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Zhao C, Shrestha N, Ren H, Zhang B, Shen Y, Meng L, Wu D, Wang B, Fan B, Luo F. The PATCH trial: 5% lidocaine-medicated plaster for trigeminal neuralgia-Results of a multicentric, enriched enrollment, randomized withdrawal, double-blind, vehicle-controlled, parallel-group study. Headache 2024. [PMID: 39193836 DOI: 10.1111/head.14814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE To explore the efficacy and safety of 5% lidocaine-medicated plaster (LMP) in patients with trigeminal neuralgia (TN). BACKGROUND TN is an excruciatingly painful type of neuropathic facial pain. Anti-epileptics are the first-line treatment for TN; however, these oral drugs alone sometimes fail to achieve satisfactory analgesic effects. Two retrospective studies have shown that LMP can be an effective and safe treatment option for some patients with TN. No other high-quality clinical studies have explored the effect and safety of LMP in patients with TN. METHODS The PATCH trial is an enriched enrollment with randomized withdrawal, double-blind, vehicle-controlled, parallel-group trial performed at five study centers. Eligible patients with TN received LMP during a 3-week initial open-label phase. Patients who met the response criteria entered the double-blind treatment phase and were randomly assigned for treatment with either LMP (LMP group) or vehicle patches (control group) at a 1:1 ratio. Patients who met the criteria for treatment failure were withdrawn from the double-blind treatment phase, and treatment was continued in the remaining patients for up to 28 days. The primary outcome was the number of treatment failures. The secondary endpoints were the time to loss of therapeutic response (LTR) in the double-blind phase and the weekly mean pain severity in both the open-label phase and the double-blind phase of the study. RESULTS The first patient was enrolled in this study on May 1, 2021, and the enrollment of the last patient was completed on August 26, 2022. A total of 307 patients were initially screened, 226 (74.0%) of whom entered the open-label phase. Of the 226 respondents, 124 (55.0%) were randomized to the double-blind phase. In the double-blind phase, 62 patients were assigned to the LMP group, and 62 were assigned to the control group. For the primary endpoint, 16 (26.0%) patients with LMP and 36 (58.0%) patients with vehicle patches met the treatment failure criteria during the double-blind phase (relative risk, 0.48; 95% confidence interval [CI], 0.31 to 0.75; p < 0.001). The survival curve of the LTR showed that the LTR of LMP was significantly longer than that of the vehicle patches (hazard ratio, 0.275; 95% CI, 0.15 to 0.50; log-rank p < 0.001). LMP also significantly reduced the weekly mean pain severity in the double-blind phase of the study (p = 0.007). CONCLUSIONS LMP produced partial relief of pain symptoms in some patients with TN. For responders, LMP may be used as an add-on therapy in a multidrug treatment protocol.
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baohui Zhang
- Department of Pain Management, Linfen People's Hospital, Linfen, Shanxi, China
| | - Ying Shen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dasheng Wu
- Department of Pain Management, Jilin Province People's Hospital, Jilin, China
| | - Baoguo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Bifa Fan
- National Pain Management & Research Center, China-Japan Friendship Hospital, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Ocay DD, Lobo K, Kim A, Halpin M, Berde CB. Development and validation of a home quantitative sensory testing tool-kit to assess changes in sensory and pain processing: a study in healthy young adults. Pain 2024:00006396-990000000-00647. [PMID: 38981069 DOI: 10.1097/j.pain.0000000000003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/23/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Quantitative sensory testing (QST) is a set of methods for quantifying somatosensory functioning. Limitations of laboratory-based QST (LQST) include high cost, complexity in training, lack of portability, and time requirements for testing. Translating QST to a home setting could facilitate future research and clinical care. The objective of this study was to develop a home QST (HQST) tool-kit that is cost-effective, easy to use, and detects changes in sensory and pain processing. Thirty-two young healthy adults underwent sensory testing on their nondominant forearm using standard in-person LQST, followed by "simulated HQST" using video guidance in a separate room from the investigator before and after application of either a lidocaine or capsaicin cream. We observed good agreement between HQST and LQST scores, with significant correlations observed between the pinprick, pressure, cold and heat measures (|ρ| range = 0.36-0.54). The participants rated the HQST protocol as highly acceptable and safe but can be improved in future implementations. Home QST was able to detect hypoesthesia to vibration after lidocaine cream application (P = 0.024, d = 0.502) and could detect hypoalgesia and hyperalgesia to pressure and heat pain sensitivity tests after application of lidocaine and capsaicin creams, respectively (P-value range = <0.001-0.036, d-value range = 0.563-0.901). Despite limitations, HQST tool-kits may become a cost-effective, convenient, and scalable approach for improving sensory profiling in clinical care and clinical research.
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Affiliation(s)
- Don Daniel Ocay
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Kimberly Lobo
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Angela Kim
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Meghan Halpin
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Charles B Berde
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
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Mao P, Zhang Y, Liu B, Li Y, Chang Y, Zhu M, Zhang Y, Fan B. Effect and safety profile of topical lidocaine on post-surgical neuropathic pain and quality of life: A systematic review and meta-analysis. J Clin Anesth 2024; 92:111219. [PMID: 37827033 DOI: 10.1016/j.jclinane.2023.111219] [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] [Received: 02/21/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 10/14/2023]
Abstract
STUDY OBJECTIVE Post-surgical chronic pain with a neuropathic component is usually more severe and leads to worse quality of life. We conducted this systematic review to examine the evidence of topical lidocaine for post-surgical neuropathic pain. DESIGN Systematic review with meta-analysis. SETTING Published randomized controlled trials (RCTs) comparing topical lidocaine with placebo or no topical lidocaine for post-surgical neuropathic pain. PATIENTS Seven RCTs including 585 patients. INTERVENTIONS We systematically searched databases for randomized controlled trials (RCTs) investigating the effect and safety outcomes of topical lidocaine compared with placebo or no intervention. MEASUREMENTS We conducted meta-analyses to evaluate the effect of topical lidocaine on pain intensity, adverse events, and quality of life. Standardized mean difference (SMD) and relative risk (RR) with 95% CIs were effect measures for continuous and dichotomous outcomes, respectively. We assessed the risk of bias of included trials and the certainty of evidence for each outcome. MAIN RESULTS Our review included 7 studies with 585 participants. There is moderate certainty evidence that topical lidocaine may increase the likelihood of global pain relief, with a relative risk (RR) of 1.98 (95% confidence interval (CI): 1.04, 3.76; I2 = 70%, P = 0.04). Low certainty evidence suggested topical lidocaine may lead to more reduction in pain intensity (SMD: -0.70; 95% confidence interval: -1.46, 0.06; I2 = 93%, P = 0.07). High certainty evidence showed that topical lidocaine did not increase the adverse event risk (RR: 1.04; 95% CI: 0.93, 1.16; I2 = 0%, P = 0.51). CONCLUSIONS Topical lidocaine may lead to pain relief and is safe to use for patient with post-surgical pain, though its impact on quality of life is unclear. This review supports the use of topical lidocaine for patients with post-surgical pain, and reveals the evidence gap in topical lidocaine use. (Registration: PROSPERO CRD42021294100).
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Affiliation(s)
- Peng Mao
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Yi Zhang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Botao Liu
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Yifan Li
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Meng Zhu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China.
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Zhuo J, Weidrick CE, Liu Y, Moffitt MA, Jansen ED, Chiel HJ, Jenkins MW. Selective Infrared Neural Inhibition Can Be Reproduced by Resistive Heating. Neuromodulation 2023; 26:1757-1771. [PMID: 36707292 PMCID: PMC10366334 DOI: 10.1016/j.neurom.2022.12.004] [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] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Small-diameter afferent axons carry various sensory signals that are critical for vital physiological conditions but sometimes contribute to pathologies. Infrared (IR) neural inhibition (INI) can induce selective heat block of small-diameter axons, which holds potential for translational applications such as pain management. Previous research suggested that IR-heating-induced acceleration of voltage-gated potassium channel kinetics is the mechanism for INI. Therefore, we hypothesized that other heating methods, such as resistive heating (RH) in a cuff, could reproduce the selective inhibition observed in INI. MATERIALS AND METHODS We conducted ex vivo nerve-heating experiments on pleural-abdominal connective nerves of Aplysia californica using both IR and RH. We fabricated a transparent silicone nerve cuff for simultaneous IR heating, RH, and temperature measurements. Temperature elevations (ΔT) on the nerve surface were recorded for both heating modalities, which were tested over a range of power levels that cover a similar ΔT range. We recorded electrically evoked compound action potentials (CAPs) and segmented them into fast and slow subcomponents on the basis of conduction velocity differences between the large and small-diameter axonal subpopulations. We calculated the normalized inhibition strength and inhibition selectivity index on the basis of the rectified area under the curve of each subpopulation. RESULTS INI and RH showed a similar selective inhibition effect on CAP subcomponents for slow-conducting axons, confirmed by the inhibition probability vs ΔT dose-response curve based on approximately 2000 CAP measurements. The inhibition selectivity indexes of the two heating modalities were similar across six nerves. RH only required half the total electrical power required by INI to achieve a similar ΔT. SIGNIFICANCE We show that selective INI can be reproduced by other heating modalities such as RH. RH, because of its high energy efficiency and simple design, can be a good candidate for future implantable neural interface designs.
