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Toumia M, Sassi S, Dhaoui R, Kouraichi C, Bel Haj Ali K, Sekma A, Zorgati A, Jaballah R, Yaakoubi H, Youssef R, Beltaief K, Mezgar Z, Khrouf M, Sghaier A, Jerbi N, Zemni I, Bouida W, Grissa MH, Boubaker H, Boukef R, Msolli MA, Nouira S. Magnesium Sulfate Versus Lidocaine as an Adjunct for Renal Colic in the Emergency Department: A Randomized, Double-Blind Controlled Trial. Ann Emerg Med 2024:S0196-0644(24)00348-2. [PMID: 39033450 DOI: 10.1016/j.annemergmed.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024]
Abstract
STUDY OBJECTIVE We wished to determine whether the addition of magnesium sulfate (MgSO4) or lidocaine to diclofenac could improve the analgesic efficacy in emergency department (ED) patients with acute renal colic. METHODS In this prospective, double-blinded, randomized controlled trial of patients aged 18 to 65 years with suspected acute renal colic, we randomized them to receive 75 mg intramuscular (IM) diclofenac and then intravenous (IV) MgSO4, lidocaine, or saline solution control. Subjects reported their pain using a numerical rating scale (NRS) before drug administration and then 5, 10, 20, 30, 60, and 90 minutes afterwards. Our primary outcome was the proportion of participants achieving at least a 50% reduction in the NRS score 30 minutes after drug administration. RESULTS We enrolled 280 patients in each group. A 50% or greater reduction in the NRS score at 30 minutes occurred in 227 (81.7%) patients in the MgSO4 group, 204 (72.9%) in the lidocaine group, and 201 (71.8%) in the control group, with significant differences between MgSO4 and lidocaine (8.8%, 95% confidence interval [CI] [1.89 to 15.7], P=.013) and between MgSO4 and control (9.9%, 95% CI [2.95 to 16.84], P=.004). Despite this, differences between all groups at every time point were below the accepted 1.3 threshold for clinical importance. There were no observed differences between groups in the frequency of rescue analgesics and return visits to the ED for renal colic. There were more adverse events, although minor, in the MgSO4 group. CONCLUSION Adding intravenous MgSO4, but not lidocaine, to IM diclofenac offered superior pain relief but at levels below accepted thresholds for clinical importance.
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Affiliation(s)
- Marwa Toumia
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Haj Ali Soua Regional Hospital, Monastir, Tunisia
| | - Sarra Sassi
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Randa Dhaoui
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Cyrine Kouraichi
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Rahma Jaballah
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Rym Youssef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Kaouthar Beltaief
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Zied Mezgar
- Emergency Department, Hached University Hospital, Sousse, Tunisia
| | - Mariem Khrouf
- Emergency Department, Hached University Hospital, Sousse, Tunisia
| | - Amira Sghaier
- Emergency Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Nahla Jerbi
- Emergency Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Wahid Bouida
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamdi Boubaker
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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Khan JS, Gilron I, Devereaux PJ, Clarke H, Ayach N, Tomlinson G, Quan ML, Ladha KS, Choi S, Munro A, Brull R, Lim DW, Avramescu S, Richebé P, Hodgson N, Paul J, McIsaac DI, Derzi S, Zbitnew GL, Easson AM, Siddiqui NT, Miles SJ, Karkouti K. Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial. Trials 2024; 25:337. [PMID: 38773653 PMCID: PMC11110187 DOI: 10.1186/s13063-024-08151-4] [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: 09/21/2023] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Persistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interventions that prevent persistent pain after breast surgery are needed to improve the quality of life of breast cancer survivors. An intraoperative intravenous lidocaine infusion has emerged as a potential intervention to decrease the incidence of PMPS. We aim to determine the definitive effects of this intervention in patients undergoing breast cancer surgery. METHODS PLAN will be a multicenter, parallel-group, blinded, 1:1 randomized, placebo-controlled trial of 1,602 patients undergoing breast cancer surgery. Adult patients scheduled for a lumpectomy or mastectomy will be randomized to receive an intravenous 2% lidocaine bolus of 1.5 mg/kg with induction of anesthesia, followed by a 2.0 mg/kg/h infusion until the end of surgery, or placebo solution (normal saline) at the same volume. The primary outcome will be the incidence of persistent pain at 3 months. Secondary outcomes include the incidence of pain and opioid consumption at 1 h, 1-3 days, and 12 months after surgery, as well as emotional, physical, and functional parameters, and cost-effectiveness. DISCUSSION This trial aims to provide definitive evidence on an intervention that could potentially prevent persistent pain after breast cancer surgery. If this trial is successful, lidocaine infusion would be integrated as standard of care in breast cancer management. This inexpensive, widely available, and easily administered intervention has the potential to reduce pain and suffering in an already afflicted patient population, decrease the substantial costs of chronic pain management, potentially decrease opioid use, and improve the quality of life in patients. TRIAL REGISTRATION This trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).
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MESH Headings
- Humans
- Lidocaine/administration & dosage
- Lidocaine/adverse effects
- Breast Neoplasms/surgery
- Female
- Pain, Postoperative/prevention & control
- Pain, Postoperative/etiology
- Pain, Postoperative/diagnosis
- Mastectomy/adverse effects
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Infusions, Intravenous
- Multicenter Studies as Topic
- Randomized Controlled Trials as Topic
- Treatment Outcome
- Pain Measurement
- Quality of Life
- Chronic Pain/prevention & control
- Chronic Pain/etiology
- Mastectomy, Segmental/adverse effects
- Time Factors
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Analgesics, Opioid/adverse effects
- Cost-Benefit Analysis
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Affiliation(s)
- James S Khan
- Department of Anesthesiology & Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, and Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, ON, Canada
| | - Nour Ayach
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - May Lynn Quan
- Department of Surgery/Oncology, University of Calgary, Calgary, AB, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia at St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen Choi
- Department of Anesthesiology and Pain Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Allana Munro
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Richard Brull
- Department of Anesthesiology and Pain Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - David W Lim
- Women's College Research Institute & Department Surgery, Women's College Hospital, Toronto, ON, Canada
| | - Sinziana Avramescu
- Department of Anesthesiology and Pain Medicine, Humber River Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de L'Est de L'Ile de Montreal (CEMTL), University of Montreal, Montreal, QC, Canada
| | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Daniel I McIsaac
- Departments of Anesthesiology & Pain Medicine and School of Epidemiology & Public Health, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Simone Derzi
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Geoff L Zbitnew
- Department of Anesthesiology, Memorial University, St. John's, NF, Canada
| | - Alexandra M Easson
- Department of Surgery and Institute of Health, Policy, Management and Evaluation (HPME), Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Naveed T Siddiqui
- Department of Anesthesiology & Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah J Miles
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, and Women's College Hospital, Toronto, ON, Canada
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Striebel J, Ruppen W, Schneider T. Simultaneous application of lidocaine and ketamine during ambulatory infusion therapy: a retrospective analysis. Pain Manag 2023; 13:539-553. [PMID: 37850330 DOI: 10.2217/pmt-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Background: Infusions with lidocaine or ketamine have been separately established in the treatment of chronic pain. This study aims to retrospectively evaluate the effect of combined infusions of lidocaine and ketamine. Materials & methods: Patient records were screened for receipt of combined ambulatory infusions of lidocaine and ketamine from 2012 through 2021. A scoring system was designed to assess pain response retrospectively. Results: A total of 319 patients were included. Median pain reduction in days was 10.00 (interquartile range: 13.25). Side effects were limited to the acute phase of infusions. A total of 41.4% of patients who received concomitant pain medication reported a dose reduction. Conclusion: Our data support combined infusions as a safe therapy option, with good short-, medium- and long-term reductions in pain and great heterogeneity in treatment response. Clinical trial registration: ClinicalTrials.gov (NCT05103319).
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Affiliation(s)
- Julia Striebel
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Wilhelm Ruppen
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Tobias Schneider
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
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Deep Learning Classification of Treatment Response in Diabetic Painful Neuropathy: A Combined Machine Learning and Magnetic Resonance Neuroimaging Methodological Study. Neuroinformatics 2023; 21:35-43. [PMID: 36018533 PMCID: PMC9931783 DOI: 10.1007/s12021-022-09603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
Functional magnetic resonance imaging (fMRI) has been shown successfully to assess and stratify patients with painful diabetic peripheral neuropathy (pDPN). This supports the idea of using neuroimaging as a mechanism-based technique to individualise therapy for patients with painful DPN. The aim of this study was to use deep learning to predict treatment response in patients with pDPN using resting state functional imaging (rs-fMRI). We divided 43 painful pDPN patients into responders and non-responders to lidocaine treatment (responders n = 29 and non-responders n = 14). We used rs-fMRI to extract functional connectivity features, using group independent component analysis (gICA), and performed automated treatment response deep learning classification with three-dimensional convolutional neural networks (3D-CNN). Using gICA we achieved an area under the receiver operating characteristic curve (AUC) of 96.60% and F1-Score of 95% in a ten-fold cross validation (CV) experiment using our described 3D-CNN algorithm. To our knowledge, this is the first study utilising deep learning methods to classify treatment response in pDPN.
