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| Treatment recommendations for central neuropathic pain adapted from current evidence based literature 19-22 26
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#### Summary points
Neuropathic pain arises from damage, or pathological change, in the peripheral or central nervous system. It is usually a chronic condition that can be difficult to treat because standard treatment with conventional analgesics does not typically provide effective relief of pain. Patients with neuropathic pain commonly present t...
Context in source publication
Context 1
... multidisciplinary organisation focused specifically on pain research and treatment Oxford Pain Internet Site (Bandolier) (www.medicine.ox.ac.uk/bandolier/booth/ • painpag/#Chronic)-Based on the principles of evidence based medicine, this site has pulled together systematic reviews with pain as an outcome is recommended for peripheral neuropathic pain condi- tions can be used for central pain; α 2 -δ anticonvulsants, tricyclic antidepressants, and serotonin and norepine- phrine reuptake inhibitors are considered to be first or second choice. Table 2 gives data for therapeutic options in detail. ...
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Background
Chronic, mostly musculoskeletal pain is common among older adults. Little is known about the prognosis of chronic pain and the neuropathic pain qualities in older adults. We studied a cohort of community-dwelling older adults, clinically assessed their pain states, classified their type of pain (nociceptive, neuropathic or combined) and...
Objective:
To describe an approach that allows for a dedicated clinical assessment and accurate recognition of peripheral neuropathic pain in primary care and to provide an update on the available pharmacologic therapies MATERIALS AND METHODS: Medline was searched using the key word "neuropathic pain". Searches were refined for each pathophysiolog...
Diagnosis of neuropathic pain (NP) can be challenging. The ID Pain (ID-P) questionnaire, a screening tool for NP, has been used widely both in the original version and translated forms. The aim of this study was to develop an Arabic version of ID-P and assess its validity and reliability in detecting neuropathic pain. The original ID-P was translat...
[Purpose] The aim of this study was to determine the frequency, type, and location of pain in hemiplegic patients and the effects on rehabilitation results in our inpatient rehabilitation unit. [Subjects and Methods] Patients rehabilitated between January 2010 and July 2012 were investigated retrospectively. Properties of pain were recorded. Pre- a...
Objective: Identify the level of knowledge of the neurophysiology of pain in patients with chronic musculoskeletal pain and compare the level of knowledge of pain according to the type of musculoskeletal pain classification.
Methods: A cross-sectional study was conducted with 83 patients with chronic musculoskeletal pain. The classification of the...
Citations
... In clinical practice, pharmacotherapeutic interventions are often combined with other procedures, since a sufficient effect of monotherapy often cannot be achieved [12]. Early initiation of drug therapy is important. ...
Patients with chronic peripheral neuropathy suffer greatly and their quality of life is often restricted. Drug therapy can be accompanied by undesirable side effects and intolerances, or the hoped-for effect does not materialize. Therefore, in addition to drug therapy, attempts are also made to treat the physical symptoms with complementary procedures. In the case of severe forms, the search for a suitable form of therapy is difficult. Complex treatments can be an innovative way to treat peripheral neuropathy. At the same time, several different therapy methods are carried out at high frequency by a specialized treatment team. This study aimed to provide an overview of possible complementary forms of therapy. The focus was on a comparison of two interdisciplinary complex therapies that are used in severe cases in an acute inpatient care setting in Germany. The six dimensions (energy, sleep, pain, physicality, emotional response and social isolation) of the Nottingham Health Profile (NHP) were used to assess quality of life. Both complex treatments (naturopathic complex therapy/multimodal pain therapy) showed a significant reduction in impairment in all dimensions of the NHP. In addition, a multivariate analysis was carried out to take into account several influencing variables at the same time. At the time of admission to the hospital, the degree of chronicity was recorded for each patient. This allowed statements to be made about the effect of the respective therapy depending on the chronification stage of the patient. It has been shown that patients with acutely exacerbated pain with the highest degree of chronicity also benefit from both complex treatments. The naturopathic complex treatment gives the treatment team more options. Aspects such as nutrition, methods from phytotherapy and traditional Chinese medicine can be integrated into inpatient care. Thus, a patient-centered, holistic therapy can take place. However, an interdisciplinary holistic therapy requires more time for both the practitioner and the patient. This should be taken into account in the health systems in the context of the diagnosis related groups.
