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Zhang EX, Yazdi C, Islam RK, Anwar AI, Alvares-Amado A, Townsend H, Allen KE, Plakotaris E, Hirsch JD, Rieger RG, Allampalli V, Hasoon J, Islam KN, Shekoohi S, Kaye AD, Robinson CL. Diabetic Neuropathy: A Guide to Pain Management. Curr Pain Headache Rep 2024:10.1007/s11916-024-01293-9. [PMID: 38967712 DOI: 10.1007/s11916-024-01293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE OF REVIEW Diabetic neuropathy is a common complication of diabetes mellitus (DM) and can affect up to 50% of DM patients during their lifetime. Patients typically present with numbness, tingling, pain, and loss of sensation in the extremities. Since there is no treatment targeting the underlying mechanism of neuropathy, strategies focus on preventative care and pain management. RECENT FINDINGS Up to 69% of patients with diabetic neuropathy receive pharmacological treatment for neuropathic pain. The United States Food and Drug Administration (FDA) confirmed four drugs for painful diabetic neuropathy (PDN): pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch. Nonpharmacological treatments such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS) both show promise in reducing pain in DM patients. Despite the high burden associated with PDN, effective management remains challenging. This update covers the background and management of diabetic neuropathy, including its epidemiology, pathogenesis, preventative care, and current therapeutic strategies.
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Affiliation(s)
- Emily X Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rahib K Islam
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Gravier Street, New Orleans, LA, 70112, USA
| | - Ahmed I Anwar
- Department of Psychology, Quinnipiac University, 275 Mt Carmel Ave, Hamden, CT, 06518, USA
| | - Alana Alvares-Amado
- American University of the Caribbean School of Medicine, 1 University Drive at, Jordan Dr, Cupecoy, Sint Maarten
| | - Horace Townsend
- American University of the Caribbean School of Medicine, 1 University Drive at, Jordan Dr, Cupecoy, Sint Maarten
| | - Kaitlyn E Allen
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Gravier Street, New Orleans, LA, 70112, USA
| | - Elena Plakotaris
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Gravier Street, New Orleans, LA, 70112, USA
| | - Jon D Hirsch
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Ross G Rieger
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Varsha Allampalli
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Jamal Hasoon
- Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA
| | - Kazi N Islam
- Agricultural Research Development Program, Central State University, 1400 Brush Row Road, Wilberforce, OH, 45384, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Jang HN, Oh TJ. Pharmacological and Nonpharmacological Treatments for Painful Diabetic Peripheral Neuropathy. Diabetes Metab J 2023; 47:743-756. [PMID: 37670573 PMCID: PMC10695723 DOI: 10.4093/dmj.2023.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/28/2023] [Indexed: 09/07/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. The lifetime prevalence of DPN is thought to be >50%, and 15%-25% of patients with diabetes experience neuropathic pain, referred to as "painful DPN." Appropriate treatment of painful DPN is important because this pain contributes to a poor quality of life by causing sleep disturbance, anxiety, and depression. The basic principle for the management of painful DPN is to control hyperglycemia and other modifiable risk factors, but these may be insufficient for preventing or improving DPN. Because there is no promising diseasemodifying medication for DPN, the pain itself needs to be managed when treating painful DPN. Drugs for neuropathic pain, such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, alpha-lipoic acid, sodium channel blockers, and topical capsaicin, are used for the management of painful DPN. The U.S. Food and Drug Administration (FDA) has approved pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch as drugs for the treatment of painful DPN. Recently, spinal cord stimulation using electrical stimulation is approved by the FDA for the treatment for painful DPN. This review describes the currently available pharmacological and nonpharmacological treatments for painful DPN.
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Affiliation(s)
- Han Na Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Yoo SH, Kim WJ, Chae JS, Kang BK, Kang MJ, Beak MH. Efficacy of scrambler therapy in patients with painful diabetic peripheral neuropathy: A single-arm, prospective, pilot study. Medicine (Baltimore) 2023; 102:e35357. [PMID: 37773810 PMCID: PMC10545242 DOI: 10.1097/md.0000000000035357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND A variety of medications are available to manage painful diabetic peripheral neuropathy (DPN), but the proper treatment remains challenging. Accordingly, various neuromodulation modalities have been used. However, no prospective clinical trials have evaluated the use of scrambler therapy (ST) in painful DPN. This study aimed to explore the long-term effects of ST in managing painful DPN. METHODS The patients received 10 consecutive STs of 45 minutes every 1 to 2 days. The primary outcome was pain score. We measured the visual analog scale (VAS) pain scores at baseline, during ST, immediately after ST, and at 1, 2, 3, and 6 months after ST. The secondary outcomes were Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein monofilament test, and Leeds Assessment of Neuropathic Symptoms and Signs pain scores, which were measured at baseline, immediately after ST, and at 1, 2, 3, and 6 months after ST. RESULTS VAS scores showed significant improvement at the 8th, 9th, and 10th sessions during ST and 1 month after ST. The MNSI self-report component score was decreased 1 month after the ST. However, all other outcomes did not show significant differences compared to the baseline. CONCLUSION ST may have short-term effects and limited long-term effects on painful DPN.
