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Albrecht PJ, Liu Y, Houk G, Ruggiero B, Banov D, Dockum M, Day A, Rice FL, Bassani G. Cutaneous targets for topical pain medications in patients with neuropathic pain: individual differential expression of biomarkers supports the need for personalized medicine. Pain Rep 2024; 9:e1119. [PMID: 38375092 PMCID: PMC10876238 DOI: 10.1097/pr9.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/30/2023] [Accepted: 11/07/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Numerous potential cutaneous targets exist for treating chronic pain with topically applied active pharmaceutical ingredients. This preliminary human skin tissue investigation was undertaken to characterize several key biomarkers in keratinocytes and provide proof-of-principle data to support clinical development of topical compounded formulations for peripheral neuropathic pain syndromes, such as postherpetic neuralgia (PHN). Objectives The study intended to identify objective biomarkers in PHN skin on a patient-by-patient personalized medicine platform. The totality of biopsy biomarker data can provide a tissue basis for directing individualized compounded topical preparations to optimize treatment efficacy. Methods Referencing 5 of the most common actives used in topical pain relief formulations (ketamine, gabapentin, clonidine, baclofen, and lidocaine), and 3 well-established cutaneous mediators (ie, neuropeptides, cannabinoids, and vanilloids), comprehensive immunolabeling was used to quantify receptor biomarkers in skin biopsy samples taken from ipsilateral (pain) and contralateral (nonpain) dermatomes of patients with PHN. Results Epidermal keratinocyte labeling patterns were significantly different among the cohort for each biomarker, consistent with potential mechanisms of action among keratinocytes. Importantly, the total biomarker panel indicates that the enriched PHN cohort contains distinct subgroups. Conclusion The heterogeneity of the cohort differences may explain studies that have not shown statistical group benefit from topically administered compounded therapies. Rather, the essential need for individual tissue biomarker evaluations is evident, particularly as a means to direct a more accurately targeted topical personalized medicine approach and generate positive clinical results.
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Affiliation(s)
| | - Yi Liu
- Professional Compounding Centers of America (PCCA), Houston, TX, USA
| | - George Houk
- Integrated Tissue Dynamics, LLC (INTiDYN), Rensselaer, NY, USA
| | - Beth Ruggiero
- Integrated Tissue Dynamics, LLC (INTiDYN), Rensselaer, NY, USA
| | - Daniel Banov
- Professional Compounding Centers of America (PCCA), Houston, TX, USA
| | - Marilyn Dockum
- Integrated Tissue Dynamics, LLC (INTiDYN), Rensselaer, NY, USA
| | - A.J. Day
- Professional Compounding Centers of America (PCCA), Houston, TX, USA
| | - Frank L. Rice
- Integrated Tissue Dynamics, LLC (INTiDYN), Rensselaer, NY, USA
| | - Gus Bassani
- Professional Compounding Centers of America (PCCA), Houston, TX, USA
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Ffrench C, Finn D, Velligna A, Ivory J, Healy C, Butler K, Sezgin D, Carr P, Probst S, McLoughlin A, Arshad S, McIntosh C, Gethin G. Systematic review of topical interventions for the management of pain in chronic wounds. Pain Rep 2023; 8:e1073. [PMID: 37711431 PMCID: PMC10499071 DOI: 10.1097/pr9.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/09/2022] [Accepted: 12/24/2022] [Indexed: 09/16/2023] Open
Abstract
Chronic wounds adversely affect quality of life. Pain is associated with chronic wounds, and its impact can vary according to wound aetiology, condition, and patient factors. This systematic review examined the effectiveness of topical interventions in the management chronic wound-related pain guided by PRISMA recommendations of randomised controlled trials (RCTs) where pain reduction is the primary outcome. Inclusion criteria were adults (older than 18 years) with chronic venous, arterial, diabetic, or pressure ulcers where pain has been managed through topical administration of pharmacological/nonpharmacological agents. Searches were conducted in Ovid Embase, Ovid MEDLINE, EBSCOhost, CINAHL, CENTRAL, PubMed, Web of Science, and Scopus. Studies were screened for eligibility; risk of bias and data were extracted by 2 independent assessors. Searches retrieved 10,327 titles and abstracts (7760 after deduplication). Nine full texts (1323 participants) examining ibuprofen (n = 4), morphine (n = 2), BWD + PHMB [polihexanide-containing biocellulose wound dressing] (n = 1), and EMLA (n = 2) were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was not possible, but initial exploration suggests improved outcomes (reduced pain) for ibuprofen when compared with controls. Two studies involving morphine showed conflicting findings. Included studies often had small samples, and considering confounding factors (eg, comorbidities), the results should be interpreted with caution. Review of included studies suggests that topical interventions may provide pain relief in individuals with chronic wounds. Further adequately powered RCTs are recommended to assess the efficacy of topical interventions for the management of chronic wound-related pain.