... The symptoms of neuropathic pain can develop within days of the fracture or take several weeks or months to manifest. 3 Neuropathic pain substantially reduces healthrelated quality of life 4 and people with neuropathic pain consume a substantial amount of healthcare resources. Estimates of direct medical costs attributable to neuropathic pain are around €2951 per patient per year, whilst direct non-medical costs have been estimated at around €1242 per patient per year and indirect costs (i.e. the value of time off work or absenteeism) at around €5492 per patient per year (in 2012 prices). ...
Introduction
Neuropathic pain is prevalent among people after lower limb fracture surgery and is associated with lower health-related quality of life and greater disability. This study estimates the financial cost and pain medication use associated with neuropathic pain in this group.
Methods
A secondary analysis using pain data collected over six postoperative months from participants randomised in the Wound Healing in Surgery for Trauma (WHiST) trial. Pain states were classified as pain-free, chronic non-neuropathic pain (NNP) or chronic neuropathic pain (NP). Cost associated with each pain state from a UK National Health Service (NHS) and personal social services (PSS) perspective were estimated by multivariate models based on multiple imputed data. Pain medication usage was analysed by pain state.
Results
A total of 934 participants who provided either 3- or 6-months pain data were included. Compared to participants with NP, those with NNP (adjusted mean difference -£730, p = 0.38, 95% CI −2368 to 908) or were pain-free (adjusted mean difference -£716, p = 0.53, 95% CI −2929 to 1497) had lower costs from the NHS and PSS perspective in the first three postoperative months. Over the first three postoperative months, almost a third of participants with NP were prescribed opioids and 8% were prescribed NP medications. Similar trends were observed by 6 months postoperatively.
Conclusion
This study found healthcare costs were higher amongst those with chronic NP compared to those who were pain-free or had chronic NNP. Opioids, rather than neuropathic pain medications, were commonly prescribed for NP over the first six postoperative months, contrary to clinical guidelines.
... impact of neuropathic pain's nature on the quality of life and the need for complex therapy [11]. The costs of NeP are substantial and include medical expenses and productivity loss, adding to the economic burden [12]. ...
Neuropathic pain is a complex and debilitating condition that affects millions of people worldwide. While several treatment options are available, they often have limited efficacy and are associated with adverse effects. In recent years, gels have emerged as a promising option for the treatment of neuropathic pain. Inclusion of various nanocarriers, such as cubosomes and niosomes, into gels results in pharmaceutical forms with higher drug stability and increased drug penetration into tissues compared to products currently marketed for the treatment of neuropathic pain. Furthermore, these compounds usually provide sustained drug release and are biocompatible and biodegradable, which makes them a safe option for drug delivery. The purpose of this narrative review was to provide a comprehensive analysis of the current state of the field and identify potential directions for future research in the development of effective and safe gels for the treatment of neuropathic pain, ultimately improving the quality of life for patients suffering from neuropathic pain.
... Pain and sensory abnormalities were considered as CPSP if they had newly developed following stroke and in the body parts corresponding to the brain territory of the stroke [1,3]. Other causes of pain, such as hemiplegic musculoskeletal shoulder pain, peripheral entrapment neuropathy, radiculopathy, and painful spasticity, were excluded based on signs and symptoms noted on physical examination, and on ultrasonography and electromyography [11][12][13]. Complex regional pain syndromes were excluded using the Budapest criteria [14]. ...