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5
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Lee JH, Koutalianos EP, Leimer EM, Bhullar RK, Argoff CE. Intravenous Lidocaine in Chronic Neuropathic Pain: A Systematic Review. Clin J Pain 2022; 38:739-748. [PMID: 36288104 DOI: 10.1097/ajp.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES A systematic review of original research articles was conducted to evaluate the safety and efficacy of lidocaine infusion in the treatment of adult patients with chronic neuropathic pain. MATERIALS AND METHODS Original research from 1970 to September 2021 describing adult patients with chronic neuropathic pain receiving at least 1 dose of intravenous lidocaine was included. Extracted data included study design, sample size, patient demographics and comorbidities, etiology and duration of pain, pain intensity scores, time to pain resolution, lidocaine dose and administration frequency, lidocaine serum concentration, and adverse events. Each study was evaluated for level of evidence using the 2017 American Association of Neurology classification system. RESULTS Twenty-seven studies evaluating lidocaine infusion treatment in chronic neuropathic pain met inclusion criteria. One class I study was identified for patients with neuropathic pain due to spinal cord injury . Two Class II studies were identified, one describing neuropathic pain due to peripheral nerve injury and another due to diabetic neuropathy. Across all studies, study design, participants, and experimental interventions were heterogenous with wide variation. DISCUSSION This qualitative review found insufficient, heterogenous evidence and therefore no recommendation can be made for lidocaine infusion treatment in patients with chronic neuropathic pain due to spinal cord injury, peripheral nerve injury, diabetic neuropathy, postherpetic neuralgia, or complex regional pain syndrome type II. Larger randomized, double-blind, placebo-controlled studies are required to further establish the efficacy of lidocaine infusion in patients with these etiologies of chronic neuropathic pain.
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Affiliation(s)
| | - Evangeline P Koutalianos
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY
| | - Elizabeth M Leimer
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
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6
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Horvat S, Staffhorst B, Cobben JHMG. Intravenous Lidocaine for Treatment of Chronic Pain: A Retrospective Cohort Study. J Pain Res 2022; 15:3459-3467. [PMID: 36329833 PMCID: PMC9624148 DOI: 10.2147/jpr.s379208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Neuropathic pain is a widespread problem with a big impact on quality of life. The currently used drug regimens are often insufficiently effective or cause - sometimes unacceptable - side effects. Intravenous lidocaine could be an alternative treatment, by blocking spontaneous depolarization and hyperexcitability in upregulated sodium channels in nociceptors. Research so far has shown varying results but the treatment protocols differed a lot and follow-up was usually short. In our hospital, lidocaine infusions have been applied for many years in a unique treatment protocol consisting of a relatively high dose of lidocaine (1000 mg) administered over 25 hours. Our aim is to share information on both the efficacy and safety of this treatment schedule. Methods We conducted a retrospective cohort study in all patients who received a lidocaine infusion between January 2014 and January 2018. The standard infusion protocol consists of a total of 1000 mg lidocaine administered intravenously during 25 hours (40 mg/hour). Pain diagnoses were stratified into 15 groups, in agreement with diagnoses used in daily practice. Effectiveness of the treatment was classified as effect or no effect based on the description found in the chart. Results We included 282 patients, with a median age of 58 years and 64% of whom were female. Patients with myofascial pain syndrome, peripheral (mono)neuropathy, small fiber neuropathy and vascular disease benefited most. Patients with cancer pain, postherpetic neuralgia, chemotherapy-induced neuropathy and radicular pain showed the least pain improvement. There were no serious adverse events. Conclusion In selected patients, lidocaine infusions may be a safe and efficacious treatment for chronic neuropathic pain. More prospective research is needed to further determine the optimal dosing, duration and interval of lidocaine infusion therapy, and to better understand in which specific patient categories this treatment is most beneficial.
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Affiliation(s)
- Sanja Horvat
- Department of Anesthesiology and Pain Medicine, University Medical Centre Groningen, Groningen, The Netherlands,Correspondence: Sanja Horvat, Email
| | - Bas Staffhorst
- Department of Anesthesiology and Pain Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Jan-Hein M G Cobben
- Department of Anesthesiology and Pain Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
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7
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Koosha F, Sheikhzadeh P. Investigating Radioprotective Effect of Hesperidin/Diosmin Compound Against 99mTc-MIBI-Induced Cardiotoxicity: Animal Study. Cardiovasc Toxicol 2022; 22:646-654. [PMID: 35522359 DOI: 10.1007/s12012-022-09744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
This study was designed to indicate the cardiotoxicity due to 99mTc-MIBI injection in myocardial perfusion imaging in wistar Rats. In addition, protective effect of hesperidin/diosmin compound (HDC) against the cardiotoxicity was evaluated. Twenty five male rats were randomly divided into five groups. The rats in Group 1 (control) only received PBS. For Group 2 (HDC only) the rats treated with only HDC. The rats in Group 3 (radiation) received PBS before injection and exposure to 1 mCi 99mTc-MIBI. The rats in Group 4 (HDC + radiation) treated with HDC before exposure. For Group 5 (radiation + HDC) the rats were exposed and thereafter administered HDC. The Animals of this study were orally administered 100 mg/kg/day of the HDC for 7 days. Then, the rats were sacrificed and afterwards their heart tissues were carefully extracted for biochemical and histopathological evaluations. According to our results in the radiation group, the rate of rupture of cardiomyocyte fibers was higher than other groups, and in some fibers, the presence of lymphocytes was observed. Relative improvement was observed in radiation + HDC group compared to the radiation group and also a small number of cardiomyocyte fibers were torn and in some fibers, the presence of lymphocytes was observed, which was less than the model group. Collagen deposition significantly increased in radiation group compared to control group (P < 0.05). It can be seen that the percentage of collagen deposition decreased substantially in the group treated with HDC before or after radiation compared to radiation group (P < 0.05). The MDA activities significantly reduced (P < 0.05) in both (HDC + radiation) and (radiation + HDC) groups. SOD activity significantly increased in both (radiation + HDC) and (HDC + radiation) groups compared to that of radiation group (P < 0.05). It could be concluded that the HDC is safe and promising useful therapeutic agent in radiation induced cardiotoxicity for patients undergoing nuclear medicine procedures.
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Affiliation(s)
- Fereshteh Koosha
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Sheikhzadeh
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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8
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de Carvalho JF, Skare TL. Lidocaine in fibromyalgia: A systematic review. World J Psychiatry 2022; 12:615-622. [PMID: 35582338 PMCID: PMC9048454 DOI: 10.5498/wjp.v12.i4.615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/15/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) patients are treated with antidepressants, and in most cases, these drugs lose efficacy or present side effects. Intravenous lidocaine (IL) is an anesthetic drug used in some FM trials.
AIM To systematically review the safety and efficacy of IL in FM patients.
METHODS To systematically search PubMed for articles in English, Spanish, and Japanese with English Abstracts on FM and lidocaine between 1966 and February 2021. This study was registered at PROSPERO.
RESULTS We found only ten articles published in this field, with a total of 461 patients. Females predominated varying from 95% to 100% in the studies. Age varied from 40.9 to 55 years old. Disease duration varied from 1 mo to 6.4 years. Lidocaine dose varied from 2 to 7.5 mg/kg via intravenous infusion. Follow-up period varied from 65.7 to 90 days. Regarding outcomes, most studies used the visual analogue scale (VAS) for pain; before short-term lidocaine administration, VAS was between 6.1 and 8.1 and after treatment was between 1.7 and 4.5 mm. Concerning long term lidocaine, VAS varied from 30% to 35.4% after lidocaine infusion. Side effects were observed in 0% to 39.6% of cases, they were usually mild or moderate.
CONCLUSION This study demonstrates the short-term effectiveness and safety of intravenous lidocaine in FM patients. However, more studies, including long-term follow-up, are still needed.
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Affiliation(s)
| | - Thelma L Skare
- Rheumatology Unit, Evangélico Mackenzie Hospital, Curitiba 80730-420, Brazil
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Wang B, Zhong JL, Jiang N, Shang J, Wu B, Chen YF, Lu HD. Exploring the Mystery of Osteoarthritis using Bioinformatics Analysis of Cartilage Tissue. Comb Chem High Throughput Screen 2022; 25:53-63. [PMID: 33292128 DOI: 10.2174/1386207323666201207100905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is a kind of chronic disease relating to joints, which seriously affectsthe daily life activities of the elderly and can also lead to disability. However, the pathogenesis of OA is still unclear, which leads to limited treatment and the therapeutic effect far from people's expectations. This study aims to filter out key genes in the pathogenesis of OA and explore their potential role in the occurrence and development of OA. METHODS The dataset of GSE117999 was obtained and analyzed in order to identify the differentially expressed genes (DEGs), hub genes and key genes. We also identified potential miRNAs which may play a major role in the pathogenesis of OA, and verified their difference in OA by real-time quantitative PCR (RT-qPCR). DGldb was found to serve as an indicator to identify drugs with potential therapeutic effects on key genes and Receiver Operating Characteristic (ROC) analysis was used for identifying underlying biomarkers of OA. RESULTS We identified ten key genes, including MDM2, RB1, EGFR, ESR1, UBE2E3, WWP1, BCL2, OAS2, TYMS and MSH2. Then, we identified hsa-mir-3613-3p, hsa-mir-548e-5p and hsamir- 5692a to be potentially related to key genes. In addition, RT-qPCR confirmed the differential expression of identified genes in mouse cartilage with or without OA. We then identified Etoposide and Everolimus, which were potentially specific to the most key genes. Finally, we speculated that ESR1 might be a potential biomarker of OA. CONCLUSION In this study, potential key genes related to OA and their biological functions were identified, and their potential application value in the diagnosis and treatment of OA has been demonstrated, which will help us to improve the therapeutic effect of OA.