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Affiliation(s)
- Cathal Ffrench
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
| | - David Finn
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
- Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Akke Velligna
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
| | - John Ivory
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Irish Research Council (IRC), Dublin, Ireland
| | - Catherine Healy
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
- Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Karen Butler
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
| | - Peter Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Sebastian Probst
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
- Care Directorate, University Hospital Geneva, Geneva, Switzerland
| | - Aonghus McLoughlin
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Department of Medicine, University of Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | - Sundus Arshad
- Department of Medicine, University of Galway, Galway, Ireland
| | - Caroline McIntosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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Liu Y, May BH, Hyde AJ, He Y, Guo X, Zhang AL, Lu C, Xue CC, Zhang H. Topical Traditional Chinese Medicines for Cancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Integr Cancer Ther 2023; 22:15347354231210870. [PMID: 37962002 PMCID: PMC10647965 DOI: 10.1177/15347354231210870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Safe and effective management of cancer-related pain is a worldwide challenge. In the search for treatment options, natural products used in Chinese herbal medicines (CHMs) have received attention in clinical studies for their effects on cancer-related pain. The objective of this systematic review is to evaluate the clinical evidence for topically applied CHMs as adjunctive treatments for cancer pain management. METHODS Nine biomedical databases and 4 clinical trial registries were searched for randomized-controlled trials (RCTs) that reported measures of pain and/or quality of life. Risk of bias was assessed using the Cochrane tool. Meta-analysis employed mean difference (MD) with 95% confidence intervals (random effects). RESULTS Twenty (20) RCTs (1636 participants) met the inclusion criteria. Meta-analyses were grouped based on the comparisons and outcome measures. For pain intensity, there was a greater reduction in the topical CHM group versus placebo (MD -0.72 [-1.04, -0.40]), no difference when compared to tramadol (MD -0.15 [-0.38, 0.08]), and a greater reduction when topical CHMs were combined with conventional analgesic medications (MD -0.67 [-0.93, -0.40]). Analgesic onset time was reduced in the CHM group compared to tramadol (MD -26.02 [-27.57, -24.47] minutes), and for CHMs combined with conventional medications (MD -19.17 [-21.83, -16.52] minutes). When CHMs were combined with analgesic medications, improvements were found for duration of analgesia (MD 1.65 [0.78, 2.51] hours), analgesic maintenance dose (MD -31.72 [-50.43, -13.01] milligrams/day), and quality of life. CONCLUSION Addition of topical CHMs to conventional analgesic medications was associated with improved outcomes for pain intensity, some other pain-related outcomes, and measures of quality of life. Limitations included methodological issues in some studies and considerable heterogeneity in some pooled results.