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Affiliation(s)
- Seung Hee Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Won-joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Bo Kyung Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min Jeong Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min Hyouk Beak
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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Kulikova N, Khalilovich AZM, Konchugova T, Rachin A, Chkheidze T, Kulchitskaya D, Anatoliy F, Sanina NP, Ivanova E. Analgesic effects of high-frequency and low-frequency TENS currents in patients with distal neuropathy. Eur J Transl Myol 2022; 32. [PMID: 35833896 PMCID: PMC9580526 DOI: 10.4081/ejtm.2022.10687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Currently, diabetes mellitus (DM) is relevant problem, both for its prevalence and complications, including distal polyneuropathy (DPNP). At the same time, discussions continue on analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) in DPNP. Aim of this study was to conduct a multi-faceted assessment of pain syndrome in these patients before and after TENS, taking into account levels of polyneuropathy, its severity and age of patients. The study was conducted in accordance with the research of the Federal State Budgetary Institution of the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation (CTR No. 121040100062-3) and with the permission of the Local Ethics Committee (IRB No. 2 dated 14.01.2021). The study included 75 patients with DM type II with DPNP, which are distributed into 3 groups of 25 people: Group 1a, patients received high–frequency TENS (HF); Group Ib, patients received low-frequency TENS (LF); as control, Group C received a standard method of pharmacological therapy without physiotherapy. Intensity of DPNP was evaluated before and after the course of treatment using a visual analog scale (VAS), the McGill Pain Questionnaire (MPQ), and a graphical linear analysis of pain on the neuropathic pain diagnostic questionnaire 4 (DN4) scale. TENS provides an analgesic effect that may exceed pharmacotherapy in terms of efficacy and safety. There was a 65.9% reduction in neuropathic pain according to VAS after a course of application, with the effects remaining up to 34% during the 6-month follow-up. HF TENS provided a higher significant analgesic effects than LF TENS, as it ensures the reduction of pain syndrome according to VAS by 25.8% (p <0.01), and total estimated characteristics - 35.5% (p <0.01), and touch - in at 58.1% (p = 0.001) and according to the scales of the MPQ (S) and DN4 - by 21% (p = 0.007). The observed differences in analgesic effects between HF TENS and LF TENS are based on analyses of pain in the immediate and long-term follow-up periods of type II DM patients with DPNP. These results, based on summation of the estimated parameters of the international pain scales support expectation of an expansion of the the use of analgesic TENS in aging patients suffering with DM of varying severity and extent of DPNP damage, a goal of great scientific and practical importance.
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Affiliation(s)
- Natalia Kulikova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia; Medical Institute of the Russian University of Friendship of Peoples, Moscow.
| | | | - Tatiana Konchugova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow.
| | - Andrey Rachin
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow.
| | - Tinatin Chkheidze
- Medical Institute of the Russian University of Friendship of Peoples, Moscow.
| | - Detelina Kulchitskaya
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow.
| | - Fesyun Anatoliy
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow.
| | - Natalia P Sanina
- Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow.
| | - Elena Ivanova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow.
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Johnson MI, Paley CA, Wittkopf PG, Mulvey MR, Jones G. Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060803. [PMID: 35744066 PMCID: PMC9230499 DOI: 10.3390/medicina58060803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.
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Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Correspondence: ; Tel.: +44-113-812-30-83
| | - Carole A. Paley
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Research & Development Department, Airedale NHS Foundation Trust, Steeton, Keighley BD20 6TD, UK
| | - Priscilla G. Wittkopf
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Matthew R. Mulvey
- Academic Unit of Primary and Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK;
| | - Gareth Jones
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
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Al-Zamil M, Minenko IA, Kulikova NG, Alade M, Petrova MM, Pronina EA, Romanova IV, Narodova EA, Nasyrova RF, Shnayder NA. Clinical Experience of High Frequency and Low Frequency TENS in Treatment of Diabetic Neuropathic Pain in Russia. Healthcare (Basel) 2022; 10:healthcare10020250. [PMID: 35206866 PMCID: PMC8871830 DOI: 10.3390/healthcare10020250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 01/20/2023] Open
Abstract
Background: Transcutaneous electrical nerve stimulation (TENS) is presently one of the main methods of treatment for neuropathic pain in type II diabetes mellitus. The discussion about which TENS frequency is more effective in the treatment of neuropathic pain has been ongoing for many years. Despite this, the response of different aspects of neuropathic pain to various TENS modalities has not been sufficiently studied. Aim: To analyze changes in characteristics of neuropathic pain depending on the frequency of TENS. Materials and methods: Seventy-five Russian diabetic patients with painful distal axonal neuropathy were enrolled in the study. Patients were assigned to three groups: in the HF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + high-frequency TENS (HF); in the LF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + low-frequency TENS (LF); in the control group, 25 patients underwent just standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin). Pain intensity was calculated before and after treatment with visual analogue scale (VAS), McGill pain questionnaire (MPQ), Douleur Neuropathique 4 Questions (DN4) and Pain Drawing. Results: TENS increased the therapeutic effect of standard drug therapy, in the treatment of neuropathic pain, by 65.9% and prolonged its efficacy by 31% for up to 6 months after treatment. HF TENS had a more pronounced analgesic effect than LF TENS based on VAS (34.7%), sensory (57.6%) MPQ dimensions and DN4 (21%). Affective MPQ dimension with the use of LF TENS was lower than HF TENS by 34.7% immediately after treatment, by 47.3% after 2 months and by 34.8% after 6 months of the follow-up period. Conclusion: There are significant differences between HF and LF TENS based on pain assessment using various pain scales. This reflects the distinctive effects of different TENS modalities on different aspects of neuropathic pain.