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Affiliation(s)
- Bin Wang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
| | - Jun-Long Zhong
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
| | - Ning Jiang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
| | - Jie Shang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
| | - Biao Wu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
| | - Yu-Feng Chen
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
| | - Hua-Ding Lu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong,China
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Staudt MD, Prabhala T, Sheldon BL, Quaranta N, Zakher M, Bhullar R, Pilitsis JG, Argoff CE. Current Strategies for the Management of Painful Diabetic Neuropathy. J Diabetes Sci Technol 2022; 16:341-352. [PMID: 32856490 PMCID: PMC8861791 DOI: 10.1177/1932296820951829] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The development of painful diabetic neuropathy (PDN) is a common complication of chronic diabetes that can be associated with significant disability and healthcare costs. Prompt symptom identification and aggressive glycemic control is essential in controlling the development of neuropathic complications; however, adequate pain relief remains challenging and there are considerable unmet needs in this patient population. Although guidelines have been established regarding the pharmacological management of PDN, pain control is inadequate or refractory in a high proportion of patients. Pharmacotherapy with anticonvulsants (pregabalin, gabapentin) and antidepressants (duloxetine) are common first-line agents. The use of oral opioids is associated with considerable morbidity and mortality and can also lead to opioid-induced hyperalgesia. Their use is therefore discouraged. There is an emerging role for neuromodulation treatment modalities including intrathecal drug delivery, spinal cord stimulation, and dorsal root ganglion stimulation. Furthermore, consideration of holistic alternative therapies such as yoga and acupuncture may augment a multidisciplinary treatment approach. This aim of this review is to focus on the current management strategies for the treatment of PDN, with a discussion of treatment rationale and practical considerations for their implementation.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Tarun Prabhala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany NY, USA
| | - Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany NY, USA
| | - Nicholas Quaranta
- Department of Anesthesiology, Albany Medical College, Albany, New York, USA
| | - Michael Zakher
- Department of Anesthesiology, Albany Medical College, Albany, New York, USA
| | - Ravneet Bhullar
- Department of Anesthesiology, Albany Medical College, Albany, New York, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany NY, USA
| | - Charles E Argoff
- Department of Neurology, Albany Medical College, Albany, New York, USA
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11
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Vacher E, Kosela M, Song-Smith C, Morell-Ducos F, Fayaz A. Lidocaine infusions in chronic pain management: A prospective case series analysis. Br J Pain 2021; 16:270-280. [PMID: 35646339 PMCID: PMC9136989 DOI: 10.1177/20494637211054198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic pain conditions are prevalent and cause a significant burden of disease. Intravenous lidocaine infusions have been reported to have an analgesic effect in patients with chronic neuropathic pain, but there is limited data supporting the efficacy of lidocaine across other chronic pain phenotypes. Our study aimed to evaluate the efficacy of a single infusion of intravenous lidocaine for pain relief and the impact on quality of life. We evaluated data from 74 patients with chronic pain who were treated with intravenous lidocaine at a specialist pain centre. Participants completed a questionnaire consisting of the Brief Pain Inventory (BPI) Short Form and additional EQ-5D quality of life metrics, before treatment and at follow-up. Data comparing pain severity did not demonstrate a statistically significant change after treatment when averaged across the entire patient cohort (6.15–5.88, p = .106), irrespective of gender or pain phenotype. Scores for pain interference showed statistically significant reductions following treatment (7.05–6.41, p = .023), which may have been driven through improvements in sleep (7.41–6.35, p = .001); however, these reductions are not clinically significant. The patient cohort was stratified into responders and non-responders based on >30% improvement in response to an overall impression of pain reduction question following treatment. In the ‘responder’ cohort, pain intensity scores showed a statistically significant reduction post-infusion (6.18–5.49, p = .0135), but no change was apparent for non-responders (6.07–6.09, p = .920). There were no differences between responders and non-responders for pain sub-types in our study. This study found no difference in pain outcomes in a cohort of patients with chronic pain, a mean of 63 days following a single lidocaine infusion. However, a specific subgroup of responders may show slight improvements in some pain outcomes that may warrant further exploration.
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Affiliation(s)
| | | | | | - Fausto Morell-Ducos
- Anaesthesia and Pain Consultant, University College London Hospitals NHS Trust
- Honorary Lecturer, University College London
| | - Alan Fayaz
- Anaesthesia and Pain Consultant, University College London Hospitals NHS Trust
- Honorary Associate Professor, University College London
- Clinical Lead, Pain Education Research Centre PERC, University College London Hospitals NHS Trust
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12
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Todorovic MS, Frey K, Swarm RA, Bottros M, Rao L, Tallchief D, Kraus K, Meacham K, Bakos K, Zang X, Lee JB, Kagan L, Haroutounian S. Prediction of Individual Analgesic Response to Intravenous Lidocaine in Painful Diabetic Peripheral Neuropathy: A Randomized, Placebo-controlled, Crossover Trial. Clin J Pain 2021; 38:65-76. [PMID: 34723864 PMCID: PMC8727500 DOI: 10.1097/ajp.0000000000001001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Intravenous lidocaine can alleviate painful diabetic peripheral neuropathy (DPN) in some patients. Whether quantitative sensory testing (QST) can identify treatment responders has not been prospectively tested. MATERIALS AND METHODS This was a prospective, randomized, double-blind, crossover, placebo-controlled trial comparing intravenous lidocaine to normal saline (placebo) for painful DPN. Thirty-four participants with painful DPN were enrolled and administered intravenous lidocaine (5 mg/kg ideal body weight) or placebo as a 40-minute infusion, after a battery of QST parameters were tested on the dorsal foot, with a 3-week washout period between infusions. RESULTS Thirty-one participants completed both study sessions and were included in the final analysis. Lidocaine resulted in a 51% pain reduction 60 to 120 minutes after infusion initiation, as assessed on a 0 to 10 numerical rating scale, while placebo resulted in a 33.5% pain reduction (difference=17.6%, 95% confidence interval [CI], 1.9%-33.3%, P=0.03). Neither mechanical pain threshold, heat pain threshold, or any of the other measured QST parameters predicted the response to treatment. Lidocaine administration reduced mean Neuropathic Pain Symptom Inventory paresthesia/dysesthesia scores when compared with placebo by 1.29 points (95% CI, -2.03 to -0.55, P=0.001), and paroxysmal pain scores by 0.84 points (95% CI, -1.62 to -0.56, P=0.04), without significant changes in burning, pressing or evoked pain subscores. DISCUSSION While some participants reported therapeutic benefit from lidocaine administration, QST measures alone were not predictive of response to treatment. Further studies, powered to test more complex phenotypic interactions, are required to identify reliable predictors of response to pharmacotherapy in patients with DPN.
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Affiliation(s)
| | - Karen Frey
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
| | - Robert A. Swarm
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
- Washington University Pain Center, St Louis, MO, USA, 63110
| | - Michael Bottros
- Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, CA, 90033
| | - Lesley Rao
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
- Washington University Pain Center, St Louis, MO, USA, 63110
| | - Danielle Tallchief
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
| | - Kristin Kraus
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
| | - Kathleen Meacham
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
- Washington University Pain Center, St Louis, MO, USA, 63110
| | - Kristopher Bakos
- Investigational Drug Service, Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Xiaowei Zang
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, NJ, USA, 08854
| | - Jong Bong Lee
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, NJ, USA, 08854
| | - Leonid Kagan
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, NJ, USA, 08854
- Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, NJ, USA, 08854
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 63110
- Washington University Pain Center, St Louis, MO, USA, 63110
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13
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Licina A, Silvers A. Perioperative Intravenous Lidocaine Infusion for Post-operative Analgesia in Patients undergoing Surgery of the Spine Systematic Review and Meta-analysis. PAIN MEDICINE 2021; 23:45-56. [PMID: 34196720 DOI: 10.1093/pm/pnab210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to examine the impact of perioperative intravenous lidocaine infusion on pain management scores, opioid consumption, adverse events and hospital length of stay in patients undergoing spinal surgery. METHODS We included randomized controlled trials (RCT's) evaluating the use of perioperative intravenous lidocaine in adult and paediatric patients undergoing spinal surgery. Primary outcomes were post-operative pain scores at rest, at two, four- six, twenty-four and forty-eight hours and adverse events attributable to lidocaine administration. We searched electronic databases from inception to present. We used Cochrane's standard methods. We used a random-effects model to synthetize data. We conducted three subgroup analysis: major versus minor surgery, patients with chronic pain conditions versus patients without, and adult versus paediatric. RESULTS A total of eight studies were included comparing patients having intravenous lidocaine (n = 349) to controls (n = 343). Intravenous lidocaine administration was associated with significantly reduced visual analogue pain scores at two MD= -1.13, four-six MD =-0.79 and twenty-four hours MD= -0.50 post-operatively. In the adults, efficacy of treatment was extended to forty-eight hours MD= -0.72. Perioperative intravenous lidocaine administration was associated with reduced peri-operative opioid consumption at twenty-four and forty-eight as well as decreased hospital length of stay. CONCLUSION Perioperative intravenous lidocaine infusion consistently improves analgesic measures in adult and paediatric population in the first twenty-four hours, with an effective decrease in opioid consumption noted to forty-eight hours. These results are most generalizable in the adult population in the first four-six to twenty four post-operative hours.