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Affiliation(s)
- Yihong Liu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Brian H. May
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Anna J. Hyde
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yihan He
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Chuanjian Lu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Haibo Zhang
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Albrecht PJ, Houk G, Ruggiero E, Dockum M, Czerwinski M, Betts J, Wymer JP, Argoff CE, Rice FL. Keratinocyte Biomarkers Distinguish Painful Diabetic Peripheral Neuropathy Patients and Correlate With Topical Lidocaine Responsiveness. FRONTIERS IN PAIN RESEARCH 2021; 2:790524. [PMID: 35295428 PMCID: PMC8915676 DOI: 10.3389/fpain.2021.790524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/03/2021] [Indexed: 01/11/2023] Open
Abstract
This study investigated quantifiable measures of cutaneous innervation and algesic keratinocyte biomarkers to determine correlations with clinical measures of patient pain perception, with the intent to better discriminate between diabetic patients with painful diabetic peripheral neuropathy (PDPN) compared to patients with low-pain diabetic peripheral neuropathy (lpDPN) or healthy control subjects. A secondary objective was to determine if topical treatment with a 5% lidocaine patch resulted in correlative changes among the quantifiable biomarkers and clinical measures of pain perception, indicative of potential PDPN pain relief. This open-label proof-of-principle clinical research study consisted of a pre-treatment skin biopsy, a 4-week topical 5% lidocaine patch treatment regimen for all patients and controls, and a post-treatment skin biopsy. Clinical measures of pain and functional interference were used to monitor patient symptoms and response for correlation with quantitative skin biopsy biomarkers of innervation (PGP9.5 and CGRP), and epidermal keratinocyte biomarkers (Nav1.6, Nav1.7, CGRP). Importantly, comparable significant losses of epidermal neural innervation (intraepidermal nerve fibers; IENF) and dermal innervation were observed among PDPN and lpDPN patients compared with control subjects, indicating that innervation loss alone may not be the driver of pain in diabetic neuropathy. In pre-treatment biopsies, keratinocyte Nav1.6, Nav1.7, and CGRP immunolabeling were all significantly increased among PDPN patients compared with control subjects. Importantly, no keratinocyte biomarkers were significantly increased among the lpDPN group compared with control. In post-treatment biopsies, the keratinocyte Nav1.6, Nav1.7, and CGRP immunolabeling intensities were no longer different between control, lpDPN, or PDPN cohorts, indicating that lidocaine treatment modified the PDPN-related keratinocyte increases. Analysis of the PDPN responder population demonstrated that increased pretreatment keratinocyte biomarker immunolabeling for Nav1.6, Nav1.7, and CGRP correlated with positive outcomes to topical lidocaine treatment. Epidermal keratinocytes modulate the signaling of IENF, and several analgesic and algesic signaling systems have been identified. These results further implicate epidermal signaling mechanisms as modulators of neuropathic pain conditions, highlight a novel potential mode of action for topical treatments, and demonstrate the utility of comprehensive skin biopsy evaluation to identify novel biomarkers in clinical pain studies.
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Affiliation(s)
- Phillip J. Albrecht
- Neuroscience and Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY, United States
- Division of Health Sciences, University at Albany, Albany, NY, United States
- *Correspondence: Phillip J. Albrecht
| | - George Houk
- Neuroscience and Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY, United States
| | - Elizabeth Ruggiero
- Neuroscience and Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY, United States
| | - Marilyn Dockum
- Neuroscience and Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY, United States
| | | | - Joseph Betts
- Neuroscience and Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY, United States
| | - James P. Wymer
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Charles E. Argoff
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Frank L. Rice
- Neuroscience and Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY, United States
- Division of Health Sciences, University at Albany, Albany, NY, United States
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Casula E, Letizia Manca M, Manconi M. An integrative review on the uses of plant-derived bioactives formulated in conventional and innovative dosage forms for the local treatment of damaged nasal cavity. Int J Pharm 2021; 610:121229. [PMID: 34715259 DOI: 10.1016/j.ijpharm.2021.121229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 12/22/2022]
Abstract
Plants and their derivates have been used as medicines for centuries and today is being re-discovered their usefulness for the human health. The therapeutic properties of phytochemicals are re-evaluated under the light of medical and pharmacological research, pushed by a constantly growing market demand, where consumers trust more natural products than synthetic drugs. New studies are enlightening the effectiveness of phytochemicals against a wide range of ailments, nevertheless very few evaluate the efficacy of topical formulations based on natural bioactive molecules in the treatment of nasal mucosal diseases. This review aims at exploring this little covered topic. An overview on the properties and functionality of the nasal mucosa and the different diseases affecting it has been provided. We summarized various nasal dosage forms containing natural bioactive and explored how innovative delivery systems loading phytochemicals can improve the treatment results. Finally, the potential use of novel nanocarriers for the treatment of nasal ailments has been covered as well.