Central post-stroke pain (CPSP) is an intractable neuropathic pain that can occur following central nervous system injuries. Spino-thalamo-cortical pathway damage contributes to CPSP development. However, brain regions involved in CPSP are unknown and previous studies were limited to supratentorial strokes with cortical lesion involvement. We analyzed the brain metabolism changes associated with CPSP following pontine hemorrhage. Thirty-two patients with isolated pontine hemorrhage were examined; 14 had CPSP, while 18 did not. Brain glucose metabolism was evaluated using 18F-fluorodeoxyglucose-positron emission tomography images. Additionally, regions revealing metabolic correlation with CPSP severity were analyzed. Patients with CPSP showed changes in the brain metabolism in the cerebral cortices and cerebellum. Compared with the control group, the CPSP group showed significant hypometabolism in the contralesional rostral anterior cingulum and ipsilesional primary motor cortex (Puncorrected < 0.001). However, increased brain metabolism was observed in the ipsilesional cerebellum (VI) and contralesional cerebellum (lobule VIIB) (Puncorrected < 0.001). Moreover, increased pain intensity correlated with decreased metabolism in the ipsilesional supplementary motor area and contralesional angular gyrus. This study emphasizes the role of the many different areas of the cortex that are involved in affective and cognitive processing in the development of CPSP.
... Abnormal sensation with overlying pain in a neuroanatomical distribution [138] Fluctuating, dull-aching, widespread pain and comorbid symptoms (e.g., sleep, psychological, memory, and/or fatigue problems) [9] ± Sensory sensitivity (e.g., light, [63] smells [64] ) Diagnosis/screening Physical examination, imaging [113] Physical examination [138,139] ± confirmatory testing [129] , screening tools: Neuropathic Pain Questionnaire, [141] painDETECT (PD-Q) [142] Patient history [9] , screening tools: 2016 Fibromyalgia Survey Criteria [9,65] Treatment Pharmacologic: [124] NSAIDs, acetaminophen, opioids Interventional: [9,113,123] surgery, injections Nonpharmacologic: [129,145] adjunct integrative therapies Pharmacologic: [129,139,144] gabapentin/pregabalin, TCA, or SNRI; lidocaine patch, topical capsaicin. Interventional: [129,139] nerve blocks, nerve stimulation, intrathecal therapies Nonpharmacologic: [9,68] education, self-directed therapies Pharmacologic: [13] Lowdose TCA (e.g., cyclobenzaprine 5-20 mg at bedtime), SNRI (depression, fatigue), gabapentinoids (sleep, anxiety ...
... Abnormal sensation with overlying pain in a neuroanatomical distribution [138] Fluctuating, dull-aching, widespread pain and comorbid symptoms (e.g., sleep, psychological, memory, and/or fatigue problems) [9] ± Sensory sensitivity (e.g., light, [63] smells [64] ) Diagnosis/screening Physical examination, imaging [113] Physical examination [138,139] ± confirmatory testing [129] , screening tools: Neuropathic Pain Questionnaire, [141] painDETECT (PD-Q) [142] Patient history [9] , screening tools: 2016 Fibromyalgia Survey Criteria [9,65] Treatment Pharmacologic: [124] NSAIDs, acetaminophen, opioids Interventional: [9,113,123] surgery, injections Nonpharmacologic: [129,145] adjunct integrative therapies Pharmacologic: [129,139,144] gabapentin/pregabalin, TCA, or SNRI; lidocaine patch, topical capsaicin. Interventional: [129,139] nerve blocks, nerve stimulation, intrathecal therapies Nonpharmacologic: [9,68] education, self-directed therapies Pharmacologic: [13] Lowdose TCA (e.g., cyclobenzaprine 5-20 mg at bedtime), SNRI (depression, fatigue), gabapentinoids (sleep, anxiety ...
... [129] Neuropathic pain is characterized by pain originating from a region of the body with abnormal sensation. [138] Patients may report pain in the absence of any stimulus; pain in response to normally nonpainful stimuli, such as clothing or cold air (allodynia); and/or pain out of proportion to a noxious stimulus (hyperalgesia). [129,138] The character of the pain may range from abnormal sensations (e.g., tingling, numbness), including temperature differences (e.g., burning, cold), to pain that is sharp or stabbing. ...
Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health‐related quality of life (HRQOL) and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as GI bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including non‐pharmacologic therapies, to patients’ needs.
... The first-line pharmacological management of neuropathic and nociplastic pain is usually a combination of antiepileptics and antidepressants, as the patients usually do not respond to a single agent ( Figure 2) [42,56]. Whereas in cases of nociceptive pain, the treatment is typically guided by NSAIDs with various formulations and routes of administrations depending upon the location and character of pain [35,37]. ...
Chronic pain is known as ongoing pain that lasts longer than three months with increasing healing time. It is approximated that 20% of adults of different sexes, races, and socioeconomic backgrounds fall victim to chronic pain. It is a result of several factors and can have lifelong effects. Pain is a complex matter to measure; therefore, the physician needs to understand the patient's health state to create a management plan tending to each issue adequately. There are many complications of such pain, and it can interfere terribly with an individual's quality of life. This article has reviewed the complex pathogenesis of chronic pain and the spectrum of non-pharmacologic modalities and pharmacological treatment options. It has also explored the efficacy of certain drugs and underlined the importance of nonpharmacological options such as physical exercise, cognitive therapy, and physical modalities to treat chronic pain and all the conditions that accompany this disorder.
... Peripheral neuropathic pain (PNP) is very prevalent since it affects up to two-thirds of individuals with PN, regardless of etiology [10][11][12]. PNP is a challenging condition for clinicians to treat and patients often have a poor quality of life, independent of the disease severity [13,14], as the response to pharmacological treatment is often inadequate [15]. Often polypharmacy and/or the use of other non-pharmacological interventions are needed to optimally control pain [16,17]. ...
Introduction
Physical exercise appeared to be effective, when implemented as an adjuvant to the pharmacotherapy option, in a variety of painful conditions. Peripheral neuropathic pain (PNP) is very prevalent and it affects up to two-thirds of individuals with polyneuropathy (PN), regardless of etiology. The aim of this systematic review was to evaluate the currently available studies that assess adjuvant physical exercise for the management of PNP.
Methods
A systematic literature search was conducted in the PubMed international database. For the systematic search three medical subject headings (MeSH) were used. Term A was “physical exercise” OR “exercise” OR “activity” OR “workout” OR “training”; term B was “pain” OR “painful”; term C was “neuropathy” OR “polyneuropathy”. Additionally, three filters were used; human subjects, English language and full text. The reference lists of eligible papers and relevant reviews were also meticulously searched in order to include further relevant studies. Six papers eligible to be included were identified.
Results
Physical exercise in various forms can be of benefit in the management of PNP when used as adjuvant to the standard care. Overall, using the American Society of Interventional Pain Physicians (ASIPP) criteria the current best available evidence exists for both aerobic and muscle strengthening exercise programs (level II evidence). The intensity of the exercise seems to play a significant role, with higher intensity interval training programs more promising, though this remains to be confirmed in future studies.
Conclusions
Physical exercise is a promising non-pharmacological intervention for the management of PNP. Future RCTs should be conducted to make a face-to-face comparison of the available exercise treatments with the aim to design specific exercise programs for patients with PNP.
... First, fewer than half of patients are managed with a single treatment agent, and we lack a standardized management approach [6]. Similarly, current evidence does not address the long-term safety of combination therapy, nor does it support chronic opioid analgesics as first-line treatment [7,8]. Unfortunately, practitioners often rely on third-line therapies, many patients take chronic opioid analgesics, and much of neuropathic pain remains uncontrolled [4,[8][9][10][11]. ...
Objective
Neuropathic pain is complex and often refractory. Clinical hypnosis has emerged as a viable treatment for pain. This scoping review is the first comprehensive review of hypnosis for chronic neuropathic pain. It critically assesses available evidence noting practice implications, literature gaps, and future research opportunities.
Subjects
Individuals with chronic neuropathic pain treated with hypnosis.
Methods
Following PRISMA guidelines, we searched PubMed, CINAHL, Embase, and PsycInfo for studies for which the intervention and primary outcome(s) were associated with hypnosis and neuropathic pain, respectively. Included studies were empirical, in English, and published from January 1996—August 2021.