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Affiliation(s)
- Junqi Zhuo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Chloe E Weidrick
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Yehe Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael A Moffitt
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - E Duco Jansen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Biophotonics Center, Vanderbilt University, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
| | - Hillel J Chiel
- Department of Biology, Case Western Reserve University, Cleveland OH, USA; Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
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Mullins CF, Fuccaro M, Pang D, Min L, Andreou AP, Lambru G. A single infusion of intravenous lidocaine for primary headaches and trigeminal neuralgia: a retrospective analysis. Front Neurol 2023; 14:1202426. [PMID: 37638187 PMCID: PMC10448809 DOI: 10.3389/fneur.2023.1202426] [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] [Received: 04/08/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Intravenous (IV) lidocaine has been used as a transitional treatment in headache and facial pain conditions, typically as an inpatient infusion over several days, which is costly and may increase the risk of adverse effects. Here we report on our experience using a single one-hour IV lidocaine infusion in an outpatient day-case setting for the management of refractory primary headache disorders with facial pain and trigeminal neuralgia. Methods This is a retrospective, single-center analysis on patients with medically refractory headache with facial pain and trigeminal neuralgia who were treated with IV lidocaine between March 2018 and July 2022. Lidocaine 5 mg.kg-1 in 60 mL saline was administered over 1 h, followed by an observation period of 30 min. Patients were considered responders if they reported reduction in pain intensity and/or headache frequency of 50% or greater. Duration of response was defined as short-term (< 2 weeks), medium-term (2-4 weeks) and long-term (> 4 weeks). Results Forty infusions were administered to 15 patients with trigeminal autonomic cephalalgias (n = 9), chronic migraine (n = 3) and trigeminal neuralgia (n = 3). Twelve patients were considered responders (80%), eight of whom were complete responders (100% pain freedom). The average duration of the treatment effect for each participant was 9.5 weeks (range 1-22 weeks). Six out of 15 patients reported mild and self-limiting side effects (40%). Conclusion A single infusion of IV lidocaine might be an effective and safe transitional treatment in refractory headache conditions with facial pain and trigeminal neuralgia. The sustained effect of repeated treatment cycles in some patients may suggest a role as long-term preventive therapy in some patients.
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Affiliation(s)
- C. F. Mullins
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - M. Fuccaro
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - D. Pang
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - L. Min
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - A. P. Andreou
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - G. Lambru
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Schaldemose EL, Raaschou-Nielsen L, Böhme RA, Finnerup NB, Fardo F. It is one or the other: No overlap between healthy individuals perceiving thermal grill illusion or paradoxical heat sensation. Neurosci Lett 2023; 802:137169. [PMID: 36898653 DOI: 10.1016/j.neulet.2023.137169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
Paradoxical heat sensation (PHS) and the thermal grill illusion (TGI) are both related to the perception of warmth or heat from innocuous cold stimuli. Despite being described as similar perceptual phenomena, recent findings suggested that PHS is common in neuropathy and related to sensory loss, while TGI is more frequently observed in healthy individuals. To clarify the relationship between these two phenomena, we conducted a study in a cohort of healthy individuals to investigate the association between PHS and TGI. We examined the somatosensory profiles of 60 healthy participants (34 females, median age 25 years) using the quantitative sensory testing (QST) protocol from the German Research Network on Neuropathic Pain. The number of PHS was measured using a modified thermal sensory limen (TSL) procedure where the skin was transiently pre-warmed, or pre-cooled before the PHS measure. This procedure also included a control condition with a pre-temperature of 32 °C. The number of TGI responses was quantified during simultaneous application of warm and cold innocuous stimuli. All participants had normal thermal and mechanical thresholds compared to the reference values from the QST protocol. Only two participants experienced PHS during the QST procedure. In the modified TSL procedure, we found no statistically significant differences in the number of participants reporting PHS in the control condition (N = 6) vs. pre-warming (N = 3; min = 35.7 °C, max = 43.5 °C) and pre-cooling (N = 4, min = 15.0 °C, max = 28.8 °C) conditions. Fourteen participants experienced TGI, and only one participant reported both TGI and PHS. Individuals with TGI had normal or even increased thermal sensation compared to individuals without TGI. Our findings demonstrate a clear distinction between individuals experiencing PHS or TGI, as there was no overlap observed when using identical warm and cold temperatures that were alternated either temporally or spatially. While PHS was previously related to sensory loss, our study revealed that TGI is associated with normal thermal sensitivity. This suggests that an efficient thermal sensory function is essential in generating the illusory sensation of pain of the TGI.
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Affiliation(s)
- Ellen Lund Schaldemose
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Line Raaschou-Nielsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rebecca Astrid Böhme
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Francesca Fardo
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Qureshi Z, Ali MN, Khalid M. An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy. J Diabetes Res 2022; 2022:9989272. [PMID: 35127954 PMCID: PMC8813291 DOI: 10.1155/2022/9989272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/11/2021] [Accepted: 12/27/2021] [Indexed: 12/20/2022] Open
Abstract
Diabetes is the 4th most common disease affecting the world's population. It is accompanied by many complications that deteriorate the quality of life. Painful diabetic neuropathy (PDN) is one of the debilitating consequences of diabetes that effects one-third of diabetic patients. Unfortunately, there is no internationally recommended drug that directly hinders the pathological mechanisms that result in painful diabetic neuropathy. Clinical studies have shown that anticonvulsant and antidepressant therapies have proven fruitful in management of pain associated with PDN. Currently, the FDA approved medications for painful diabetic neuropathies include duloxetine, pregabalin, tapentadol extended release, and capsaicin (for foot PDN only). The FDA has also approved the use of spinal cord stimulation system for the treatment of diabetic neuropathy pain. The drugs recommended by other regulatory bodies include gabapentin, amitriptyline, dextromethorphan, tramadol, venlafaxine, sodium valproate, and 5 % lidocaine patch. These drugs are only partially effective and have adverse effects associated with their use. Treating painful symptoms in diabetic patient can be frustrating not only for the patients but also for health care workers, so additional clinical trials for novel and conventional treatments are required to devise more effective treatment for PDN with minimal side effects. This review gives an insight on the pathways involved in the pathogenesis of PDN and the potential pharmacotherapeutic agents. This will be followed by an overview on the FDA-approved drugs for PDN and commercially available topical analgesic and their effects on painful diabetic neuropathies.