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Affiliation(s)
- Eleonora Casula
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy
| | - Maria Letizia Manca
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy.
| | - Maria Manconi
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy
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6
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Corona A, Bigelow A. Conservative Management of Patients with End-Stage Renal Disease #408. J Palliat Med 2021; 24:287-288. [PMID: 33522853 DOI: 10.1089/jpm.2020.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Russo J, Fiegel J, Brogden NK. Rheological and Drug Delivery Characteristics of Poloxamer-Based Diclofenac Sodium Formulations for Chronic Wound Site Analgesia. Pharmaceutics 2020; 12:pharmaceutics12121214. [PMID: 33333773 PMCID: PMC7765230 DOI: 10.3390/pharmaceutics12121214] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic wounds are a significant and growing health problem, and clinical treatment is often a painful experience. A topical dosage form would be optimal to treat this pain. Poloxamer 407, a thermosensitive polymer that is a liquid at low temperatures but gels at higher temperatures, is well suited to administer topical analgesics to chronic wound sites. The goal of this study was to evaluate the gelation and drug delivery properties of poloxamer 407 gels containing diclofenac sodium for potential use in chronic wound analgesic delivery. The gelation properties of poloxamer formulations were evaluated rheologically. Drug delivery properties of poloxamers loaded with diclofenac sodium were evaluated using snakeskin dialysis membranes, intact porcine ear skin, and porcine ear skin impaired via tape stripping. A commercial gel product and a solution of diclofenac sodium in water were used as control formulations. Poloxamer concentration and gelation temperature varied inversely, and the addition of higher concentrations of diclofenac sodium correlated to significant increases in poloxamer gelation temperature. Poloxamer solutions were effective in limiting the permeation of diclofenac sodium through membranes with impaired barrier properties, and delivery of diclofenac sodium from poloxamer 407 did not vary significantly from delivery observed from the commercial gel product. The amount of drug delivered in 24 h did not change significantly with changes in poloxamer 407 concentration. The results of this study indicate that poloxamer 407 may be a useful formulation component for administration of an analgesic product to a chronic wound site.
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Affiliation(s)
- Jackson Russo
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA 52242, USA;
| | - Jennifer Fiegel
- Department of Chemical and Biochemical Engineering, The University of Iowa, Iowa City, IA 52242, USA;
| | - Nicole K. Brogden
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA 52242, USA;
- Department of Dermatology, The University of Iowa, Iowa City, IA 52242, USA
- Correspondence:
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Gudin JA, Dietze DT, Hurwitz PL. Improvement of Pain and Function After Use of a Topical Pain Relieving Patch: Results of the RELIEF Study. J Pain Res 2020; 13:1557-1568. [PMID: 32617016 PMCID: PMC7326193 DOI: 10.2147/jpr.s258883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/19/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Pain is the most common reason for patients to consult primary care providers. Identification of effective treatments with minimal adverse events is critical to safer opioid-sparing and multi-modal approaches to pain treatment. Topical analgesic patches target medication to peripheral sites of pain while potentially avoiding adverse effects associated with systemic medications. Opioids, prescription nonsteroidal anti-inflammatory drugs, and over-the-counter oral medications are associated with systemic toxicities, increasing morbidity and mortality. This study evaluated a topical analgesic pain-relieving patch in reducing pain severity and improving function in patients with mild to moderate arthritic, neurological, or musculoskeletal pain. PATIENTS AND METHODS This Institutional Review Board-approved study evaluated the effectiveness of a topical pain-relieving patch in reducing Brief Pain Inventory (BPI) scores in patients. The treatment group (TG) (n=152) received patches for 14 days. A control group (CG) (n=47) did not receive the patch. After day 14, 34 CG patients crossed over to treatment (CROSSG) with the patch. Surveys were administered to patients at baseline and 14 days to assess changes in pain severity and interference. Changes in oral pain medication use, side effects, and satisfaction use were also assessed. RESULTS Paired data were collected in the CG, TG and CROSSG. At day 14, TG pain severity score and pain interference score decreased (49% and 58.1%, respectively). Pain severity and interference scores decreased less in the CG (12.3% and 14.8%, respectively). In the study, 60.5% of the TG were using concomitant oral pain medications "a lot less", and 90.8% were very/extremely satisfied with the patch. CROSSG patients showed similar reductions in pain severity and interference scores after patch treatment. No side effects of treatment were reported. CONCLUSION Results indicate that this topical analgesic pain-relieving patch can reduce BPI pain severity and interference scores in adult patients with mild to moderate arthritic, neurological, and musculoskeletal pain and should be considered as a treatment option.