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14
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Choi YH, Kim DH, Paik NJ, Park J. Long-term analgesic effects of peripheral nerve block in patients with central post-stroke pain: A retrospective series. Pain Pract 2021; 21:843-849. [PMID: 33991164 DOI: 10.1111/papr.13031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Central post-stroke pain (CPSP) has a detrimental effect on the quality of life of post-stroke patients. However, no definitive and effective method has been established yet for the treatment of CPSP. OBJECTIVE We aimed to examine the applicability of single-injection peripheral nerve blocks (PNBs) for the treatment of CPSP. SUBJECTS In this retrospective study, we included 22 patients (mean age = 56.3 years; 13 men and 9 women) diagnosed with CPSP who visited an outpatient rehabilitation clinic in Seoul National University Bundang Hospital between December 2018 and April 2020. METHODS The patients underwent ultrasound-guided single-injection PNB (lidocaine + epinephrine [1: 200,000]) according to the primary site of pain. The level of pain (measured using a numeric rating scale) was recorded before and after the PNB, and the occurrence of adverse events were also measured. The primary outcome of this study was the amount of pain reduction after PNB. Secondary outcome measures obtained 1 month after the PNB included the pain reduction rate 1 month after the PNB, the patient-reported satisfaction and effectiveness regarding the PNB, intention for re-injection, and the patients' willingness to recommend this procedure to others. RESULTS The mean pain reduction after PNB was 3.3 ± 2.8. PNB was associated with pain reduction that persisted for greater than 1 month in 68% (15/22) of the patients. Thirteen of 22 patients reported a pain reduction of 50% or more. The mean pain reduction rate was 43.6%. Of the 22 patients, 13 were willing to undergo a second round of treatment with PNB. Nine of them underwent the procedure. No adverse events were observed in this study. CONCLUSIONS Our study provides preliminary data suggesting that PNB could be an effective and feasible method to treat CPSP.
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Affiliation(s)
- Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital Seoul, Seoul, South Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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15
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Licina A, Silvers A. Perioperative intravenous lignocaine infusion for postoperative pain control in patients undergoing surgery of the spine: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e036908. [PMID: 33051233 PMCID: PMC7554463 DOI: 10.1136/bmjopen-2020-036908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intravenous lignocaine is an amide local anaesthetic known for its analgesic, antihyperalgesic and anti-inflammatory properties. Administration of intravenous lignocaine has been shown to enhance perioperative recovery parameters. This is the protocol for a systematic review which intends to summarise the evidence base for perioperative intravenous lignocaine administration in patients undergoing spinal surgery. METHODS AND ANALYSIS Our primary outcomes include: postoperative pain scores at rest and movement at predefined early, intermediate and late time points and adverse events. Other outcomes of interest include perioperative opioid consumption, composite morbidity, surgical complications and hospital length of stay. We will include randomised controlled trials, which compared intravenous lignocaine infusion vs standard treatment for perioperative analgesia. We will search electronic databases from inception to present; MEDLINE, EMBASE and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two team members will independently screen all citations, full-text articles and abstract data. The individual study risk of bias will be appraised using the Cochrane risk of bias tool. We will obtain a risk ratio or mean difference (MD) from the intervention and control group event rates based on the nature of data. We will correct for the variable measurement tools by using the standardised MD (SMD). We will use a random-effects model to synthesise data. We will conduct five subgroup analysis: major versus minor surgery, emergency versus elective surgery, patients with chronic pain conditions versus patients without, duration of lignocaine infusion and adult versus paediatric. Confidence in cumulative evidence for will be classified according to the Grading of Recommendations, Assessment, Development and Evaluation system. We will construct summary of findings tables supported detailed evidence profile tables for predefined outcomes. ETHICS AND DISSEMINATION Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD420201963314.
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Affiliation(s)
- Ana Licina
- Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
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16
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Hawley P, Fyles G, Jefferys SG. Subcutaneous Lidocaine for Cancer-Related Pain. J Palliat Med 2020; 23:1357-1364. [DOI: 10.1089/jpm.2019.0621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Philippa Hawley
- Pain and Symptom Management/Palliative Care Department, BC Cancer, Vancouver, British Columbia, Canada
- Division of Palliative Care, Interdepartmental Division of Departments of Medicine, Family Practice, and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Fyles
- Division of Palliative Care, Interdepartmental Division of Departments of Medicine, Family Practice, and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Pain and Symptom Management/Palliative Care Program, BC Cancer, Kelowna, British Columbia, Canada
| | - Stephen G. Jefferys
- Pain and Symptom Management/Palliative Care Program, BC Cancer, Kelowna, British Columbia, Canada
- Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada
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17
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Røikjer J, Mørch CD, Ejskjaer N. Diabetic Peripheral Neuropathy: Diagnosis and Treatment. Curr Drug Saf 2020; 16:2-16. [PMID: 32735526 DOI: 10.2174/1574886315666200731173113] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is traditionally divided into large and small fibre neuropathy (SFN). Damage to the large fibres can be detected using nerve conduction studies (NCS) and often results in a significant reduction in sensitivity and loss of protective sensation, while damage to the small fibres is hard to reliably detect and can be either asymptomatic, associated with insensitivity to noxious stimuli, or often manifests itself as intractable neuropathic pain. OBJECTIVE To describe the recent advances in both detection, grading, and treatment of DPN as well as the accompanying neuropathic pain. METHODS A review of relevant, peer-reviewed, English literature from MEDLINE, EMBASE and Cochrane Library between January 1st 1967 and January 1st 2020 was used. RESULTS We identified more than three hundred studies on methods for detecting and grading DPN, and more than eighty randomised-controlled trials for treating painful diabetic neuropathy. CONCLUSION NCS remains the method of choice for detecting LFN in people with diabetes, while a gold standard for the detection of SFN is yet to be internationally accepted. In the recent years, several methods with huge potential for detecting and grading this condition have become available including skin biopsies and corneal confocal microscopy, which in the future could represent reliable endpoints for clinical studies. While several newer methods for detecting SFN have been developed, no new drugs have been accepted for treating neuropathic pain in people with diabetes. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors and anticonvulsants remain first line treatment, while newer agents targeting the proposed pathophysiology of DPN are being developed.
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Affiliation(s)
- Johan Røikjer
- Department of Health Science and Technology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Carsten Dahl Mørch
- Department of Health Science and Technology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Niels Ejskjaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Role of Diosmin in protection against the oxidative stress induced damage by gamma-radiation in Wistar albino rats. Regul Toxicol Pharmacol 2020; 113:104622. [DOI: 10.1016/j.yrtph.2020.104622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/02/2020] [Accepted: 02/18/2020] [Indexed: 01/04/2023]
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Moisset X, Bouhassira D, Avez Couturier J, Alchaar H, Conradi S, Delmotte MH, Lanteri-Minet M, Lefaucheur JP, Mick G, Piano V, Pickering G, Piquet E, Regis C, Salvat E, Attal N. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol (Paris) 2020; 176:325-352. [PMID: 32276788 DOI: 10.1016/j.neurol.2020.01.361] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.