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Affiliation(s)
- Zunaira Qureshi
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, H-12, 44000 Islamabad, Pakistan
| | - Murtaza Najabat Ali
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, H-12, 44000 Islamabad, Pakistan
| | - Minahil Khalid
- Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, H-12, 44000 Islamabad, Pakistan
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Peres M, Huet F, Le Bonniec M, Guéhenneux S, Vié K, Misery L. Evaluation of the effects on cutaneous sensitivity of a face emulsion containing sclareolide in women presenting with sensitive skin through quantitative sensory testing. J Eur Acad Dermatol Venereol 2021; 36:e74-e75. [PMID: 34487370 DOI: 10.1111/jdv.17638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- M Peres
- Department of Dermatology, University Hospital of Brest, Brest, France.,LIEN, University of Brest, Brest, France
| | - F Huet
- Department of Dermatology, University Hospital of Brest, Brest, France.,LIEN, University of Brest, Brest, France
| | | | | | - K Vié
- Clarins Laboratories, Pontoise, France
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France.,LIEN, University of Brest, Brest, France
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Greuber E, Vought K, Patel K, Suzuki H, Usuda K, Shiramizu A, Koplowitz LP, Koplowitz B, Maibach HI, Lissin D. Biorelevant In Vitro Skin Permeation Testing and In Vivo Pharmacokinetic Characterization of Lidocaine from a Nonaqueous Drug-in-Matrix Topical System. AAPS PharmSciTech 2021; 22:215. [PMID: 34386908 PMCID: PMC8360843 DOI: 10.1208/s12249-021-02101-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Recently, lidocaine topical systems utilizing nonaqueous matrices have been developed and provide efficient lidocaine delivery through the skin, such that lower concentrations of drug provide equivalent or greater drug delivery than drug-in-matrix hydrogel lidocaine patches. This study characterizes drug delivery from a nonaqueous lidocaine topical system with increasing drug load both in vitro and in vivo. Topical systems formulated with either 1.8% or 5.4% lidocaine were applied to healthy volunteers' backs (n = 15) for 12 h in a single-center, open-label, four-treatment, four-period crossover pharmacokinetic study. Subjects were dosed with either three 1.8% systems or one, two, or three 5.4% systems in each period. Blood was collected for up to 48 h, and plasma lidocaine levels were measured with a validated HPLC method. In parallel, human and mouse skin models characterized the in vitro skin permeation profile. The pharmacokinetic profile was linear between one, two, and three lidocaine 5.4% applications. Application of three lidocaine 1.8% systems (108 mg lidocaine) was bioequivalent to one lidocaine 5.4% system (108 mg lidocaine). Both topical systems remained well adhered to the skin and irritation was mild. The 5.4% system had approximately threefold higher skin permeability than the 1.8% system in the mouse and human skin models. The results indicate increasing the drug load by three times results in triple the drug delivery both in vivo and in vitro. The relationship between the in vitro permeation and in vivo absorption correlates and is nonlinear.
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Zhao C, Shrestha N, Liu H, Shen Y, Meng L, Fan B, Luo F. The PATCH trial: efficacy and safety of 5% lidocaine-medicated plaster for the treatment of patients with trigeminal neuralgia: a study protocol for a multicentric, double-blind, enriched enrolment randomised withdrawal, vehicle-controlled study. BMJ Open 2021; 11:e045493. [PMID: 34341037 PMCID: PMC8330571 DOI: 10.1136/bmjopen-2020-045493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/13/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Trigeminal neuralgia (TN) is characterised by a sudden, severe, electric shock like paroxysmal pain, which is almost always associated with triggers. Carbamazepine is the first-line medical management of TN. However, side effects are common. Currently, there is no ideal treatment for TN. Since there is a known abnormality of Na+ channels in the trigger zone, 5% lidocaine-medicated plaster (LMP), which can block the Na+ channels on Aδ and C fibres, is an effective treatment method in many chronic pain conditions. A case report has found the benefit of LMP for the treatment of TN without any side effects. Whether LMP is an option for the treatment of TN is worth exploring. METHODS AND ANALYSIS The PATCH trial is a double-blind, enriched enrolment with randomised withdrawal, vehicle-controlled trial, aiming to explore the effects and safety of LMP in patients with TN. There is a 3-week initial open-label phase, followed by a 4-week double-blind treatment phase for responders. In the double-blind phase, patients will have to withdraw from this PATCH study if they meet one of the following criteria for treatment failure such as: >50% increase in pain intensity or paroxysms, lack of efficacy or side effects. The primary outcome will be the number of treatment failures. Adverse events will also be monitored throughout the study. ETHICS AND DISSEMINATION This study protocol has been approved by the Institutional Review Board of Beijing Tiantan Hospital (approval number: KY 2020-102-02). The results will be disseminated in international academic meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04570293.
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Tiantan Hospital, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongbing Liu
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bifa Fan
- National Pain Management & Research Center, China-Japan Friendship Hospital, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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11
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Drop homotopic effects of masseter-muscle pain on somatosensory sensitivity in healthy participants. Sci Rep 2021; 11:10575. [PMID: 34012096 PMCID: PMC8136476 DOI: 10.1038/s41598-021-89937-3] [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: 11/02/2020] [Accepted: 04/28/2021] [Indexed: 11/15/2022] Open
Abstract
Current pain classifications use 1.0-kg palpation of the masseter muscle to distinguish between “pain patients” and “healthy controls” but a thorough understanding of the normal physiological responses to various somatosensory stimuli is lacking. The aim of this study was to investigate somatosensory function of the skin over the masseter muscle in healthy participants that were divided into a masseter pain prone group (MPP) (n = 22) and non-MPP group (n = 22), according to the response to a 1.0-kg palpation. Quantitative sensory testing (QST) was performed at the skin above the right masseter muscle (homotopic). In an additional experiment, 13 individuals each from MPP and non-MPP received application of 60% topical lidocaine tape to the skin over the masseter muscle for 30 min. Immediately after, mechanical pain sensitivity (MPS), dynamic mechanical allodynia, and pressure pain threshold were tested. Homotopic MPS was significantly higher and PPTs significantly lower in MPP than in N-MPP (P < 0.05). Strikingly, no other differences in QST outcomes were observed between the groups (P > 0.05). After lidocaine application, no significant differences in homotopic MPS were observed between groups. The presence or absence of acute provoked pain in masseter muscle is exclusively associated with differences in homotopic MPS which is decreased following topical anesthesia.
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Park S, Nahm FS, Han WK, Park S, Han S, Park KH, Lim C. The 5% Lidocaine Patch for Decreasing Postoperative Pain and Rescue Opioid Use in Sternotomy: A Prospective, Randomized, Double-blind Trial. Clin Ther 2020; 42:2311-2320. [DOI: 10.1016/j.clinthera.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/12/2022]
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13
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Local anaesthesia decreases nerve growth factor induced masseter hyperalgesia. Sci Rep 2020; 10:15458. [PMID: 32963266 PMCID: PMC7508842 DOI: 10.1038/s41598-020-71620-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.
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14
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Ren X, Yang R, Li L, Xu X, Liang S. Long non coding RNAs involved in MAPK pathway mechanism mediates diabetic neuropathic pain. Cell Biol Int 2020; 44:2372-2379. [PMID: 32844535 DOI: 10.1002/cbin.11457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetes is the largest global epidemic of the 21st century, and the cost of diabetes and its complications comprise about 12% of global health expenditure. Diabetic neuropathy is the most common complication of diabetes, affecting up to 50% of patients over the course of their disease. Among them, 30%-50% develop neuropathic pain, which has typical symptoms that originate from the toes and progress to foot ulcers and seriously influence quality of life. The pathogenesis of diabetic neuropathic pain (DNP) is complicated and incompletely understood and there is no effective treatment except supportive treatment. Long noncoding RNAs (lncRNAs), a class of noncoding RNAs exceeding 200 nucleotides in length, have been shown to play key roles in fundamental cellular processes, and are considered to be potential targets for treatment. Recent research indicates that lncRNA is involved in the pathogenesis of DNP. Certain overexpressed lncRNAs can enhance the purinergic receptor-mediated neuropathic pain in peripheral ganglia and inflammatory cytokines are released due to receptors activated by adenosine triphosphate. In recent years, our laboratory also has been exploring the relationship and pathogenesis between lncRNAs and DNP. In this review, we focus on the recent progress in functional lncRNAs associated with DNP and investigate their roles related to respective receptors.
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Affiliation(s)
- Xinlu Ren
- Queen Mary University of London Joint Programme, Nanchang University, Nanchang, Jiangxi, China
| | - Runan Yang
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
| | - Lin Li
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
| | - Xiumei Xu
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
| | - Shangdong Liang
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
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15
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S. A. E, M. A. E, Y. A, M. A. T K. Ultrasound-guided serratus plane block with continuous postoperative drug delivery system for acute nociceptive and neuropathic pain after mastectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1780678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- ElKaradawy S. A.
- Department of Anaesthesia and Pain Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - ElFakharany M. A.
- Department of Anaesthesia and Pain Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed Y.