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Affiliation(s)
- Jeffrey A Gudin
- Englewood Hospital Medical Center, Englewood, NJ; Rutgers New Jersey Medical School, Department of Anesthesiology, Newark, NJ, USA
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McPherson T, Fontane P, Bilger R. Patient Experiences with Compounded Topical Pain Creams. J Pain Palliat Care Pharmacother 2020; 34:82-89. [DOI: 10.1080/15360288.2020.1733168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Khan J, Zusman T, Wang Q, Eliav E. Acute and Chronic Pain in Orofacial Trauma Patients. J Endod 2019; 45:S28-S38. [DOI: 10.1016/j.joen.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Khan J, Zusman T, Wang Q, Eliav E. Acute and chronic pain in orofacial trauma patients. Dent Traumatol 2019; 35:348-357. [PMID: 31125489 DOI: 10.1111/edt.12493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 01/07/2023]
Abstract
Trauma or injury to the dentition and supporting tissues is associated with pain and discomfort, as expected, that may present immediately, shortly afterwards, or within a few days. Pain is an essential response to injury because it allows the organism to develop avoidance behavior to potential threats and helps the organism to avoid usage of the injured organ during the healing process. Not only does external trauma induce pain, but also essential invasive dental procedures such as extractions, dental implant insertions, root canal treatments, and oral surgeries are accompanied by similar post-surgical (post-traumatic) pain. The pain intensity after trauma varies and does not always correlate with the extent of injury. Trauma to the orofacial region or the teeth may also indirectly affect and induce pain in other orofacial structures such as the masticatory muscles, the temporomandibular joint, and even the cervical spine. In most cases, the pain will resolve as soon as healing of the affected tissue occurs or after dental and routine palliative treatment. In a limited number of cases, the pain persists beyond healing and evolves into a chronic pain state. Chronic pain in the orofacial region presents diagnostic and management challenges. Misdiagnosis or delayed diagnosis of the oral chronic pain condition may lead to unnecessary dental treatment. This article will discuss diagnosis and treatment for acute and chronic pain as well as potential mechanisms involved in the undesirable transition from acute to chronic pain.
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Affiliation(s)
- Junad Khan
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Tal Zusman
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Qian Wang
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, Rochester, NY, USA
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McBane SE, Coon SA, Anderson KC, Bertch KE, Cox M, Kain C, LaRochelle J, Neumann DR, Philbrick AM. Rational and irrational use of nonsterile compounded medications. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Scott A. Coon
- American College of Clinical Pharmacy; Lenexa Kansas
| | | | | | - Mara Cox
- American College of Clinical Pharmacy; Lenexa Kansas
| | - Courtney Kain
- American College of Clinical Pharmacy; Lenexa Kansas
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13
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Rice FL, Castel D, Ruggiero E, Dockum M, Houk G, Sabbag I, Albrecht PJ, Meilin S. Human-like cutaneous neuropathologies associated with a porcine model of peripheral neuritis: A translational platform for neuropathic pain. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2019; 5:100021. [PMID: 31194066 PMCID: PMC6550106 DOI: 10.1016/j.ynpai.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 01/10/2023]
Abstract
Despite enormous investment in research and development of novel treatments, there remains a lack of predictable, effective, and safe therapeutics for human chronic neuropathic pain (NP) afflictions. NP continues to increase among the population and treatments remain a major unmet public health care need. In recent years, numerous costly (time and money) failures have occurred attempting to translate successful animal pain model results, typically using rodents, to human clinical trials. These continued failures point to the essential need for better animal models of human pain conditions. To address this challenge, we have previously developed a peripheral neuritis trauma (PNT) model of chronic pain induced by a proximal sciatic nerve irritation in pigs, which have a body size, metabolism, skin structure, and cutaneous innervation more similar to humans. Here, we set out to determine the extent that the PNT model presents with cutaneous neuropathologies consistent with those associated with human chronic NP afflictions. Exactly as is performed in human skin biopsies, extensive quantitative multi-molecular immunofluorescence analyses of porcine skin biopsies were performed to assess cutaneous innervation and skin structure. ChemoMorphometric Analysis (CMA) results demonstrated a significant reduction in small caliber intraepidermal nerve fiber (IENF) innervation, altered dermal vascular innervation, and aberrant analgesic/algesic neurochemical properties among epidermal keratinocytes, which are implicated in modulating sensory innervation. These comprehensive pathologic changes very closely resemble those observed from CMA of human skin biopsies collected from NP afflictions. The results indicate that the porcine PNT model is more appropriate for translational NP research compared with commonly utilized rodent models. Because the PNT model creates cutaneous innervation and keratinocyte immunolabeling alterations consistent with human NP conditions, use of this animal model for NP testing and treatment response characteristics will likely provide more realistic results to direct successful translation to humans.