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Affiliation(s)
- X Moisset
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - D Bouhassira
- INSERM U987, CETD, Ambroise-Paré Hospital, AP-HP, Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, Versailles, France
| | - J Avez Couturier
- Service de Neuropédiatrie, Consultation Douleur Enfant, CIC-IT 1403, CHU de Lille, Lille, France
| | - H Alchaar
- 73, boulevard de Cimiez, Nice, France
| | - S Conradi
- CETD, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - M H Delmotte
- GHU, Paris site Ste-Anne, Structure Douleurs, 1, rue Cabanis, Paris 14, France
| | - M Lanteri-Minet
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; Département d'Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France
| | - J P Lefaucheur
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France; Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - G Mick
- Centre d'Évaluation et Traitement de la Douleur du Voironnais, Centre Hospitalier de Voiron, Laboratoire P2S, Université de Lyon, Lyon, France
| | - V Piano
- Centre Hospitalier de Draguignan, Service Algologie 4(e), route de Montferrat, 83007 Draguignan cedex, France
| | - G Pickering
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; Clinical Pharmacology Department, CPC/CIC Inserm 1405, University Hospital CHU, Clermont-Ferrand, France
| | - E Piquet
- Département d'Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France
| | - C Regis
- CETD, CHU Montpellier, Montpellier, France
| | - E Salvat
- Centre d'Évaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - N Attal
- INSERM U987, CETD, Ambroise-Paré Hospital, AP-HP, Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, Versailles, France
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Minhaj FS, Hoang-Nguyen M, Tenney A, Bragg A, Zhang W, Foster J, Rotoli J, Acquisto NM. Evaluation of opioid requirements in the management of renal colic after guideline implementation in the emergency department. Am J Emerg Med 2019; 38:2564-2569. [PMID: 31932132 DOI: 10.1016/j.ajem.2019.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Evaluate opioid prescribing before and after emergency department (ED) renal colic guideline implementation focused on multi-modal pain management. METHODS Retrospective study of ED patients who received analgesia for urolithiasis before and after guideline implementation. The guideline recommends oral acetaminophen, intravenous (IV) ketorolac, and a fluid bolus as first line, IV lidocaine as second line, and opioids as refractory therapy to control pain. Opioid exposure, adverse effects, length of stay (LOS), and ED representation were evaluated. Comparisons were made with univariate analyses. Backwards stepwise binomial multivariate logistic regression to identify factors related to opioid use was performed. RESULTS Overall, 962 patients were included (451 pre- and 511 post-implementation). ED and discharge opioid use decreased; 65% vs. 58% and 71% vs. 63% in pre- and post-implementation groups, respectively. More post-implementation patients received non-opioid analgesia (65% vs. 56%) and non-opioid analgesia prior to opioids (50% vs. 38%). A longer ED LOS and higher initial pain score were associated with ED opioid administration. Guideline implementation, receiving non-opioid therapy first, and first renal colic episode were associated with decreased ED opioid administration. Seventeen adverse events (1.8%) were reported. There was no difference in change in ED pain score between groups, but patients in the post-implementation group were admitted more and had a higher 7-day ED representation (11% vs. 7%). CONCLUSIONS A multimodal analgesia protocol for renal colic was associated with decreased opioid prescribing, higher rates of admission to the hospital, and a higher 7-day ED representation rate.
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Affiliation(s)
- Faisal Syed Minhaj
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America.
| | - Mercy Hoang-Nguyen
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America
| | - Austin Tenney
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America
| | - Andrew Bragg
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America
| | - Wen Zhang
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America
| | - Justin Foster
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America
| | - Jason Rotoli
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America; Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States of America
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Vafa A, Afzal SM, Barnwal P, Rashid S, Shahid A, Alpashree, Islam J, Sultana S. Protective role of diosmin against testosterone propionate-induced prostatic hyperplasia in Wistar rats: Plausible role of oxidative stress and inflammation. Hum Exp Toxicol 2019; 39:1133-1146. [DOI: 10.1177/0960327119889655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Benign prostatic hyperplasia (BPH) is an important key health concern for aging men. Polyphenolic compounds have been found to possess important roles in the inhibition of numerous ailments that involve reactive oxygen species and inflammation. Diosmin is a citrus flavone that possesses antioxidant, anti-inflammatory, antiproliferative, and anticancer activities, so based on these properties of diosmin, we decided to evaluate its effect on testosterone propionate (TP)-induced BPH. A total of 30 Wistar rats were randomly assigned to five groups having six animals in each. This study was of 28 days in which TP (5 mg kg−1) was administered to induce BPH in the last 10 days of the study. It was found that diosmin at the doses of 20 and 40 mg kg−1significantly reduced malondialdehyde and xanthine oxidase formation in a dose-dependent manner; however, it replenished catalase, glutathione (GSH), and GSH-dependent enzymes, that is, glutathione peroxidase, glutathione reductase, and glutathione- S-transferase significantly against TP-induced BPH. Further, immunohistochemical study showed that diosmin alleviated inflammatory markers (nuclear factor kappa-light-chain-enhancer of activated B cells, cyclooxygenase-2, and interleukin-6). It was also found that diosmin downregulated the expression of androgen receptor and decreased the prostate-specific antigen concentration dose-dependently, significantly against TP-induced BPH. Diosmin also restored histoarchitecture of the prostate in a dose-dependent manner. Findings from the present study revealed the protective role of diosmin against TP-induced BPH in Wistar rats.
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Affiliation(s)
- A Vafa
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - SM Afzal
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - P Barnwal
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - S Rashid
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
- Department of Pharmacology and Toxicology, College of Pharmacy, Girls Section, Prince Sattam Bin Abdulaziz University, Al-Kharj, KSA
| | - A Shahid
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - Alpashree
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - J Islam
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - S Sultana
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, Hamdard Nagar, New Delhi, India
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The Analgesic and Emotional Response to Intravenous Lidocaine Infusion in the Treatment of Postherpetic Neuralgia: A Randomized, Double-Blinded, Placebo-controlled Study. Clin J Pain 2019; 34:1025-1031. [PMID: 29698250 DOI: 10.1097/ajp.0000000000000623] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study evaluated the analgesic efficacy and emotional response to intravenous lidocaine infusion compared with placebo in patients with postherpetic neuralgia (PHN). METHODS In this randomized, double-blinded study, patients with PHN received 5 mg/kg intravenous lidocaine infusion or placebo. The primary outcome was pain measured by Visual Analogue Scale, Von Frey, and area of allodynia. Moreover, emotional status of anxiety and depression were evaluated by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Quality of life was assessed by Short Form Health Survey 36. RESULTS In total, 197 patients were enrolled and eligible data were collected from 183 of those patients. The Visual Analogue Scale scores were reduced to a minimum at 2 weeks (2.74, 2.99) after infusion, but no significant difference was found between the lidocaine and placebo groups. Similar changes were also found in mechanical pain threshold and area of allodynia. However, the lidocaine group was associated with a statistically significant reduction in consumption of analgesics with a relative risk of 6.2 (95% confidence interval [CI], 2.24-17.16). Lidocaine infusion also significantly improved the anxiety and depression status; the values of mean change in anxiety and depression were 3.89 (95% CI, 1.43-6.35) and 4.3 (95% CI, 0.63-7.98), respectively, at 2 weeks. Moreover, improvement was exhibited in Short Form Health Survey 36 health status, with the mean change of 49.81 (95% CI, 28.17-71.46) at 1 week, in particular scores on vitality, physical and emotional role functioning, and mental health. CONCLUSIONS The analgesic response of 5 mg/kg lidocaine intravenous infusion is comparable to placebo in patients with PHN, but intravenous lidocaine infusion significantly reduced total analgesic consumption, and improved the overall emotional and health status.
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Zhu B, Zhou X, Zhou Q, Wang H, Wang S, Luo K. Intra-Venous Lidocaine to Relieve Neuropathic Pain: A Systematic Review and Meta-Analysis. Front Neurol 2019; 10:954. [PMID: 31620064 PMCID: PMC6759769 DOI: 10.3389/fneur.2019.00954] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background: The prevalence of neuropathic pain is estimated to be between 7 and 10% in the general population. The efficacy of intravenous (IV) lidocaine has been studied by numerous clinical trials on patients with neuropathic pain. The aim of this systematic review and meta-analysis was to evaluate the efficacy of IV lidocaine compared with a placebo for neuropathic pain and secondly to assess the safety of its administration. Methods: A literature search on PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases was performed for relevant studies published up to February 2019. Randomized controlled trials (RCTs) evaluating IV lidocaine treatment for pain relief in patients with neuropathic pain were included. Results: 26 articles met the inclusion criteria. Patients with varied etiology of neuropathic pain were among the patient samples of these studies. Fifteen articles were included for quantitative analysis. Lidocaine was superior to a placebo in relieving neuropathic pain in the early post-infusion period [Mean Difference (MD) = -11.9; 95% Confidence interval (CI): -16.8 to -7; p < 0.00001]. Multiple infusions of lidocaine over a period of 4 weeks, however, had no significant effect on reliving neuropathic pain (MD = -0.96; 95% CI: -2.02 to 0.11; p = 0.08). IV lidocaine was also associated with a significant number of adverse events compared to a placebo [Odds Ratio (OR) = 7.75; 95% CI: 3.18-18.92; p < 0.00001]. Conclusion: Our study indicates that while IV lidocaine is effective in pain control among patients with neuropathic pain in the immediate post-infusion period, it does not have a long-lasting, persistent effect. IV infusions of the drug are associated with an increased risk of side effects compared to a placebo. However, the risk of serious adverse events is negligible. Further, well-designed RCTs evaluating the effects of various dosages and infusion periods of IV lidocaine are required to provide clear guidelines on its clinical use.