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Khaled M. A. T
- Department of Anaesthesia and Pain Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
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16
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Ernberg M, Wieslander Fältmars A, Hajizadeh Kopayeh M, Arzt Wallén S, Cankalp T, Christidis N. The Effect of Granisetron on Sensory Detection and Pain Thresholds in Facial Skin of Healthy Young Males. Front Neurol 2020; 11:237. [PMID: 32328025 PMCID: PMC7161671 DOI: 10.3389/fneur.2020.00237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The specific serotonin type 3 (5-HT3)-receptor antagonist granisetron effectively reduces clinical as well as experimental muscle pain and hyperalgesia and with a duration that exceeds that of lidocaine. Hence, it may be an alternative to lidocaine as a local anesthetic. There are also some indications that granisetron in addition to 5-HT3 receptors blocks sodium channels. Thus, the local anesthetic effect by granisetron may resemble that of lidocaine, but this has not been tested. The aim of this study was therefore to compare the effect granisetron has on facial skin sensitivity to the effect of lidocaine and isotonic saline. Methods: This was a randomized, controlled, and double-blind study, in which 1 ml of either granisetron (test-substance), lidocaine (positive control), or isotonic saline (negative control) was injected into the skin over the masseter muscle at three different occasions in 18 healthy males (27.2 ± 5.8 years old). Skin detection thresholds and pain thresholds for thermal stimuli as well as mechanical detection thresholds and sensitivity to a painful mechanical (pinprick) stimulus were assessed before (baseline) and 5, 20, 40, and 60 min after injection. The quality and area of subjective sensory change over the cheek were assessed 20 min after injection. Results: All substances increased the mechanical detection threshold (granisetron: p = 0.011; lidocaine: p = 0.016; saline: p = 0.031). Both granisetron and lidocaine, but not isotonic saline, increased the heat detection thresholds (p < 0.001 and p < 0.02, respectively), but not the cold detection thresholds. Granisetron and lidocaine also reduced pinprick pain (p = 0.001 for each comparison). There were no significant differences between granisetron and lidocaine for any of these variables. There was no effect on thermal pain thresholds for any substance. Conclusion: The similar analgesic patterns on mechanical sensory and pain thresholds as well as thermal sensory thresholds over the facial skin by subcutaneous injection of granisetron and lidocaine shown in this study and the absence of paresthesia, in combination with the reduced pain intensity and pressure pain sensitivity shown in previous studies, indicate that granisetron might be a novel candidate as a local anesthetic.
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Affiliation(s)
- Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Anna Wieslander Fältmars
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Milad Hajizadeh Kopayeh
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Sofia Arzt Wallén
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Therese Cankalp
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
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17
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Post Herpetic Neuralgia: Recent Advancements. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Alam U, Sloan G, Tesfaye S. Treating Pain in Diabetic Neuropathy: Current and Developmental Drugs. Drugs 2020; 80:363-384. [DOI: 10.1007/s40265-020-01259-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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19
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Ardeleanu V, Toma A, Pafili K, Papanas N, Motofei I, Diaconu CC, Rizzo M, Pantea Stoian A. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. ACTA ACUST UNITED AC 2020; 56:medicina56010025. [PMID: 31936646 PMCID: PMC7022869 DOI: 10.3390/medicina56010025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms "distal symmetrical polyneuropathy", "neuropathic pain treatment", "diabetic neuropathy", "diabetes complications", "glycaemic control", "antidepressants", "opioids", and "anticonvulsants". Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.
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Affiliation(s)
- Valeriu Ardeleanu
- Department of Surgery, University “Dunarea de Jos”, 800008 Galati, Romania;
- Department of Surgery, University “Ovidius’’, 900470 Constanta, Romania
- Arestetic Clinic, 800098 Galati, Romania
| | - Alexandra Toma
- Department of Surgery, University “Dunarea de Jos”, 800008 Galati, Romania;
- Department of Surgery, Emergency County Clinical Hospital “Sf. Apostol Andrei”, 800578 Galati, Romania
- Correspondence: (A.T.); (A.P.S.)
| | - Kalliopi Pafili
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece; (K.P.); (N.P.)
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece; (K.P.); (N.P.)
| | - Ion Motofei
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Camelia Cristina Diaconu
- Internal Medicine Department, Clinical Emergency Hospital of Bucharest, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties School of Medicine, University of Palermo, 90133 Palermo, Italy;
- Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine Columbia, Columbia, SC 29209, USA
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (A.T.); (A.P.S.)
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20
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Meyer-Frießem CH, Eitner LB, Kaisler M, Maier C, Vollert J, Westermann A, Zahn PK, Avila González CA. Perineural injection of botulinum toxin-A in painful peripheral nerve injury - a case series: pain relief, safety, sensory profile and sample size recommendation. Curr Med Res Opin 2019; 35:1793-1803. [PMID: 31148462 DOI: 10.1080/03007995.2019.1626228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Subcutaneous injection of botulinum toxin-A (sBONT-A) is a novel treatment for peripheral neuropathic pain. While its analgesic effects are well documented, this treatment is often not comfortable and fails in patients who show signs of sensory loss but rarely allodynia. There are some case reports about perineural BONT-A injection (pBONT-A) which could be an alternative approach. Here we present a retrospective, open label case series of pBONT-A's efficacy and safety regarding neurological consequences involving changes in somatosensory profiles of both responders and non-responders. Methods: Sixty patients (53 ± 13years, 77% males) with PNI were treated with pBONT-A after a test injection with a local anesthetic, which prompted distinctive pain relief. Quantitative sensory testing (QST; DFNS protocol) and pain intensity were assessed before and ≥7 days post pBONT-A injection. Definition of response: satisfactory pain reduction of ≥30% NRS (numerical rating scale: 0 = no pain, 10 = worst pain) for ≥4 days. Statistics: Paired t-test, Mann-Whitney U-test, χ2 test. Results: A temporary weak paresis in one case was clinically verified. The QST -parameters remained unchanged, but patients with more frequent hyperalgesia signs reported less analgesia (p = .04). The pBONT-A injection prompted pain relief by 24.8% (NRS: 6.0 ± 1.7 vs. 4.5 ± 2.1; p < .0001); 57% (n = 34) were responders (NRS: 6.0 ± 1.6 vs. 3.4 ± 1.6, relief of 43.4%; p < .0001). Based on these results, we suggest that future parallel design trials on pBONT-A need to include at least 84 patients. Discussion: Ultrasound-guided pBONT-A injection seems to be a safe treatment leading to a sufficient pain relief for some months without sensory changes. Surprisingly, pBONT-A showed a pronounced analgesic effect also in patients without signs of hyperalgesia.
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Affiliation(s)
- Christine H Meyer-Frießem
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Lynn B Eitner
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Neuropediatrics, Ruhr-University Bochum, University Children's Hospital , Bochum , Germany
| | - Miriam Kaisler
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Christoph Maier
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Neuropediatrics, Ruhr-University Bochum, University Children's Hospital , Bochum , Germany
| | - Jan Vollert
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Pain Research, Department of Surgery and Cancer, Imperial College , London , UK
- Neurophysiology, Center of Biomedicine and Medical Technology Mannheim CBTM, Medical Faculty Mannheim, Heidelberg University , Heidelberg , Germany
| | - Andrea Westermann
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Carla A Avila González
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hessing Foundation , Augsburg , Germany
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21
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Costa YM, Ferreira DMAO, Conti PCR, Baad‐Hansen L, Svensson P, Bonjardim LR. Topical anaesthesia degree is reduced in temporomandibular disorders patients: A novel approach to assess underlying mechanisms of the somatosensory alterations. J Oral Rehabil 2019; 47:113-122. [DOI: 10.1111/joor.12874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Yuri Martins Costa
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| | - Dyna Mara A. O. Ferreira
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Paulo César R. Conti
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Lene Baad‐Hansen
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Peter Svensson
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
| | - Leonardo R. Bonjardim
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
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Nielson Hoberg T, Frahm S, Hennings K, Arendt‐Nielsen L, Dahl Mørch C. Assessing the modulation of cutaneous sensory fiber excitability using a fast perception threshold tracking technique. Muscle Nerve 2019; 60:367-375. [DOI: 10.1002/mus.26520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Tatiana Nielson Hoberg
- Department of Health Science and TechnologyCenter for Sensory‐Motor Interaction (SMI), Aalborg University Fredrik Bajers Vej 7 D3, 9220 Aalborg Ø Denmark
| | - Steffen Frahm
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and TechnologyAalborg University Aalborg Denmark
| | - Kristian Hennings
- Department of Health Science and TechnologyCenter for Sensory‐Motor Interaction (SMI), Aalborg University Fredrik Bajers Vej 7 D3, 9220 Aalborg Ø Denmark
| | - Lars Arendt‐Nielsen
- Department of Health Science and TechnologyCenter for Sensory‐Motor Interaction (SMI), Aalborg University Fredrik Bajers Vej 7 D3, 9220 Aalborg Ø Denmark
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and TechnologyAalborg University Aalborg Denmark
| | - Carsten Dahl Mørch
- Department of Health Science and TechnologyCenter for Sensory‐Motor Interaction (SMI), Aalborg University Fredrik Bajers Vej 7 D3, 9220 Aalborg Ø Denmark
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and TechnologyAalborg University Aalborg Denmark
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23
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Aboelnour NH, Abouelnaga WA. Lidocaine iontophoresis for postmastectomy intercostobrachial neuralgia: single-blinded randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_17_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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24
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Yang XD, Fang PF, Xiang DX, Yang YY. Topical treatments for diabetic neuropathic pain. Exp Ther Med 2019; 17:1963-1976. [PMID: 30783472 PMCID: PMC6364237 DOI: 10.3892/etm.2019.7173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/22/2018] [Indexed: 12/14/2022] Open
Abstract
Diabetic neuropathic pain (DNP) has a huge impact on quality of life and can be difficult to treat. Oral treatment is the most frequently used method for DNP, but its use is often limited by systemic side effects. Topical use of drugs as an alternative option for DNP treatment is currently gaining interest. In the present review, a summary is provided of the available agents for topical use in patients with DNP, including lidocaine plasters or patches, capsaicin cream, gel or patches, amitriptyline cream, clonidine gel, ketamine cream, extracts from medicinal plants including nutmeg extracts and Citrullus colocynthis extract oil, and certain compounded topical analgesics. Furthermore, the potential efficacy of these treatments is addressed according to the available clinical research literature. It has been indicated that these topical drugs have the potential to be valuable additional options for the management of DNP, with adequate safety and continuous long-term treatment efficacy. Compounded topical agents are also effective and safe for patients with DNP and could be another area worthy of further investigation based on the strategy of using low-dose, complementary therapies for DNP. The findings indicate that developing topical drugs acting on different targets in the process of DNP is a valuable area of future research.