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Affiliation(s)
- Frank L. Rice
- Neuroscience & Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY 12144, United States
- Division of Health Sciences, University at Albany, Rensselaer, NY 12144, United States
| | - David Castel
- The Neufeld Cardiac Research Institute, Sheba Medical Centre, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Elizabeth Ruggiero
- Neuroscience & Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY 12144, United States
| | - Marilyn Dockum
- Neuroscience & Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY 12144, United States
| | - George Houk
- Neuroscience & Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY 12144, United States
| | - Itai Sabbag
- Lahav Research Institute, Kibutz Lahav, Negev 85335, Israel
| | - Phillip J. Albrecht
- Neuroscience & Pain Research Group, Integrated Tissue Dynamics, LLC, Rensselaer, NY 12144, United States
- Division of Health Sciences, University at Albany, Rensselaer, NY 12144, United States
| | - Sigal Meilin
- MD Biosciences, Neurology R&D Division, Nes-Ziona 74140, Israel
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14
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Devor M. Rethinking the causes of pain in herpes zoster and postherpetic neuralgia: the ectopic pacemaker hypothesis. Pain Rep 2018; 3:e702. [PMID: 30706041 PMCID: PMC6344138 DOI: 10.1097/pr9.0000000000000702] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/10/2018] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion. OBJECTIVES AND METHODS Consideration of the evidence supporting this explanation in light of contemporary understanding of the pain system finds it wanting. An alternative hypothesis is proposed as a replacement. RESULTS This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity. CONCLUSIONS The shift in perspective regarding the pain mechanism in HZ/PHN has specific implications for clinical management.
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Affiliation(s)
- Marshall Devor
- Department of Cell and Developmental Biology, Institute of Life Sciences, and Center for Research on Pain, The Hebrew University of Jerusalem, Jerusalem, Israel
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15
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16
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Gudin JA, Brennan MJ, Harris ED, Hurwitz PL, Dietze DT, Strader JD. Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: an exploratory analysis. Postgrad Med 2017; 130:42-51. [DOI: 10.1080/00325481.2018.1414551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | | | - James D Strader
- Safe Harbor Compliance and Clinical Services, LLC, Austin, TX, USA
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17
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Knezevic NN, Tverdohleb T, Nikibin F, Knezevic I, Candido KD. Management of chronic neuropathic pain with single and compounded topical analgesics. Pain Manag 2017; 7:537-558. [PMID: 29125423 DOI: 10.2217/pmt-2017-0020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The goal of our review was to emphasize important aspects that physicians should take into consideration when prescribing topical analgesics as part of chronic neuropathic pain treatment. We discuss the dermatopharmacokinetics and microstructural components of the skin, differences between topical and transdermal drug delivery, and topical medication effects on peripheral neuropathy and central sensitization. Even though the US FDA approved topical analgesics are 8%-capsaicin and 5%-lidocaine patches for treating postherpetic neuralgia, there are many other studies conducted on the efficacy of topical ketamine cream, clonidine gel, topical gabapentin, topical baclofen and topical phenytoin for peripheral neuropathic pain, either alone or in combination with other formulations. Furthermore, we discuss new compounded topical analgesics that are becoming more popular and that are showing promising results in the management of chronic peripheral neuropathies. However, more studies are needed for elucidation of the role of topical analgesics and their effects, especially when combined with other treatments.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.,Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Tatiana Tverdohleb
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Farid Nikibin
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.,Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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18
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Gudin JA, Brennan MJ, Harris ED, Hurwitz PL, Dietze DT, Strader JD. Changes in pain and concurrent pain medication use following compounded topical analgesic treatment for chronic pain: 3- and 6-month follow-up results from the prospective, observational Optimizing Patient Experience and Response to Topical Analgesics study. J Pain Res 2017; 10:2341-2354. [PMID: 29042810 PMCID: PMC5634368 DOI: 10.2147/jpr.s143513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Opioids and other controlled substances prescribed for chronic pain are associated with abuse, addiction, and death, prompting national initiatives to identify safe and effective pain management strategies including topical analgesics. Methods This prospective, observational study evaluated changes from baseline in overall mean