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Affiliation(s)
- Bo Zhu
- Department of Anesthesiology, Zhejiang Chinese Medical University Affiliated Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Xiayun Zhou
- Department of Anesthesiology, Zhejiang Chinese Medical University Affiliated Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Qinghe Zhou
- Department of Anesthesiology, Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Haiyan Wang
- Department of Anesthesiology, Zhejiang Chinese Medical University Affiliated Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Shougen Wang
- Department of Anesthesiology, Zhejiang Chinese Medical University Affiliated Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Kaitao Luo
- Department of Acupuncture, Zhejiang Chinese Medical University Affiliated Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
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24
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Hermanns H, Hollmann MW, Stevens MF, Lirk P, Brandenburger T, Piegeler T, Werdehausen R. Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: a narrative review. Br J Anaesth 2019; 123:335-349. [DOI: 10.1016/j.bja.2019.06.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023] Open
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Iacob E, Hagn EE, Sindt J, Brogan S, Tadler SC, Kennington KS, Hare BD, Bokat CE, Donaldson GW, Okifuji A, Junkins SR. Tertiary Care Clinical Experience with Intravenous Lidocaine Infusions for the Treatment of Chronic Pain. PAIN MEDICINE 2019; 19:1245-1253. [PMID: 29016948 DOI: 10.1093/pm/pnx167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To evaluate the safety of and long-term pain relief due to intravenous lidocaine infusion for the treatment of chronic pain in a tertiary pain management clinic. Design Retrospective chart review. Methods Medical records were reviewed from 233 adult chronic pain patients who underwent one to three lidocaine infusions. The initial lidocaine challenge consisted of 1,000 mg/h administered intravenously for up to 30 minutes until infusion was complete, full pain resolution, the patient requested to stop, side effects (SEs) became intolerable, and/or if there were any safety concerns. Subsequent infusions were tailored to patient response. Data reviewed included pain diagnosis, lidocaine dose, SEs, and duration of pain relief documented at a follow-up visit. Results Patients primarily had neuropathic pain (80%), were 94% white, 58% were female, and there was an average pain duration of 7.9 years. SEs were usually mild and transient, including perioral tingling, dizziness, tinnitus, and nausea/vomiting, and they were uncommon after the initial infusion. Overall, 41% of patients showed long-lasting pain relief, with positive response to the initial infusion associated with receiving and benefitting from subsequent infusions. Benefit by pain diagnoses varied from 32% to 58%. Conclusions Our retrospective study in a heterogeneous population with chronic pain suggests that intravenous lidocaine is a safe treatment. Data also suggest long-term pain relief in a significant proportion of patients. Additional study is important in order to delineate patient selection, determine optimal dosing and treatment frequency, assess pain reduction and duration, and treatment cost-effectiveness.
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Affiliation(s)
- Eli Iacob
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Research Center, University of Utah School of Medicine, Salt Lake City, Utah
| | - Emily E Hagn
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
| | - Jill Sindt
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
| | - Shane Brogan
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
| | - Scott C Tadler
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Konrad S Kennington
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Bradford D Hare
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
| | - Christina E Bokat
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
| | - Gary W Donaldson
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Research Center, University of Utah School of Medicine, Salt Lake City, Utah
| | - Akiko Okifuji
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Research Center, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
| | - Scott R Junkins
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Anesthesiology, Pain Management Center, University of Utah, Salt Lake City, Utah, USA
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26
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Affiliation(s)
- Eduardo Bruera
- Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta, Canada
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27
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Efficacy and Safety of Lidocaine Infusion Treatment for Neuropathic Pain: A Randomized, Double-Blind, and Placebo-Controlled Study. Reg Anesth Pain Med 2019; 43:415-424. [PMID: 29381569 DOI: 10.1097/aap.0000000000000741] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Lidocaine infusion therapy (LIT) is an effective treatment for relieving neuropathic pain (NeP). However, it remains unclear whether pain relief can be sustained through repeated lidocaine infusions. This study aimed to determine whether repeated intravenous administration of low-dose lidocaine could provide prolonged pain relief in patients with specific NeP conditions. METHODS This is a prospective, randomized, double-blind, placebo-controlled, parallel study. We compared the efficacy and safety of lidocaine infusions (3 mg/kg) in the LIT group and normal saline infusions in the control group once a week for 4 consecutive weeks in patients with postherpetic neuralgia or complex regional pain syndrome type II. The primary outcome was the difference in the percentage change in the 11-point numerical rating scale (NRS) pain score from baseline to after the final infusion. Secondary outcomes included pain scores during 4 weeks of follow-up and any complications. RESULTS Forty-two patients completed this study protocol. The percentage reduction in NRS pain scores after the final infusion was significantly greater in the LIT group compared with the control group (P = 0.011). However, this pain reduction was not detectable at the 4-week follow-up. The difference in the percentage change in NRS pain scores was especially prominent in the LIT group after the third and fourth infusions. None of the study participants experienced serious complications from the treatment. CONCLUSIONS Lidocaine infusion therapy (3 mg/kg of lidocaine administered over 1 hour) provided effective short-term pain relief, which was substantially prominent after repeated infusions were administered to patients with refractory NeP. CLINICAL TRIAL REGISTRATION This study was registered at ClinicalTrials.gov, identifier NCT02597257.
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28
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Berk T, Silberstein SD. The Use and Method of Action of Intravenous Lidocaine and Its Metabolite in Headache Disorders. Headache 2018. [DOI: 10.1111/head.13298] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas Berk
- NYU School of Medicine; New York NY 10016 USA
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Ahmed S, Mundhe N, Borgohain M, Chowdhury L, Kwatra M, Bolshette N, Ahmed A, Lahkar M. Diosmin Modulates the NF-kB Signal Transduction Pathways and Downregulation of Various Oxidative Stress Markers in Alloxan-Induced Diabetic Nephropathy. Inflammation 2017; 39:1783-97. [PMID: 27492452 DOI: 10.1007/s10753-016-0413-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hyperglycaemia-mediated oxidative stress plays an imperative role in the progression of diabetic nephropathy. NF-kB is an important transcription factor in eukaryotes which regulates a diverse array of cellular process, including inflammation, immunological response, apoptosis, growth and development. Increased expression of NF-kB plays a vital role in the pathogenesis of many inflammatory diseases including diabetic nephropathy. Hence, the present study was designed to explore the nephroprotective nature of diosmin by assessing the various biochemical parameters, markers of oxidative stress and proinflammatory cytokine levels in alloxan-induced diabetic Wistar rats. Type 2 diabetes was induced in Wistar rats by single intraperitoneal injection of alloxan (120 mg/kg body weight). Seventy-two hours after the conformation of diabetes (blood glucose level ≥ 250 mg/dl), the rats were segregated into four groups, each group having six animals. Diabetic rats were treated with diosmin at a dose of 50 mg and 100 mg/kg body weight respectively. After the 28th day of treatment, rats were sacrificed, blood serum, plasma and kidney tissue were collected for various biochemical analysis. Inflammatory cytokine levels were measured through ELISA kit. Diosmin treatment produces significant reduction in the blood glucose and plasma insulin level and increases the body weight when compared with diabetic rats. Elevated level of malondialdehyde (MDA) and decrease levels of superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH) and nitric oxide (NO) were significantly restored after 28 days of diosmin treatment. Diosmin treatment group also restores the normal architecture of the kidney tissue which was confirmed by histopathological examination. Moreover, oral administration of diosmin shows a significant normalization in the level of NF-kB, proving its pivotal role in maintaining renal function. The above ameliorative effects were more pronounced with diosmin at a dose of 100 mg/kg body weight. The above results permit us to conclude that treatment with diosmin halts hyperglycaemia-mediated oxidative stress and decline in pro-inflammatory cytokines and thus has beneficial anti-diabetic activity.
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Affiliation(s)
- Sahabuddin Ahmed
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Bhangagarh, Guwahati, Assam, 781032, India.
| | - Nitin Mundhe
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Bhangagarh, Guwahati, Assam, 781032, India
| | - Manash Borgohain
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Bhangagarh, Guwahati, Assam, 781032, India
| | - Liakat Chowdhury
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Bhangagarh, Guwahati, Assam, 781032, India
| | - Mohit Kwatra
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Bhangagarh, Guwahati, Assam, 781032, India
| | - Nityanand Bolshette
- Department of Biotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Guwahati, Assam, 781032, India
| | - Anwaruddin Ahmed
- Department of Pathology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, 560074, India
| | - Mangala Lahkar
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Bhangagarh, Guwahati, Assam, 781032, India.,Department of Pharmacology, Gauhati Medical College, Guwahati, Assam, 781032, India
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30
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Cheng GS, Ilfeld BM. A review of postoperative analgesia for breast cancer surgery. Pain Manag 2016; 6:603-618. [DOI: 10.2217/pmt-2015-0008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An online database search with subsequent article review was performed in order to review the various analgesic modalities for breast cancer surgery. Of 514 abstracts, 284 full-length manuscripts were reviewed. The effect of pharmacologic interventions is varied (NSAIDS, opioids, anticonvulsants, ketamine, lidocaine). Likewise, data from high-quality randomized, controlled studies on wound infiltration (including liposome encapsulated) and infusion of local anesthetic are minimal and conflicting. Conversely, abundant evidence demonstrates paravertebral blocks and thoracic epidural infusions provide effective analgesia and minimize opioid requirements, while decreasing opioid-related side effects in the immediate postoperative period. Other techniques with promising – but extremely limited – data include cervical epidural infusion, brachial plexus, interfascial plane and interpleural blocks. In conclusion, procedural interventions involving regional blocks are more conclusively effective than pharmacologic modalities in providing analgesia to patients following surgery for breast cancer.