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Affiliation(s)
- Xi-Ding Yang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China.,Phase I Clinical Trial Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Ping-Fei Fang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China.,Phase I Clinical Trial Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Da-Xiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China.,Hunan Provincial Engineering Research Center of Translational Medical and Innovative Drug, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Yong-Yu Yang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China.,Hunan Provincial Engineering Research Center of Translational Medical and Innovative Drug, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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25
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Quantitative and qualitative assessment of sensory changes induced by local anesthetics block of two different trigeminal nerve branches. Clin Oral Investig 2018; 23:2637-2649. [DOI: 10.1007/s00784-018-2695-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
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Shrestha M, Chen A. Modalities in managing postherpetic neuralgia. Korean J Pain 2018; 31:235-243. [PMID: 30310548 PMCID: PMC6177534 DOI: 10.3344/kjp.2018.31.4.235] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. Despite the current advancement of treatments, PHN persists in many individuals influencing their daily activities and reducing their quality of life. Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. These medications come with their adverse effects, so they should be used carefully with the elderly or with patients with significant comorbidities. Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. However, the efficacy, safety, and tolerability of these invasive methods need to be carefully monitored when administering them. Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. The zoster vaccine has effectively reduced the incidence of HZ and PHN. In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities.
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Affiliation(s)
- Meera Shrestha
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Shi, China
| | - Aijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Shi, China
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27
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Re Bravo V, Aprea F, Bhalla RJ, De Gennaro C, Cherubini GB, Corletto F, Vettorato E. Effect of 5% transdermal lidocaine patches on postoperative analgesia in dogs undergoing hemilaminectomy. J Small Anim Pract 2018; 60:161-166. [DOI: 10.1111/jsap.12925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/15/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- V. Re Bravo
- Dick White Referrals; Station Farm - London Road, Six Mile Bottom Cambridgeshire CB8 0UH UK
| | - F. Aprea
- Service of Veterinary Anaesthesia and Analgesia; Carrer de Stradella 9, 07013 Palma Majorca Spain
| | - R. J. Bhalla
- Dick White Referrals; Station Farm - London Road, Six Mile Bottom Cambridgeshire CB8 0UH UK
| | - C. De Gennaro
- Dick White Referrals; Station Farm - London Road, Six Mile Bottom Cambridgeshire CB8 0UH UK
| | - G. B. Cherubini
- Dick White Referrals; Station Farm - London Road, Six Mile Bottom Cambridgeshire CB8 0UH UK
| | - F. Corletto
- Dick White Referrals; Station Farm - London Road, Six Mile Bottom Cambridgeshire CB8 0UH UK
| | - E. Vettorato
- Dick White Referrals; Station Farm - London Road, Six Mile Bottom Cambridgeshire CB8 0UH UK
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28
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Duncan CC, Kluger DT, Davis TS, Warren DJ, Page DM, Hutchinson DT, Clark GA. Selective Decrease in Allodynia With High‐Frequency Neuromodulation via High‐Electrode‐Count Intrafascicular Peripheral Nerve Interface After Brachial Plexus Injury. Neuromodulation 2018; 22:597-606. [DOI: 10.1111/ner.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - David T. Kluger
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - Tyler S. Davis
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - David J. Warren
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - David M. Page
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | | | - Gregory A. Clark
- Department of Bioengineering University of Utah Salt Lake City UT USA
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29
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Dernek B, Adiyeke L, Duymus TM, Aydogmus S, Kesiktas FN, Paker N. Efficacy of subcutaneous lidocaine injection in venous insufficiency: a prospective, randomized, controlled study, and new treatment protocol. J Phys Ther Sci 2018; 30:748-754. [PMID: 29950758 PMCID: PMC6016308 DOI: 10.1589/jpts.30.748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/05/2018] [Indexed: 01/16/2023] Open
Abstract
[Purpose] The purpose of this study was to evaluate the efficacy of subcutaneous
injection with lidocaine in patients with chronic venous insufficiency in the early stage.
[Subjects and Methods] Patients (n=50) randomized to the treatment group received
subcutaneous injections from a mixture of physiological saline sterile solution and
lidocaine once a week to both legs below the knee for 5 sessions. Patients in the
treatment group were also given ankle pumping exercises and compression stockings
throughout the treatment. Patients randomized to the control group (n=50) received only
ankle pumping exercises and compression stockings. Patients were evaluated using the
visual analog scale (VAS) for pain and Chronic Venous Disease Quality of life
Questionnaire (CIVIQ-20) for quality-of-life at months 1, 3, 6, at the end of month 12,
and at the end of the injection treatment for 5 sessions. [Results] CIVIQ-20 and VAS
results were significantly lower in the treatment group, than in the control group at
months 1, 3 and 6. However, CIVIQ-20 and VAS results were not significantly different,
compared with the pre-operative period at month 12. [Conclusion] We observed that 5-week
subcutaneous lidocaine injection treatment was effective in patients who do not respond to
oral medical treatment or in whom surgery is not considered.
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Affiliation(s)
- Bahar Dernek
- Istanbul Physical Medicine and Rehabilitation Training Hospital, Turkey
| | - Levent Adiyeke
- Department of Orthopaedics, Haydarpaşa Numune Training and Research Hospital: Uskudar, Istanbul, Turkey
| | - Tahir Mutlu Duymus
- Department of Orthopaedics, Haydarpaşa Numune Training and Research Hospital: Uskudar, Istanbul, Turkey
| | - Suavi Aydogmus
- Department of Orthopaedics, Maltepe State Hospital, Turkey
| | | | - Nurdan Paker
- Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Physical Therapy and Rehabilitation Clinic, Turkey
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30
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Martini A, Del Balzo G, Schweiger V, Zanzotti M, Picelli A, Parolini M, Chinellato E, Tamburin S, Polati E. Efficacy of lidocaine 5% medicated plaster (VERSATIS®) in patients with localized neuropathic pain poorly responsive to pharmacological therapy. Minerva Med 2018; 109:344-351. [PMID: 29856191 DOI: 10.23736/s0026-4806.18.05690-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Localized neuropathic pain (LNP) is a subgroup of neuropathic pain characterized by consistent and circumscribed area(s) of maximum pain, associated with negative or positive sensory signs and/or spontaneous symptoms characteristic of NP. Lidocaine medicated plasters (LMP) have shown to be effective in pain relief in selective LNP syndromes. METHODS We collected data of 130 patients in our database with LNP syndromes who used LMP. RESULTS Forty-one patients out of 130 patients (32%) were treated with antiepileptics, antidepressants and opioids without improvement and/or with intolerable adverse effects and are not assuming systemic therapy anymore. Globally, during the 12 months follow-up, 15% of patients reached a complete pain relief without any systemic therapy, mainly in trigeminal and post-herpetic neuralgia (P=0.009), 38% of patients reduced analgesic drug consumption with the highest reduction in radiculopathy, post-herpetic neuralgia and trigeminal neuralgia. Topical and transient adverse effects, such as itching or local erythema, were seen in 19/130 (14.6%) patients; 7 of these patients (5.4%) needed to discontinue the treatment due to the occurrence of adverse effects. The dropout rate on global population (excluding cured and lost to follow-up) was 45%, and the main cause of dropouts was the inefficacy of treatment in the first 3 months of therapy with LMP. CONCLUSIONS LMP treatment is safe and worth consideration also as add-on therapy in order to reduce analgesic drug consumption in selected LNP.
