw) and tramadol (5 mg/kg-bw) were orally administered 11 days concomitantly with vincristine. The thermal sensitivity was evaluated in the 7th and 11th post-treatment days. We recorded the nociceptive reaction latencies in response to a given thermal stimulus 38 C (thermal allodynia) and 52 degrees C (thermal hyperalgesia) using the hot plate test (Ugo Basile Hot Plate). No thermal allodynia was observed. On day 7 a statistically significant reduction of the nociceptive reaction latencies was observed on VCR group 5.74 +/- 1.72 s. (p< 0.001), GBV group 6.32 +/- 1.79 s. (p< 0.001), and AMV group 6.13 +/- 2.25 s. (p< 0.005). Tramadol produced a statistically significant increase of nociceptive reaction latencies with 22.52 % (p< 0.05) compared to VCR group. These results show that tramadol, that has a double mechanism of action: it binds with a low affinity to mu-opioid receptors, and it activates central monoaminergic pathways inhibiting the neuronal uptake of serotonin and noradrenalin, is highly effective to reverse neuropathic hyperalgesia produced by vincristine to mice in the hot plate test.
... The mainstay of the treatment of pain in neuropathies are tricyclic antidepressants and anticonvulsants. The available evidence for the efficacy of these drugs has repeatedly been reviewed, and treatment algorithms have been developed [65][66][67][68][69]. Gabapentin, initially investigated for the treatment of painful diabetic neuropathy and postherpetic neuralgia, has meanwhile proved efficacious for a variety of neuropathic pain states [10]. ...
To summarize the current understanding of clinical assessment, pathophysiology, and treatment of pain in neuropathies, focusing on selected entities in which the understanding of the mechanisms underlying pain has advanced recently.
Ongoing studies are classifying the symptoms and signs of painful neuropathies, assuming that this approach may indicate particular pathomechanisms leading to more rational treatment. Nerve injury induces a large number of cellular changes, the relevance of which for the occurrence of pain is still under investigation. In models of diabetic neuropathy, an altered distribution of sodium channels, hyperexcitability of neurons, and changes in spinal connectivity seem to underlie the development of pain. The role of inflammatory mediators has been explored in inflammatory and degenerative neuropathies. Second messenger pathways contributing to hyperalgesia in various neuropathies have been identified, opening up new treatment options. A number of newer and older drugs have been studied for their use in painful neuropathies in clinical trials. Epidemiology has shown that, despite the availability of drugs with moderate efficacy in the treatment of neuropathic pain, a large percentage of patients do not gain access to them.
Advances in the standardization of assessment of patients with painful neuropathies are beginning to have an impact on how clinical studies are designed. Major progress has been made in the understanding of cellular and molecular changes after nerve injury, but their relevance for the pathophysiology of pain in neuropathies has still to be determined.