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Affiliation(s)
- Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia;
- Correspondence: (M.A.-Z.); (N.A.S.); Tel.: +7-(812)-670-02-20 (M.A.-Z. & N.A.S.)
| | - Inessa A. Minenko
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, 119435 Moscow, Russia;
| | - Natalia G. Kulikova
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia;
| | | | - Marina M. Petrova
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Elena A. Pronina
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Irina V. Romanova
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Ekaterina A. Narodova
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Regina F. Nasyrova
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia;
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, 443099 Samara, Russia
| | - Natalia A. Shnayder
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia;
- Correspondence: (M.A.-Z.); (N.A.S.); Tel.: +7-(812)-670-02-20 (M.A.-Z. & N.A.S.)
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Abstract
BACKGROUND Diabetic neuropathy is a multifaceted condition affecting up to 50% of individuals with long standing diabetes. The most common presentation is peripheral diabetic sensory neuropathy (DPN). METHODS We carried out a systematic review of papers dealing with diabetic neuropathy on Pubmed in addition to a targeted Google search.Search terms included small fiber neuropathy,diffuse peripheral neuropathy, quantitative sensory testing, nerve conduction testing, intra-epidermal nerve fiber density, corneal confocal reflectance microscopy, aldose reductase inhbitors, nerve growth factor, alpha-lipoic acid, ruboxistaurin, nerve growth factor antibody, and cibinetide. RESULTS Over the past half century, there have been a number of agents undergoing unsuccessful trials for treatment of DPN.There are several approved agents for relief of pain caused by diabetic neuropathy, but these do not affect the pathologic process. EXPERT OPINION The failure to find treatments for diabetic neuropathy can be ascribed to (1) the complexity of design of studies and (2) the slow progression of the condition, necessitating long duration trials to prove efficacy.We propose a modification of the regulatory process to permit early introduction of agents with demonstrated safety and suggestion of benefit as well as prolongation of marketing exclusivity while long term trials are in progress to prove efficacy.
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Affiliation(s)
- Marc S Rendell
- The Association for Diabetes Investigators , Newport Coast, California. USA
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Xia P, Yang T, Wang X, Li X. Combination of pregabalin and transcutaneous electrical nerve stimulation for neuropathic pain in a stroke patient after contralateral C7 nerve transfer: a case report. Int J Neurosci 2020; 131:1248-1253. [PMID: 32576077 DOI: 10.1080/00207454.2020.1786687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Contralateral C7 nerve transfer is a new surgical treatment for stroke patients with unilateral upper extremity paralysis, but neuropathic pain in the nonparalyzed side is the common complication after surgery. We report a stroke patient with neuropathic pain after C7 nerve transfer who received combination treatment of transcutaneous electrical nerve stimulation(TENS) and pregabalin. CASE SUMMARY A 53-year old, 6 months post-stroke patient with right hemiplegia after contralateral C7 nerve transfer was admitted in our department with a significant neuropathic pain in his left upper extremity. The treatment of pregabalin and TENS were used for patient. The visual analogue scale(VAS), medical outcomes study sleep scale(MOS-SS) and hospital anxiety and depression scale(HADS) were assessed after 1 months treatment. After treatment, the pain of his nonparalyzed upper extremity was relieved, the sleeping quality and the anxiety and depression were improved in patient. CONCLUSION This report suggests that the combination of pregabalin and TENS have prominent clinical effects on neuropathic pain of nonparalyzed side in stroke patients after contralateral C7 nerve transfer.
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Affiliation(s)
- Peng Xia
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ting Yang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoju Wang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xueping Li
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Carey ET, Till SR, As-Sanie S. Pharmacological Management of Chronic Pelvic Pain in Women. Drugs 2017; 77:285-301. [DOI: 10.1007/s40265-016-0687-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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