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Affiliation(s)
- Alvise Martini
- Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Center, Verona University Hospital, Policlinico GB Rossi, Verona, Italy -
| | - Giovanna Del Balzo
- Section of Forensic Medicine, Department of Medicine and Public Health, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Center, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Michele Zanzotti
- Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Center, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Massimo Parolini
- Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Center, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Eris Chinellato
- School of Science and Engineering, Middlesex University, London, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine, and Movement Sciences, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
| | - Enrico Polati
- Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Center, Verona University Hospital, Policlinico GB Rossi, Verona, Italy
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31
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Comparative Analysis of the Effectiveness of the Topical Administration of Benzocaine and EMLA ® on Oral Pain and Tactile Sensitivity. Int J Dent 2018; 2018:7916274. [PMID: 29593794 PMCID: PMC5821963 DOI: 10.1155/2018/7916274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives To compare the effectiveness of the topical administration of benzocaine and EMLA on oral pain and tactile sensitivity. Materials and Methods A randomized, double-blind, split-mouth clinical trial was carried out with 20 volunteers. The sensorial and quantitative tests were applied before the contact with topical anesthetic and after the application. Results In the superficial tactile perception test, when we compared each group singly, there were statistically significant values in the decrease of superficial tactile perception when compared to the moment prior to the application of anesthetic agents. For the sensitivity to mechanical pain, no statistical significant difference was observed at evaluated times. In the needle penetration test, in an intergroup analysis, we found a decrease in the pain sensitivity to needle penetration at 5 min (p=0.053) and at 10 min (p=0.019) after the contact of the anesthetic drug with the oral mucosa. Conclusion The application of topical anesthetic drugs reduces the discomfort associated with this procedure, mainly until the first 10 minutes. Only the needle penetration sensitivity test showed sufficient sensitivity to reveal a difference in the anesthetic effect between EMLA and benzocaine. This trial is registered with RBR-2N2GSW.
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32
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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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33
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Side effects can enhance treatment response through expectancy effects: an experimental analgesic randomized controlled trial. Pain 2018; 158:1014-1020. [PMID: 28178072 DOI: 10.1097/j.pain.0000000000000870] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In randomized controlled trials, medication side effects may lead to beliefs that one is receiving the active intervention and enhance active treatment responses, thereby increasing drug-placebo differences. We tested these hypotheses with an experimental double-blind randomized controlled trial of a nonsteroidal anti-inflammatory drug with and without the addition of atropine to induce side effects. One hundred healthy volunteers were told they would be randomized to either combined analgesics that might produce dry mouth or inert placebos. In reality, they were randomized double blind, double-dummy to 1 of the 4 conditions: (1) 100 mg diclofenac + 1.2 mg atropine, (2) placebo + 1.2 mg atropine, (3) 100 mg diclofenac + placebo, or (4) placebo + placebo, and tested with heat-induced pain. Groups did not differ significantly in demographics, temperature producing moderate pain, state anxiety, or depression. Analgesia was observed in all groups; there was a significant interaction between diclofenac and atropine, without main effects. Diclofenac alone was not better than double-placebo. The addition of atropine increased pain relief more than 3-fold among participants given diclofenac (d = 0.77), but did not enhance the response to placebo (d = 0.09). A chain of mediation analysis demonstrated that the addition of atropine increased dry mouth symptoms, which increased beliefs that one had received the active medication, which, in turn, increased analgesia. In addition to this indirect effect of atropine on analgesia (via dry mouth and beliefs), analyses suggest that among those who received diclofenac, atropine directly increased analgesia. This possible synergistic effect between diclofenac and atropine might warrant future research.
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34
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Vollert J, Magerl W, Baron R, Binder A, Enax-Krumova EK, Geisslinger G, Gierthmühlen J, Henrich F, Hüllemann P, Klein T, Lötsch J, Maier C, Oertel B, Schuh-Hofer S, Tölle TR, Treede RD. Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models. Pain 2018; 159:1090-1102. [DOI: 10.1097/j.pain.0000000000001190] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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35
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Lue YJ, Wang HH, Cheng KI, Chen CH, Lu YM. Thermal pain tolerance and pain rating in normal subjects: Gender and age effects. Eur J Pain 2018; 22:1035-1042. [PMID: 29388295 DOI: 10.1002/ejp.1188] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Thermal detection thresholds and thermal pain thresholds are important in quantitative sensory testing. Although they have been well studied for assessing somatosensory function, the investigation of thermal pain tolerance has been insufficient. The aim of this study was to explore the characteristics of thermal pain tolerance and pain ratings in healthy subjects. METHODS Cold pain tolerance (CPTol) and heat pain tolerance (HPTol) were tested in 213 healthy adults aged 18-81 years recruited from the local community. The thermal detection and thermal pain thresholds were also tested to investigate the association with pain tolerance. The visual analogue scale (VAS) was used for assessing pain severity immediately after the thermal pain and tolerance tests. RESULTS The normality of the CPTol and HPTol was acceptable. Most participants rated the pain induced by the CPTol and HPTol testing as moderate. HPTol was lower in women than in men (p = 0.001), but CPTol did not differ between sexes. The pain ratings of CPTol and HPTol did not differ between sexes, but significant age effects were observed. The association of the tolerance temperature with pain ratings was weak, while those of pain ratings for CPTol and HPTol were strong (r = 0.87). CONCLUSIONS Women were more sensitive to tolerance heat pain stimuli. Younger participants reported more pain for thermal pain and tolerance tests. SIGNIFICANCE Thermal pain tolerance and pain rating for the thermal pain tolerance temperature depend on gender and age. Women are more sensitive to heat temperatures, young people rate more pain, and the pain ratings of heat and cold are strongly correlated.
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Affiliation(s)
- Y-J Lue
- Department of Physical Therapy, College of Health Sciences, Kaohsiung Medical University, Taiwan.,Department of Rehabilitation Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - H-H Wang
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - K-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Taiwan
| | - C-H Chen
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Taiwan.,Orthopaedic Research Centre, Kaohsiung Medical University, Taiwan.,Division of Adult Reconstruction Surgery, Department of Orthopedics, Kaohsiung Medical University Hospital, Taiwan.,Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Taiwan
| | - Y-M Lu
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Taiwan
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36
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Luh JJ, Huang WT, Lin KH, Huang YY, Kuo PL, Chen WS. Effects of Extracorporeal Shock Wave-Mediated Transdermal Local Anesthetic Drug Delivery on Rat Caudal Nerves. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:214-222. [PMID: 29107354 DOI: 10.1016/j.ultrasmedbio.2017.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Cavitation plays a substantial role in the clinical effects of extracorporeal shock wave therapy (ESWT). It is also generally accepted as a major mechanism in sonophoresis. To identify the enhancing effect of extracorporeal shock wave-mediated transdermal drug delivery, 24 Wistar rats were randomly assigned to four groups: (i) topical application of a eutectic mixture of local anesthetics (EMLA); (ii) 1-MHz ultrasound; (iii) ESWT pre-treatment combined with EMLA application; (iv) ESWT concurrent with EMLA application on rat tails. The degree of anesthesia was assessed using the amplitude and latency of sensory nerve action potentials within 5 min after a 60-min EMLA application. The results indicated that ESWT pre-treatment and concurrent ESWT accelerated the anesthetic effects of the EMLA cream on the tail nerve (p < 0.05). This finding might indicate that shock wave-mediated transdermal drug delivery is possible during the ESWT period.
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Affiliation(s)
- Jer-Junn Luh
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC
| | - Wan-Ting Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Kwan-Hwa Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Therapy, Tzu Chi University, Hualien City, Taiwan, ROC
| | - Yi-You Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan, ROC
| | - Po-Ling Kuo
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC; Department of Electrical Engineering, National Taiwan University, Taipei City, Taiwan, ROC
| | - Wen-Shiang Chen
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC.