severity and interference scores on the Brief Pain Inventory scale and the use of concurrent pain medications at 3- and 6-month follow-up assessments in chronic pain patients treated with topical analgesics. Changes in pain severity and interference and medication usage were compared between treated patients and unmatched and matched controls. Results The unmatched intervention group (unmatched-IG) included 631 patients who completed baseline and 3-month follow-up surveys (3-month unmatched-IG) and 158 who completed baseline and 6-month follow-up assessments (6-month unmatched-IG). Baseline and 3-month follow-up data were provided by 76 unmatched controls and 76 matched controls (3-month unmatched-CG and matched-CG), and 51 unmatched and 36 matched patients completed baseline and 6-month follow-up surveys (6-month unmatched-CG and matched-CG). Baseline demographic characteristics and mean pain severity and interference scores were similar between groups. There were statistically significant decreases from baseline in mean pain severity and interference scores within the 3- and 6-month unmatched-IG (all P<0.001). Significantly greater decreases in the mean change from baseline in pain severity and interference scores were evident for the 3- and 6-month unmatched-IG versus unmatched-CG (all P<0.001), with similar results when the 3- and 6-month matched-IG and matched-CG were compared. A higher percentage of the 3- and 6-month unmatched-IG and matched-IG de-escalated use of concurrent pain medications (all P<0.001), while significantly higher percentages of the unmatched-CG and matched-CG escalated medication use. Side effects were reported by <1% of the unmatched-IG. Conclusion Topical analgesics appear to be effective and safe for the treatment of chronic pain, with randomized controlled trials needed to confirm these findings.
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Affiliation(s)
- Jeffrey A Gudin
- Pain Medicine and Palliative Care, Englewood Hospital and Medical Center, Englewood, NJ
| | | | | | | | | | - James D Strader
- Safe Harbor Compliance and Clinical Services, LLC, Austin, TX, USA
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19
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Clark GT, Padilla M, Dionne R. Medication Treatment Efficacy and Chronic Orofacial Pain. Oral Maxillofac Surg Clin North Am 2017; 28:409-21. [PMID: 27475515 DOI: 10.1016/j.coms.2016.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful.
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Affiliation(s)
- Glenn T Clark
- Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA.
| | - Mariela Padilla
- Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA
| | - Raymond Dionne
- Department of Pharmacology, Brody School of Medicine, 6S19 Brody Medical Science Building, 600 Moye Boulevard, East Carolina University, Schools of Medicine and Dental Medicine, Greenville, NC 27834-4354, USA
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20
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Liu KS, Huang TH, Aljuffali IA, Chen EL, Wang JJ, Fang JY. Exploring the structure-permeation relationship of topical tricyclic antidepressants used for skin analgesia. Int J Pharm 2017; 523:386-397. [DOI: 10.1016/j.ijpharm.2017.03.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/06/2017] [Accepted: 03/19/2017] [Indexed: 12/17/2022]
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21
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Glinn MA, Lickteig AJ, Weber L, Recer S, Salske M, Harvey A, Rappold B, Stensland J, Bell P. Urinary Concentrations of Topically Administered Pain Medications. J Anal Toxicol 2017; 41:127-133. [PMID: 28376226 DOI: 10.1093/jat/bkw110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/21/2016] [Indexed: 11/12/2022] Open
Abstract
A common treatment for chronic pain is prescription of analgesics, but their long-term use entails risk of morbidity, addiction and misuse. One way to reduce the risk of abuse is prescribing of analgesics in a topical form. Physicians are urged to perform urine drug testing to ensure that patients are compliant with their medication regimens. However, there is little data on the efficiency of transdermal delivery for many analgesic drugs, and no data on expected urine drug levels. This study includes data from over 29,000 specimens tested for gabapentin, ketamine, cyclobenzaprine or amitriptyline used orally or topically. Gabapentin and amitriptyline concentrations were more likely to be below the limits of detection (25-40 ng/mL) in the urine of patients using them topically as compared with patients using them orally. Levels in gabapentin-positive topical specimens were much lower than in gabapentin-positive oral specimens (261 ng/mL vs >10,000 ng/mL). In contrast, ketamine and cyclobenzaprine were more readily detectable in the urine of topical users. Ketamine topical specimens were positive 12% more often than oral specimens, and mean topical specimen levels were 68-100% those of oral specimens. Cyclobenzaprine specimens were equally likely to be positive whether the dose was oral or topical, although mean levels after topical dosing were approximately 13-21% those after oral dosing. These findings are consistent with the reported percutaneous absorption efficiencies of gabapentin and ketamine, and are likely to be related to the absorption efficiencies of cyclobenzaprine and amitriptyline.