Results
Nine articles with 301 total participants were reviewed. Neuropathic pain included, for example, complex regional pain syndrome (CRPS), brachial neuralgia, and spinal cord injury. Hypnosis dose varied with administration and format. Six studies used comparators. Every trial demonstrated pain and quality-of-life benefits, with several controlled trials indicating hypnosis as superior to active comparator or standard of care. CRPS-specific studies showed notable improvements but had significant study limitations. Methodological weaknesses involved trial design, endpoints, and recruitment strategies.
Conclusions
The evidence is weak because of poor study design, yet encouraging both for analgesia and functional restoration in hard-to-treat chronic neuropathic pain conditions. We highlight and discuss key knowledge gaps and identify particular diagnoses with promising outcomes after hypnosis treatment. This review illustrates the need for further empirical controlled research regarding hypnosis for chronic neuropathic pain and provides suggestions for future studies.
... 8 Diagnosis of neuropathic pain was clinically made based on characteristic symptoms, clinical examination and medical history. 9 Patients who were not able to fill in the questionnaires were excluded. ...
Forty per cent of cancer pain associate neuropathic and nociceptive pain simultaneously, and refractory pain affects 15% of cancer pain. Methadone is an effective opioid in treating nociceptive pain and could have an effect on neuropathic pain. Uncertainty remains on its effects on the different subcomponents of neuropathic pain.
Objectives
To identify which subcomponents of neuropathic cancer pain are addressed using methadone.
Methods
An observational prospective cohort study of palliative care inpatients after rotation for refractory neuropathic cancer pain. Pain intensity was assessed weekly for 28 days, using a Visual Analogue Scale (VAS) and the Neuropathic Pain Symptom Inventory (NPSI).
Results
Forty-eight patients were included and 17 completed the 28 days follow-up. VAS pain rating decreased by at least 20 mm in 47% of patients and the pain intensity was significantly lower at day 28 with 53% of patients with a VAS inferior to 4 (p<0.001). The pressure/squeezing component (NPSI score) decreased by more than 2 points in 50% of patients.
A linear regression showed allodynia and pressure/squeezing were responsible for the largest part of the overall alleviation of pain (p=0.01).
Conclusions
Methadone could significantly improve neuropathic pain through a targeted effect of allodynia and its pressure/squeezing component.
... There can be hypo and hyperesthesia in the donor area. 6,7 Several analgesics like ibuprofen, acetaminophen, and tramadol are available and can be used. Postoperative infiltration of ropivacaine over strip harvesting area can significantly reduce the pain as well as fear of having the pain in linear excision surgery. ...
Hair transplant surgery per se has low risk, is relatively safe, and has minimum incidence of complications. However, it is a well-accepted fact that no medical science procedure exists without any potential risk of complications. The complication may be a single complaint in the form of pain, itching, dissatisfaction related to the procedure's outcome, or surgical complication in the form of infection, wound dehiscence or skin necrosis. Inadequate counselling increases unsatisfaction. Improper examination increases the complications, and incomplete medical history and history of allergy increases the risk during surgery.
The author collected data of his 2896 patients, operated over a period of 10 years, and recorded the complains and complications. The most common complications were sterile folliculitis, noted in 203 patients, vasovagal shock in seven patients of, hypertensive crisis in one patient, hiccups in six patients, facial edema after hair transplant in 18 patients, graft dislodgement in 8 patients, infection in two diabetic patients, minor necrotic patches in recipient area in three patients, keloid development in one patient, numbness in 18 cases, and hypersensitivity in recipient and/or donor area. Donor area effluvium was seen in one case and three patients showed recipient area effluvium. Twenty-six patients were not happy with the results, and five cases showed partial loss of implanted hair. The overall significant life-threatening or major complications were zero, but the total minor complications' percentage was 0.10%.
The key to minimize complaints and complications are detailed counselling, taking careful medical history and history of allergy, and proper examination of patients.