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37
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Knezevic NN, Tverdohleb T, Nikibin F, Knezevic I, Candido KD. Management of chronic neuropathic pain with single and compounded topical analgesics. Pain Manag 2017; 7:537-558. [PMID: 29125423 DOI: 10.2217/pmt-2017-0020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The goal of our review was to emphasize important aspects that physicians should take into consideration when prescribing topical analgesics as part of chronic neuropathic pain treatment. We discuss the dermatopharmacokinetics and microstructural components of the skin, differences between topical and transdermal drug delivery, and topical medication effects on peripheral neuropathy and central sensitization. Even though the US FDA approved topical analgesics are 8%-capsaicin and 5%-lidocaine patches for treating postherpetic neuralgia, there are many other studies conducted on the efficacy of topical ketamine cream, clonidine gel, topical gabapentin, topical baclofen and topical phenytoin for peripheral neuropathic pain, either alone or in combination with other formulations. Furthermore, we discuss new compounded topical analgesics that are becoming more popular and that are showing promising results in the management of chronic peripheral neuropathies. However, more studies are needed for elucidation of the role of topical analgesics and their effects, especially when combined with other treatments.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.,Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Tatiana Tverdohleb
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Farid Nikibin
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.,Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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38
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Pickering G, Martin E, Tiberghien F, Delorme C, Mick G. Localized neuropathic pain: an expert consensus on local treatments. Drug Des Devel Ther 2017; 11:2709-2718. [PMID: 29066862 PMCID: PMC5604568 DOI: 10.2147/dddt.s142630] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments. MATERIALS AND METHODS Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice. RESULTS Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously. CONCLUSION Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug-drug interactions.
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Affiliation(s)
- Gisèle Pickering
- Centre de Pharmacologie Clinique, CHU Clermont-Ferrand
- Inserm, CIC 1405, Neurodol 1107
- Laboratoire de Pharmacologie, Faculté de Médecine, Clermont Université, Clermont-Ferrand
| | - Elodie Martin
- Centre de Pharmacologie Clinique, CHU Clermont-Ferrand
- Laboratoire de Pharmacologie, Faculté de Médecine, Clermont Université, Clermont-Ferrand
| | - Florence Tiberghien
- Centre d’Evaluation et de Traitement de la Douleur, CHU Jean Minjoz, Besançon
| | | | - Gérard Mick
- Unité d’Evaluation et Traitement de la Douleur, Voiron
- Laboratoire AGEIS, Université Grenoble Alpes, Grenoble, France
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39
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Enax-Krumova EK, Pohl S, Westermann A, Maier C. Ipsilateral and contralateral sensory changes in healthy subjects after experimentally induced concomitant sensitization and hypoesthesia. BMC Neurol 2017; 17:60. [PMID: 28335745 PMCID: PMC5364678 DOI: 10.1186/s12883-017-0839-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In unilateral neuropathic pain. e.g. after peripheral nerve injury, both positive and negative sensory signs occur often, accompanied by minor but equally directed contralateral sensory changes. To mimic this feature, we experimentally aimed to induce concomitant c-fibre sensitization and block in healthy subjects and analyzed the bilateral sensory changes by quantitative sensory testing (QST) using the protocol of the German Research Network on Neuropathic Pain. METHODS Twenty eight healthy subjects were firstly randomized in 2 groups to receive either topical capsaicin (0.6%, 12 cm2, application duration: 15 min.) or a lidocaine/prilocaine patch (25/25 mg, 10 cm2, application duration: 60 min.) on the right volar forearm. Secondly, 7-14 days later in the same area either at first capsaicin (for 15 min.) and immediately afterwards local anesthetics (for 60 min.) was applied (Cap/LA), or in inversed order with the same application duration (LA/Cap). Before, after each application and 7-14 days later a QST was performed bilaterally. STATISTICS Wilcoxon-test, ANOVA, p < 0.05. RESULTS Single application of 0,6% capsaicin induced thermal hypoesthesia, cold hypoalgesia, heat hyperalgesia and tactile allodynia. Lidocaine/prilocaine alone induced thermal and tactile hypoesthesia as well as mechanical and cold hypoalgesia, and a heat hyperalgesia (to a smaller extent). Ipsilaterally both co-applications induced a combination of the above mentioned changes. Significant contralateral sensory changes occurred only after the co-application with concomitant sensitization and hypoesthesia and comprised increased cold (Cap/LA, LA/Cap) and mechanical detection as well as cold pain threshold (LA/Cap). CONCLUSION The present experimental model using combined application of capsaicin and LA imitates partly the complex sensory changes observed in patients with unilateral neuropathic pain and might be used as an additional surrogate model. Only the concomitant use both agents in the same area induces both positive and negative sensory signs ipsilaterally as well as parallel contralateral sensory changes (to a lesser extent). TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01540877 , registered on 23 February 2012.
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Affiliation(s)
- Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789, Bochum, Germany.
| | - Stephanie Pohl
- Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Andrea Westermann
- Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Christoph Maier
- Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
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40
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The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use. Pain Ther 2016; 5:149-169. [PMID: 27822619 PMCID: PMC5130910 DOI: 10.1007/s40122-016-0060-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Indexed: 01/24/2023] Open
Abstract
When peripheral neuropathic pain affects a specific, clearly demarcated area of the body, it may be described as localized neuropathic pain (LNP). Examples include postherpetic neuralgia and painful diabetic neuropathy, as well as post-surgical and post-traumatic pain. These conditions may respond to topical treatment, i.e., pharmaceutical agents acting locally on the peripheral nervous system, and the topical route offers advantages over systemic administration. Notably, only a small fraction of the dose reaches the systemic circulation, thereby reducing the risk of systemic adverse effects, drug–drug interactions and overdose. From the patient’s perspective, the analgesic agent is easily applied to the most painful area(s). The 5% lidocaine-medicated plaster has been used for several years to treat LNP and is registered in approximately 50 countries. Many clinical guidelines recommend this treatment modality as a first-line option for treating LNP, particularly in frail and/or elderly patients and those receiving multiple medications, because the benefit-to-risk ratios are far better than those of systemic analgesics. However, some guidelines make only a weak recommendation for its use. This paper considers the positioning of the 5% lidocaine-medicated plaster in international treatment guidelines and how they may be influenced by the specific criteria used in developing them, such as the methodology employed by randomized, placebo-controlled trials. It then examines the body of evidence supporting use of the plaster in some prevalent LNP conditions. Common themes that emerge from clinical studies are: (1) the excellent tolerability and safety of the plaster, which can increase patients’ adherence to treatment, (2) continued efficacy over long-term treatment, and (3) significant reduction in the size of the painful area. On this basis, it is felt that the 5% lidocaine-medicated plaster should be more strongly recommended for treating LNP, either as one component of a multimodal approach or as monotherapy.
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Chantelau EA. Conventional deep pressure algometry is not suitable for clinical assessment of nociception in painless diabetic neuropathy. Diabet Foot Ankle 2016; 7:31922. [PMID: 27702429 PMCID: PMC5045473 DOI: 10.3402/dfa.v7.31922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/24/2016] [Accepted: 09/03/2016] [Indexed: 12/29/2022]
Abstract
Background In diabetic persons with painless neuropathic foot ulceration, foot skin was found to be insensate to noxious pinprick stimulation (stimulation area less than 0.05 mm2), while compression of deep subcutaneous foot tissues by Algometer II® (stimulation area 1 cm2) could evoke a deep dull aching. To elucidate this discrepancy, the Algometer II stimulation technique was critically reviewed by varying probe sizes and anatomical sites in the same study population 3 years later. Methods Ten control subjects without neuropathy and 11 persons with painless diabetic neuropathy (PLDN, seven of whom with diabetic foot syndrome, i.e., past painless foot ulcer, or inactive Charcot arthropathy) were re-examined using Algometer II. Deep pressure pain perception threshold (DPPPT) was measured in random sequence with stimulation areas of 0.5 cm2, 1 cm2, and 2 cm2 (separated by 5 min intervals), at the plantar forefoot, the instep, and the hindfoot of both legs. Results In the control and PLDN groups, median DPPPTs differed significantly between stimulation areas (highest with 0.5 cm2, intermediate with 1 cm2, lowest with 2 cm2; p<0.001), and varied moderately by anatomical site. Between-group differences were relatively small. Results of the 1 cm2 assessments repeated 3 years apart were similar. Conclusions Algometer II readings represent spatial summation of low-threshold pressure-receptor rather than of high-threshold nociceptor stimulation and are, thus, unhelpful for assessing PLDN. Reproducibility of the measurements is good.