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Affiliation(s)
- Gloria S Cheng
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Ilfeld
- University of California San Diego, San Diego, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
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Przeklasa-Muszyńska A, Kocot-Kępska M, Dobrogowski J, Wiatr M, Mika J. Intravenous lidocaine infusions in a multidirectional model of treatment of neuropathic pain patients. Pharmacol Rep 2016; 68:1069-75. [DOI: 10.1016/j.pharep.2016.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022]
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Cheng GS, Ilfeld BM. An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery. PAIN MEDICINE 2016; 18:1344-1365. [DOI: 10.1093/pm/pnw172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Postthoracotomy pain management is essential imme diately after surgery and crucial for the patient suffering from this problem for a long duration. Understanding the causative and pathophysiological basis for this condition requires frequent assessment and a multidi mensional approach. Inadequate pain control has detri mental effects on the routine activities of patients as well as on their physical and emotional well-being. During the last 2 decades, the understanding of various pain-related issues has been strengthened resulting in early intervention and pain management. Various phar macological modalities including the role of nonopiates, opiates, and adjuvant drugs are helpful in combating postthoracotomy pain. A selective group of patients will benefit from interventional techniques. The treat ment decision requires a clear understanding of the disease and its impact on the patient. There must also be an understanding of risk and benefits as well as cost and benefits for various drugs and techniques before selecting the appropriate therapy.
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Affiliation(s)
- Subhash Jain
- Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Samyadev Datta
- Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Debra Tundis
- Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Dach F, Éckeli ÁL, Ferreira KDS, Speciali JG. Nerve block for the treatment of headaches and cranial neuralgias - a practical approach. Headache 2015; 55 Suppl 1:59-71. [PMID: 25644836 DOI: 10.1111/head.12516] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have presented evidence that blocking peripheral nerves is effective for the treatment of some headaches and cranial neuralgias, resulting in reduction of the frequency, intensity, and duration of pain. OBJECTIVES In this article we describe the role of nerve block in the treatment of headaches and cranial neuralgias, and the experience of a tertiary headache center regarding this issue. We also report the anatomical landmarks, techniques, materials used, contraindications, and side effects of peripheral nerve block, as well as the mechanisms of action of lidocaine and dexamethasone. CONCLUSIONS The nerve block can be used in primary (migraine, cluster headache, and nummular headache) and secondary headaches (cervicogenic headache and headache attributed to craniotomy), as well in cranial neuralgias (trigeminal neuropathies, glossopharyngeal and occipital neuralgias). In some of them this procedure is necessary for both diagnosis and treatment, while in others it is an adjuvant treatment. The block of the greater occipital nerve with an anesthetic and corticosteroid compound has proved to be effective in the treatment of cluster headache. Regarding the treatment of other headaches and cranial neuralgias, controlled studies are still necessary to clarify the real role of peripheral nerve block.
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Affiliation(s)
- Fabíola Dach
- Headache Clinic, University Hospital of School of Medicine, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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35
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Guimarães Alves IP, Montoro Nicácio G, Diniz MS, Alves Rocha TL, Prada Kanashiro G, Navarro Cassu R. Analgesic comparison of systemic lidocaine, morphine or lidocaine plus morphine infusion in dogs undergoing fracture repair. Acta Cir Bras 2014; 29:245-51. [PMID: 24760025 DOI: 10.1590/s0102-86502014000400005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/11/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the postoperative analgesic effects of lidocaine, morphine and lidocaine plus morphine administered by constant rate infusion (CRI) and analyzing their effects on opioid requirements after orthopedic surgery in dogs. METHODS Twenty-four dogs underwent fracture repairs were premedicated with IM acepromazine (0.05 mg/kg) combined with morphine (0.3mg/kg). Anesthesia was induced with IV propofol (4 to 5 mg/ kg) and maintained with isoflurane. The dogs were randomly assigned to 3 groups and administered a CRI IV of lidocaine (T-L), morphine (T-M) or lidocaine plus morphine (T-LM) at the same doses. Postoperative analgesia was assessed for 24 hours using a Visual Analog Scale (VAS) and the Glasgow Composite Pain Scale (GCPS). Rescue analgesia was performed if the evaluation score exceeded 50% of the VAS and/or 33% of the GCPS. RESULTS The pain score and postoperative opioid requirements did not differ among the treatments. Rescue analgesia was administered to 1/8 dogs in the T-M and T-LM, and to 3/8 dogs in the T-L. CONCLUSION Lidocaine, morphine or lidocaine/morphine CRI may be efficacious techniques for pain management in the first 24 hours post-surgery. However, the two drugs administered together did not reduce the postoperative opioid requirement in dogs undergoing fracture repair. Key words: Anesthesia. Analgesics. Analgesics, Opioid. Lidocaine. Morphine. Dogs.
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Affiliation(s)
| | - Gabriel Montoro Nicácio
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine, UNOESTE, Presidente Prudente, SP, Brazil
| | - Miriely Steim Diniz
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine, UNOESTE, Presidente Prudente, SP, Brazil
| | - Thalita Leone Alves Rocha
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine, UNOESTE, Presidente Prudente, SP, Brazil
| | - Glaucia Prada Kanashiro
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine, UNOESTE, Presidente Prudente, SP, Brazil
| | - Renata Navarro Cassu
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine, UNOESTE, Presidente Prudente, SP, Brazil
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Vahidi E, Shakoor D, Aghaie Meybodi M, Saeedi M. Comparison of intravenous lidocaine versus morphine in alleviating pain in patients with critical limb ischaemia. Emerg Med J 2014; 32:516-9. [DOI: 10.1136/emermed-2014-203944] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/19/2014] [Indexed: 11/04/2022]
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Salas S, Auquier P, Duffaud F, Garnier SR, Deschamps M, Honoré S, Sudour P, Baumstarck K. Efficacy of lidocaine in patients receiving palliative care with opioid-refractory cancer pain with a neuropathic component: study protocol for a randomized controlled study. Trials 2014; 15:318. [PMID: 25112302 PMCID: PMC4247742 DOI: 10.1186/1745-6215-15-318] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/31/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The management of patients suffering from opioid-refractory cancer pain with a neuropathic component remains an important challenge for healthcare workers. Only one retrospective study specifically reported the use of intravenous (IV) lidocaine amongst the palliative care unit population, the study found that there was a positive response to this therapy. These preliminary uncontrolled results need to be confirmed by randomized controlled trials. The primary objective of this study is to assess the analgesic efficacy of IV lidocaine in patients in palliative care suffering from opioid-refractory cancer pain with a neuropathic component. The secondary objectives are to assess the tolerance of, symptomatology, and patient satisfaction with the therapeutic approach. METHODS/DESIGN This will be a multicenter, prospective, randomized, placebo-controlled, double-blind, two-parallel group study. It will take place in eight adult palliative care units across France. The main inclusion criteria are as follows: adult patients suffering from opioid-refractory cancer pain with a neuropathic component, and those receiving palliative care as defined by French Society of Palliative and Support Care. Participants will be randomized (1:1 allocation ratio) to one of two treatment groups: a) lidocaine-experimental group (intravenous lidocaine), or b) placebo-control group (intravenous saline solution). Evaluation assessments will be taken at baseline (T0 randomization), 40 minutes (T1), 120 minutes (T2), 12 hours (T3), 24 hours (T4), 48 hours (T5), and 14 days (T6) after baseline. The primary endpoint is change in the pain level between T0 and T1. The secondary endpoints are: changes in the pain level between T0 and other times, intensity of the neuropathic pain component, daily opioid consumption, symptoms (as classified by the MD Anderson Symptom Inventory), adverse events, and patient's satisfaction (measured using the Pain Treatment Satisfaction Scale). A sample size of 200 individuals will be needed to obtain 90% power to detect a 25% difference in pain success at T1 between the two groups; pain success is classified as a 30% decrease in the pain level between T0 and T1 (10% of patients lost to follow-up expected). DISCUSSION The randomized, double-blind, placebo-controlled design is the most appropriate design to demonstrate the efficacy of a new experimental intervention (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study. TRIAL REGISTRATION Current controlled trials NCT02137954 (registration date: 7 May 2014).
