Diagnosis of chronic low back pain (CLBP) is traditionally predicated on identifying underlying pathological or anatomical causes, with treatment outcomes modest at best.
Alternately, it is suggested that identification of underlying pain mechanisms with treatments targeted towards specific pain phenotypes may yield more success.
Differentiation between nociceptive and neuropathic components of CLBP is problematic; evidence suggests that clinicians fail to identify a significant neuropathic component in many CLBP patients. Continue reading
Given the complexity of chronic pain management, clinicians are challenged to move toward more rigorous assessment and individualized treatment to improve quality of life for all patients.
It has become increasingly clear that chronic pain does not refer to one disorder or underlying mechanism and cannot be assessed or treated with a one-size-fits-all approach.
Advances in our understanding have led to new, more effective patient assessment and treatment strategies. Continue reading
Treatment of Neuropathic Pain – Pharmacy Times – Jeffrey Fudin, PharmD, DAAPM, FASHP, FCCP; Jeffrey Bettinger, PharmD Candidate; and Erica Wegrzyn, BA, BS, PharmD – Apr 2017
INeuropathic pain is somatosensory system disease or damage, which can be caused by a wide variety of nerve-damaging diseases or medications affecting the peripheral or central nervous system
Definitions and Pathophysiology of Neuropathic Pain
Neuropathic pain has been described as “pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in the peripheral or central nervous system.” Continue reading
Sensory profiles are heterogeneous in neuropathic pain disorders, and subgroups of patients respond differently to treatment.
To further explore this, patients in the COMBO-DN study were prospectively assessed by the Neuropathic Pain Symptom Inventory (NPSI) at baseline, after initial 8-week therapy with either duloxetine or pregabalin, and after subsequent 8-week combination/high-dose therapy. Exploratory post hoc cluster analyses were performed to identify and characterize potential subgroups through their scores in the NPSI items
In patients not responding to initial 60 mg/d duloxetine,
- adding 300 mg/d pregabalin for combination treatment was particularly effective regarding the dimensions pressing pain and evoked pain,
- whereas maximizing the duloxetine dose to 120 mg/d appeared more beneficial regarding paresthesia/dysesthesia. Continue reading
Recently, we’ve seen several individuals at our center who have Ehlers-Danlos syndrome (EDS), a known connective tissue disorder associated with, among other things, hyperelasticity. Although there are several types of EDS, that’s not the focus of today’s blog post.
People have been referred to us who have severe and chronic pain of uncertain etiology.
Although it’s been well documented that people with EDS do experience chronic pain of varying quality, other conditions, fatigue, and pain- and fatigue-related disability, overall this syndrome has been poorly understood. Continue reading
Cannabinoid Receptor 2: Pain Treatment Without Tolerance or Withdrawal – reposted with edits from April 2015
This article about a promising new medicine derived from cannabis was published by the National Institute on Drug Abuse (NIDA), on their site “drugabuse.gov“. (Other branches of the same government, FDA and DEA, still classify cannabis as a Schedule I drug,)
Chronic cannabinoid receptor 2 activation reverses paclitaxel neuropathy without tolerance or cannabinoid receptor 1-dependent withdrawal.
The treatment of cancer pain is often among the approved uses of medical cannabis in states where it is legal. Continue reading
researchers investigated the use of vaporized cannabis for neuropathic pain (NeP) in patients with spinal cord injury (SCI) or disease.
NeP in SCI patients may result from altered sensory processing due to the injury.
Spinal cord injury patients treated with vaporized cannabis had a significant analgesic response over placebo. Continue reading
Review from practicalpainmanagement.com:
This article provides a useful overview of neuropathic pain. The authors begin by distinguishing it from other types of pain (nociceptive, inflammatory, and dysfunctional). They then go on to describe neurobiological mechanisms involved in neuropathic pain. Continue reading
Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathic Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | PLoS One. 2015 Mar | free full text PubMed
Acetyl-L-carnitine (ALC), a constructive molecule in fatty acid metabolism, is an agent potentially effective for treating peripheral neuropathic pain (PNP). Its effect, however, remains uncertain. We aimed to access the efficacy and safety of ALC for the treatment of patients with PNP.
The current evidence suggests that ALC has a moderate effect in reducing pain measured on VAS in PNP patients with acceptable safety. Larger trials with longer follow-up, however, are warranted to establish the effects. Continue reading
Neurons in the gyrus cinguli create a ‘pain memory’.
Nevian and colleagues’ discovery is the identification of a cellular mechanism in a brain region called gyrus cinguli, which is typically associated with the emotional aspects of pain. In a mouse model, the researchers found that neurons in this region are modified by chronic pain, establishing a form of “pain memory.”
“The neurons are constantly activated by a noxious stimulus,” explains Nevian, “thus building a memory trace for pain that becomes irreversible. Our idea was to understand this mechanism better to derive potential new treatment strategies.” Continue reading