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Pharmacological Management of Neuropathic Pain: Current Trends and Possible Approaches. ARCHIVES OF NEUROSCIENCE 2016. [DOI: 10.5812/archneurosci.28998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Okayasu I, Komiyama O, Ayuse T, De Laat A. Effect of topical lidocaine in the oral and facial regions on tactile sensory and pain thresholds. Arch Oral Biol 2016; 72:51-55. [PMID: 27541635 DOI: 10.1016/j.archoralbio.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the effect of lidocaine application to the face, tongue and hand on sensory and pain thresholds of symptom-free subjects. DESIGN Eighteen females (mean age 25.7 years, range 22-38) participated. Using Semmes-Weinstein monofilaments, the tactile detection threshold (TDT) and the filament-prick pain detection threshold (FPT) were measured on the cheek skin (CS), tongue tip (TT) and palm side of the thenar skin (TS). Subjects were tested in 2 sessions at a 1week interval in randomised order. Lidocaine (session A) or placebo gel (session B) was applied for 5min. The TDT and FPT were measured before and after application. RESULTS The TDT at all sites in session A significantly increased after 5min, but a significant session effect on the TDT was only found at the TT (P<0.01). On the other hand, there were significant session effects on the FPT at all sites (P<0.01). CONCLUSION These results indicate that the pain threshold (FPT) is more susceptible to local anesthetics than the sensory threshold (TDT), but further study is needed to use topical lidocaine for the control of oral and facial pain in the clinic.
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Affiliation(s)
- Ichiro Okayasu
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan.
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Japan
| | - Takao Ayuse
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Antoon De Laat
- Department of Oral Health Sciences, KU Leuven, Belgium; Department of Dentistry, University Hospital Leuven, Belgium
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Abstract
Adolescents and children are frequently affected by chronic pain conditions that can lead to disability and distress. The best approach to evaluation and treatment of these conditions involves use of the biopsychosocial model, which includes use of medication management. Chronic pain conditions are treated pharmacologically with a number of different medication classes via several routes of administration as drug delivery systems have progressed. These include anti-inflammatory drugs, muscle relaxants, antiepileptic medicines, antidepressants, opioids, and local anesthetics. Most are prescribed without regulatory body approval to treat specific pain syndromes as data to support their use are sparse. Medical decision making is guided by experience, empiric evidence, extrapolation from adult studies, and matching medication classes with the theorized mechanism of the pain condition. It is not recommended that nonpain practitioners prescribe opioid medications for treatment of chronic pain conditions, and pain management practitioners should seek to minimize their use. The appropriate and commonly used medications for pain conditions are presented in this narrative review.
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Affiliation(s)
- Eapen Mathew
- Department of Anesthesiology, Frank Netter School of Medicine, Quinnipiac University, North Haven, CT; Department of Anesthesiology, Connecticut Children's Medical Center, Hartford, CT; Department of Anesthesiology, University of Connecticut School of Medicine, Farmington, CT; Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
| | - Eugene Kim
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Department of Anesthesiology, Children's Hospital of Los Angeles, Los Angeles, CA
| | - William Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
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Kondamudi PK, Tirumalasetty PP, Malayandi R, Mutalik S, Pillai R. Lidocaine Transdermal Patch: Pharmacokinetic Modeling and In Vitro-In Vivo Correlation (IVIVC). AAPS PharmSciTech 2016; 17:588-96. [PMID: 26283198 DOI: 10.1208/s12249-015-0390-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/05/2015] [Indexed: 01/22/2023] Open
Abstract
The present study aims to develop the correlation between in vitro and in vivo skin permeation of lidocaine in its transdermal patch. In order to minimize the run-to-run variability during in vitro skin permeation studies, release normalized cumulative percent (%Ct n) was calculated. A suitable polynomial mathematical model was used to establish a correlation between time and %Ct n. Percent in vivo absorbed was calculated by using numerical deconvolution (NDC) and non-compartmental analysis (NCA) methods. Pharmacokinetic (PK) parameters such as AUC last and C max were predicted with the established in vitro-in vivo correlation (IVIVC) models. The minimum prediction errors in NDC method for C max were found to be -30.9 and -25.4% for studies I (in vivo study in human volunteers with one batch of Lidoderm patch; internal validation) and II (in vivo study in human volunteers with another batch of Lidoderm patch; external validation), respectively, whereas minimum prediction errors in NCA method were relatively low (3.9 and 0.03% for studies I and II, respectively) compared to those in NDC method. The prediction errors for AUC last were found to be less than 2% for both methods and studies. The established method in this study could be a potential approach for predicting the bioavailability and/or bioequivalence for transdermal drug delivery systems.
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Freo U, Ambrosio F, Furnari M, Ori C. Lidocaine 5% Medicated Plaster for Spinal Neuropathic Pain. J Pain Palliat Care Pharmacother 2016; 30:111-3. [DOI: 10.3109/15360288.2016.1145780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ettlin DA, Lukic N, Abazi J, Widmayer S, Meier ML. Tracking local anesthetic effects using a novel perceptual reference approach. J Neurophysiol 2016; 115:1730-4. [PMID: 26792885 DOI: 10.1152/jn.00917.2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/15/2016] [Indexed: 11/22/2022] Open
Abstract
Drug effects of loco-regional anesthetics are commonly measured by unidimensional pain rating scales. These scales require subjects to transform their perceptual correlates of stimulus intensities onto a visual, verbal, or numerical construct that uses a unitless cognitive reference frame. The conceptual understanding and execution of this magnitude estimation task may vary among individuals and populations. To circumvent inherent shortcomings of conventional experimental pain scales, this study used a novel perceptual reference approach to track subjective sensory perceptions during onset of an analgesic nerve block. In 34 male subjects, nociceptive electric stimuli of 1-ms duration were repetitively applied to left (target) and right (reference) mandibular canines every 5 s for 600 s, with a side latency of 1 ms. Stimulus strength to the target canine was programmed to evoke a tolerable pain intensity perception and remained constant at this level throughout the experiment. A dose of 0.6 ml of articaine 4% was submucosally injected at the left mental foramen. Subjects then reported drug effects by adjusting the stimulus strength (in milliamperes) to the reference tooth, so that the perceived intensity in the reference tooth was equi-intense to the target tooth. Pain and stimulus perception offsets were indicated by subjects. Thus, the current approach for matching the sensory experience in one anatomic location after regional anesthesia allows detailed tracking of evolving perceptual changes in another location. This novel perceptual reference approach facilitates direct and accurate quantification of analgesic effects with high temporal resolution. We propose using this method for future experimental investigations of analgesic/anesthetic drug efficacy.
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Affiliation(s)
- Dominik A Ettlin
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nenad Lukic
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jetmir Abazi
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Sonja Widmayer
- Department of Psychiatry, Universitäre Psychiatrische Kliniken, University of Basel, Basel, Switzerland
| | - Michael L Meier
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Balgrist University Hospital, Zurich, Switzerland; and
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Mainka T, Malewicz N, Baron R, Enax-Krumova E, Treede RD, Maier C. Presence of hyperalgesia predicts analgesic efficacy of topically applied capsaicin 8% in patients with peripheral neuropathic pain. Eur J Pain 2016; 20:116-129. [DOI: 10.1002/ejp.703] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- T. Mainka
- Department of Pain Medicine; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
- Department of Neurology; University Medical Center Hamburg-Eppendorf; Germany
| | - N.M. Malewicz
- Department of Pain Medicine; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
| | - R. Baron
- Sektion Neurologische Schmerzforschung und Therapie; Klinik für Neurologie; Universitätsklinikum Schleswig-Holstein; Kiel Germany
| | - E.K. Enax-Krumova
- Department of Neurology; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
| | - R.-D. Treede
- Center for Biomedicine and Medical Technology Mannheim; Heidelberg University; Germany
| | - C. Maier
- Department of Pain Medicine; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
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Abstract
Quantitative sensory testing (QST), a set of noninvasive methods used to assess sensory and pain perception, has been used for three decades. The precision of the instruments and the uninvasiveness encouraged many QST-based trials. The developments made have benefited multiple disciplines. QST relies on analysis of an individual's response to external stimuli, reflecting the integrity of the PNS and the sensory pathway. The sensory pathway cannot be assessed in isolation from the affective and cognitive characteristics of patients or testers. Many variables potentially affect the reliability and reproducibility of QST, which after all, is designed for the testing of individuals by other individuals. Several decades of QST research have yielded exciting contributions, but the future of QST cannot be fully known.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Emergency Medicine Memorial Hermann Hospital, Houston, TX 77030, USA
- Department of Emergency Medicine Lyndon B Johnson Hospital, Houston, TX 77026, USA
| | - Salahadin Abdi
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Pain relief with lidocaine 5% patch in localized peripheral neuropathic pain in relation to pain phenotype. Pain 2015; 156:2234-2244. [DOI: 10.1097/j.pain.0000000000000266] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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