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Affiliation(s)
- Sébastien Salas
- />Service d’Oncologie Médicale Adulte et de Soins Palliatifs, Centre Hospitalier Universitaire Timone, AP-HM, Aix-Marseille University, 27 bd Jean Moulin, 13385 Marseille, France
- />CRO2, INSERM U911, Aix-Marseille University, 27 bd Jean Moulin, 13385 Marseille, France
| | - Pascal Auquier
- />EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Université de la Méditerranée, 27 bd Jean Moulin, Marseille cedex 05, F-13385 France
| | - Florence Duffaud
- />Service d’Oncologie Médicale Adulte et de Soins Palliatifs, Centre Hospitalier Universitaire Timone, AP-HM, Aix-Marseille University, 27 bd Jean Moulin, 13385 Marseille, France
| | - Stéphanie Ranque Garnier
- />Service d’Oncologie Médicale Adulte et de Soins Palliatifs, Centre Hospitalier Universitaire Timone, AP-HM, Aix-Marseille University, 27 bd Jean Moulin, 13385 Marseille, France
- />EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Université de la Méditerranée, 27 bd Jean Moulin, Marseille cedex 05, F-13385 France
| | - Mélanie Deschamps
- />Service d’Oncologie Médicale Adulte et de Soins Palliatifs, Centre Hospitalier Universitaire Timone, AP-HM, Aix-Marseille University, 27 bd Jean Moulin, 13385 Marseille, France
| | - Stéphane Honoré
- />CRO2, INSERM U911, Aix-Marseille University, 27 bd Jean Moulin, 13385 Marseille, France
- />Unité d’Expertise Pharmaceutique et Recherche Biomédicale, Pôle Pharmacie, AP-HM, 27 bd Jean MOULIN, 13385 Marseille, France
| | - Patrick Sudour
- />Direction de la Recherche, AP-HM, 80 rue Brochier, 13005 Marseille, France
| | - Karine Baumstarck
- />EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Université de la Méditerranée, 27 bd Jean Moulin, Marseille cedex 05, F-13385 France
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Neuropathic pain in osteoarthritis: a review of pathophysiological mechanisms and implications for treatment. Semin Arthritis Rheum 2014; 44:145-54. [PMID: 24928208 DOI: 10.1016/j.semarthrit.2014.05.011] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) is the leading cause of musculoskeletal pain and functional disability worldwide, affecting a growing number of individuals in the western society. Despite various conservative and interventional treatment approaches, the overall management of the condition is problematic, and pain-the major clinical problem of the disease-remains sub-optimally controlled. The objectives of this review are to present the pathophysiologic mechanisms underlying the complexity of pain in OA and to discuss the challenges for new treatment strategies aiming to translate experimental findings into daily clinical practice. METHODS A narrative literature review of studies investigating the existence of a neuropathic component in OA pain was conducted. We searched PubMed, Embase and Scopus for English language publications. A hand-search of reference lists of relevant studies was also performed. RESULTS Recent advances have shed additional light on the pathophysiology of osteoarthritic pain, highlighting the contribution of central pain pathways together with the sensitisation of peripheral joint receptors and changes of the nociceptive process induced by local joint inflammation and structural bone tissue changes. Thus, a neuropathic pain component may be predominant in individuals with minor joint changes but with high levels of pain refractory to analgesic treatment, providing an alternative explanation for osteoarthritic pain perception. CONCLUSION A growing amount of evidence suggests that the pain in OA has a neuropathic component in some patients. The deeper understanding of multiple mechanisms of OA pain has led to the use of centrally acting medicines that may have a benefit on alleviating osteoarthritic pain. The ineffective pain management and the increasing rates of disability associated with OA mandate for change in our treatment paradigm.
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Gozalo-Marcilla M, Gasthuys F, Schauvliege S. Partial intravenous anaesthesia in the horse: a review of intravenous agents used to supplement equine inhalation anaesthesia. Part 1: lidocaine and ketamine. Vet Anaesth Analg 2014; 41:335-45. [PMID: 24815750 DOI: 10.1111/vaa.12179] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the literature with regard to the use of different intravenous agents as supplements to inhalational anaesthesia in horses. These drugs include lidocaine, ketamine, opioids and α2 -agonists. The Part 1 of this review will focus in the use of lidocaine and ketamine. DATABASES USED Pubmed & Web of Science. Search terms: horse, inhalant anaesthesia, balanced anaesthesia, partial intravenous anaesthesia, lidocaine, ketamine. CONCLUSIONS Different drugs and their combinations can be administered systemically in anaesthetized horses, with the aim of reducing the amount of the volatile agent whilst improving the recovery qualities and providing a multimodal analgesic approach. However, full studies as to whether these techniques improve cardiopulmonary status are not always available and potential disadvantages should also be considered.
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Affiliation(s)
- Miguel Gozalo-Marcilla
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Mooney JJ, Pagel PS, Kundu A. Safety, Tolerability, and Short-Term Efficacy of Intravenous Lidocaine Infusions for the Treatment of Chronic Pain in Adolescents and Young Adults: A Preliminary Report. PAIN MEDICINE 2014; 15:820-5. [PMID: 24423053 DOI: 10.1111/pme.12333] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- James J Mooney
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Jain D, Bansal MK, Dalvi R, Upganlawar A, Somani R. Protective effect of diosmin against diabetic neuropathy in experimental rats. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2014; 12:35-41. [DOI: 10.1016/s2095-4964(14)60001-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Duarte RV, Raphael JH, Dimitroulas T, Sparkes E, Southall JL, Ashford RL, Kitas GD. Osteoarthritis pain has a significant neuropathic component: an exploratory in vivo patient model. Rheumatol Int 2013; 34:315-20. [DOI: 10.1007/s00296-013-2893-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 10/30/2013] [Indexed: 01/17/2023]
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McCleane G. Does intravenous lidocaine reduce fibromyalgia pain?: A randomized, double-blind, placebo controlled cross-over study. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856900750232515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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McCleane G. Intravenous infusion of lidocaine is not associated with changes in cardiovascular parameters: a study of 15 patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/15685690152385790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cammack F, Shipton EA. The christchurch earthquake: crush injury, neuropathic pain, and posttraumatic stress disorder. Case Rep Med 2013; 2013:973234. [PMID: 23956754 PMCID: PMC3728530 DOI: 10.1155/2013/973234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/26/2013] [Indexed: 01/08/2023] Open
Abstract
On February 22, 2011, an earthquake of magnitude 6.3 struck Christchurch, New Zealand. The peak ground acceleration, a measure of the shaking or intensity of an earthquake, was one of the highest ever recorded worldwide. One hundred and eighty-five people lost their lives; many others were injured. Two cases both involving young women are presented; they sustained crush injuries to limbs after being trapped by falling debris and went on to develop severe neuropathic pain. This report examines the mechanisms of neuropathic pain in the setting of crush injury, the treatment modalities, and the association between chronic pain and posttraumatic stress disorder. These case reports highlight the fact that crush injury is relatively common during major earthquakes and that neuropathic pain is an important sequel of this. Post-traumatic stress disorder is common in earthquake survivors with a recognised association with chronic pain. Pain-related disability may increase as well. Issues such as chronic pain and physical disability should not be overlooked as attention focuses on disaster management and the treatment of life-threatening injuries.
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Affiliation(s)
- Frances Cammack
- Department of Anaesthesia, Christchurch Hospital, Christchurch 8001, New Zealand
| | - Edward A. Shipton
- Department of Anaesthesia, University of Otago, P.O. Box 4345, Christchurch 8001, New Zealand
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Abstract
Arthritis pain is a complex phenomenon involving intricate neurophysiological processing at all levels of the pain pathway. The treatment options available to alleviate joint pain are fairly limited and most arthritis patients report only modest pain relief with current treatments. A better understanding of the neural mechanisms responsible for musculoskeletal pain and the identification of new targets will help in the development of future pharmacological therapies. This article reviews some of the latest research into factors which contribute to joint pain and covers areas such as cannabinoids, proteinase activated receptors, sodium channels, cytokines and transient receptor potential channels. The emerging hypothesis that osteoarthritis may have a neuropathic component is also discussed.
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Perioperative Intravenous Lidocaine Decreases the Incidence of Persistent Pain After Breast Surgery. Clin J Pain 2012; 28:567-72. [DOI: 10.1097/ajp.0b013e31823b9cc8] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Takeda M, Oshima K, Takahashi M, Matsumoto S. Systemic administration of lidocaine suppresses the excitability of rat cervical dorsal horn neurons and tooth-pulp-evoked jaw-opening reflex. Eur J Pain 2012; 13:929-34. [DOI: 10.1016/j.ejpain.2008.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 10/27/2008] [Accepted: 11/23/2008] [Indexed: 11/28/2022]
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Schuelert N, McDougall JJ. Involvement of Nav 1.8 sodium ion channels in the transduction of mechanical pain in a rodent model of osteoarthritis. Arthritis Res Ther 2012; 14:R5. [PMID: 22225591 PMCID: PMC3392791 DOI: 10.1186/ar3553] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/16/2011] [Accepted: 01/07/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A subgroup of voltage gated sodium channels including Nav1.8 are exclusively expressed on small diameter primary afferent neurons and are therefore believed to be integral to the neurotransmission of nociceptive pain. The present study examined whether local application of A-803467, a selective blocker of the Nav 1.8 sodium channel, can reduce nociceptive transmission from the joint in a rodent model of osteoarthritis (OA). METHODS OA-like changes were induced in male Wistar rats by an intra-articular injection of 3 mg sodium monoiodoacetate (MIA). Joint nociception was measured at day 14 by recording electrophysiologically from knee joint primary afferents in response to non-noxious and noxious rotation of the joint both before and following close intra-arterial injection of A-803467. The effect of Nav1.8 blockade on joint pain perception and secondary allodynia were determined in MIA treated animals by hindlimb incapacitance and von Frey hair algesiometry respectively. RESULTS A-803467 significantly reduced the firing rate of joint afferents during noxious rotation of the joint but had no effect during non-noxious rotation. In the pain studies, peripheral injection of A-803467 into OA knees attenuated hindlimb incapacitance and secondary allodynia. CONCLUSIONS These studies show for the first time that the Nav1.8 sodium channel is part of the molecular machinery involved in mechanotransduction of joint pain. Targeting the Nav1.8 sodium channel on joint nociceptors could therefore be useful for the treatment of OA pain, avoiding the unwanted side effects of non-selective nerve blocks.
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Affiliation(s)
- Niklas Schuelert
- Department of Physiology & Pharmacology, University of Calgary, 3330, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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