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Affiliation(s)
- Michele A Glinn
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Andrew J Lickteig
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Luke Weber
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Sherri Recer
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Matthew Salske
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Audrey Harvey
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Brian Rappold
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Julie Stensland
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
| | - Patrick Bell
- Essential Testing LLC, 1616 Eastport Plaza Dr, Collinsville, IL 62234, USA
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23
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Topically applied mesoridazine exhibits the strongest cutaneous analgesia and minimized skin disruption among tricyclic antidepressants: The skin absorption assessment. Eur J Pharm Biopharm 2016; 105:59-68. [DOI: 10.1016/j.ejpb.2016.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 05/29/2016] [Accepted: 05/30/2016] [Indexed: 01/16/2023]
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Sagen J, Castellanos DA, Hama AT. Antinociceptive effects of topical mepivacaine in a rat model of HIV-associated peripheral neuropathic pain. J Pain Res 2016; 9:361-71. [PMID: 27350758 PMCID: PMC4902250 DOI: 10.2147/jpr.s104397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background A consequence of HIV infection is sensory neuropathy, a debilitating condition that degrades the quality of life of HIV patients. Furthermore, life-extending antiretroviral treatment may exacerbate HIV sensory neuropathy. Analgesics that relieve other neuropathic pains show little or no efficacy in ameliorating HIV sensory neuropathy. Thus, there is a need for analgesics for people with this particular pain. While lidocaine is used in the management of painful peripheral neuropathies, another local anesthetic mepivacaine, with a potentially improved bioavailability, could be utilized for the management of HIV neuropathic pain. Methods The efficacy of topical anesthetics was evaluated in a preclinical rodent model of painful peripheral neuropathy induced by epineural administration of the HIV envelope protein gp120 delivered using saturated oxidized cellulose implanted around the sciatic nerve. Beginning at 2 weeks following gp120 administration, the effects of local anesthetics topically applied via gauze pads were tested on heat and mechanical hyperalgesia in the hind paw. Rats were tested using several concentrations of mepivacaine or lidocaine during the following 2 weeks. Results By 2 weeks following epineural gp120 implantation, the ipsilateral hind paw developed significant hypersensitivity to noxious pressure and heat hyperalgesia. A short-lasting, concentration-dependent amelioration of pressure and heat hyperalgesia was observed following topical application of mepivacaine to the ipsilateral plantar hind paw. By contrast, topical lidocaine ameliorated heat hyperalgesia in a concentration-dependent manner but not pressure hyperalgesia. Equipotent concentrations of mepivacaine and lidocaine applied topically to the tail of mice significantly increased tail withdrawal latencies in the tail flick test, demonstrating that both local anesthetics attenuate responding to a brief noxious stimulus. Conclusion These findings showed that mepivacaine, rather than lidocaine, consistently attenuated two distinct symptoms of neuropathic pain and suggest that topical formulations of this local anesthetic could have utility in the alleviation of clinical HIV neuropathic pain.
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Affiliation(s)
- Jacqueline Sagen
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel A Castellanos
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aldric T Hama
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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