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Komisarek D, Demirbas F, Haj Hassani Sohi T, Merz K, Schauerte C, Vasylyeva V. Polymorphism and Multi-Component Crystal Formation of GABA and Gabapentin. Pharmaceutics 2023; 15:2299. [PMID: 37765268 PMCID: PMC10536459 DOI: 10.3390/pharmaceutics15092299] [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: 07/10/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This study exploits the polymorphism and multi-component crystal formation of γ-amino butanoic acid (GABA) and its pharmaceutically active derivative, gabapentin. Two polymorphs of GABA and both polymorphs of gabapentin are structurally revisited, together with gabapentin monohydrate. Hereby, GABA form II is only accessible under special conditions using additives, whereas gabapentin converts to the monohydrate even in the presence of trace amounts of water. Different accessibilities and phase stabilities of these phases are still not fully clarified. Thus, indicators of phase stability are discussed involving intermolecular interactions, molecular conformations, and crystallization environment. Calculated lattice energy differences for polymorphs reveal their similar stability. Quantification of the hydrogen bond strengths with the atoms-in-molecules (AIM) model in conjunction with non-covalent interaction (NCI) plots also shows similar hydrogen bond binding energy values for all polymorphs. We demonstrate that differences in the interacting modes, in an interplay with the intermolecular repulsion, allow the formation of the desired phase under different crystallization environments. Salts and co-crystals of GABA and gabapentin with fumaric as well as succinic acid further serve as models to highlight how strongly HBs act as the motif-directing force in the solid-phase GABA-analogs. Six novel multi-component entities were synthesized, and structural and computational analysis was performed: GABA fumarate (2:1); two gabapentin fumarates (2:1) and (1:1); two GABA succinates (2:1) and (1:1); and a gabapentin:succinic acid co-crystal. Energetically highly attractive carboxyl/carboxylate interaction overcomes other factors and dominates the multi-component phase formation. Decisive commonalities in the crystallization behavior of zwitterionic GABA-derivatives are discussed, which show how they can and should be understood as a whole for possible related future products.
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Affiliation(s)
- Daniel Komisarek
- Laboratory for Crystal Engineering, Department of Inorganic and Structural Chemistry 1, Heinrich-Heine-University Dueseldorf, Universitaetsstraße 1, 40225 Duesseldorf, Germany; (D.K.)
| | - Fulya Demirbas
- Laboratory for Crystal Engineering, Department of Inorganic and Structural Chemistry 1, Heinrich-Heine-University Dueseldorf, Universitaetsstraße 1, 40225 Duesseldorf, Germany; (D.K.)
| | - Takin Haj Hassani Sohi
- Laboratory for Crystal Engineering, Department of Inorganic and Structural Chemistry 1, Heinrich-Heine-University Dueseldorf, Universitaetsstraße 1, 40225 Duesseldorf, Germany; (D.K.)
| | - Klaus Merz
- Inorganic Chemistry 1, Ruhr-University Bochum, Universitaetstrasse 150, 44801 Bochum, Germany
| | | | - Vera Vasylyeva
- Laboratory for Crystal Engineering, Department of Inorganic and Structural Chemistry 1, Heinrich-Heine-University Dueseldorf, Universitaetsstraße 1, 40225 Duesseldorf, Germany; (D.K.)
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Choudhary S, Kaur R, Waziri A, Garg A, Kadian R, Alam MS. N-type calcium channel blockers: a new approach towards the treatment of chronic neuropathic pain. EXPLORATION OF MEDICINE 2023. [DOI: 10.37349/emed.2023.00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Neuropathic pain (NP) remains maltreated for a wide number of patients by the currently available treatments and little research has been done in finding new drugs for treating NP. Ziconotide (PrialtTM) had been developed as the new drug, which belongs to the class of ω-conotoxin MVIIA. It inhibits N-type calcium channels. Ziconotide is under the last phase of the clinical trial, a new non-narcotic drug for the management of NP. Synthetically it has shown the similarities with ω-conotoxin MVIIA, a constituent of poison found in fish hunting snails (Conus magus). Ziconotide acts by selectively blocking neural N-type voltage-sensitized Ca2+ channels (NVSCCs). Certain herbal drugs also have been studied but no clinical result is there and the study is only limited to preclinical data. This review emphasizes the N-type calcium channel inhibitors, and their mechanisms for blocking calcium channels with their remedial prospects for treating chronic NP.
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Affiliation(s)
- Shikha Choudhary
- School of Medical and Allied Sciences, K.R. Mangalam University, Gurugram 122103, Haryana, India
| | - Raminderjit Kaur
- School of Medical and Allied Sciences, K.R. Mangalam University, Gurugram 122103, Haryana, India
| | - Aafrin Waziri
- University School of Biotechnology, Guru Gobind Singh Indraprastha University, Delhi, 110078, India
| | - Arun Garg
- Department of Pharmacology, NIMS Institute of Pharmacy, NIMS University, Jaipur 303121, Rajasthan, India
| | - Renu Kadian
- Ram Gopal College of Pharmacy, Gurugram 122506, Haryana, India
| | - Md Sabir Alam
- SGT College of Pharmacy, SGT University, Gurugram 122505, Haryana, India
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3
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Pain and Analgesic related insomnia. Pain Manag Nurs 2022; 24:254-264. [DOI: 10.1016/j.pmn.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/11/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
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4
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Jin GJ, Peng X, Chen ZG, Wang YL, Liao WJ. Celastrol attenuates chronic constrictive injury-induced neuropathic pain and inhibits the TLR4/NF-κB signaling pathway in the spinal cord. J Nat Med 2021; 76:268-275. [PMID: 34510370 DOI: 10.1007/s11418-021-01564-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
Tripterygium wilfordii Hook F. is a well-known but poisonous traditional Chinese medicine used for treating a wide variety of inflammatory and autoimmune disorders. Celastrol, a quinone methyl triterpenoid compound and a representative component of T. wilfordii Hook F., shows a variety of pharmacological activities, such as anti-inflammatory and antitumor activities. Here, we investigated the antineuropathic pain (NP) effect of celastrol and its potential mechanisms. Rats with chronic constrictive injury (CCI)-induced NP were used to evaluate the analgesic effect of celastrol. Gabapentin was used as a reference compound (positive control). The results showed that gabapentin (100 mg/kg, i.p.) and multiple doses of celastrol (0.5, 1 and 2 mg/kg, i.p.) increased the threshold of mechanical and thermal pain in the rats with NP. Western blot results showed that celastrol significantly inhibited the activation of microglia and astrocytes in the spinal cord of rats with NP. Additionally, the levels of the proinflammatory cytokines tumor necrosis factor α (TNF-α), interleukin 1β and interleukin 6, detected by ELISA in the spinal cord of the rats with NP, were significantly inhibited by celastrol. Furthermore, celastrol treatment dramatically inhibited the expression of the TLR4/NF-κB signaling pathway in the spinal cord. Taken together, our findings suggested that celastrol could attenuate mechanical and thermal pain in CCI-induced NP, and this protection might be attributed to inhibiting the TLR4/NF-κB signaling pathway and exerting anti-inflammatory effects in the spinal cord.
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Affiliation(s)
- Gui-Juan Jin
- Department of Neonatology, The First People's Hospital of Jingmen, Jingmen, Hubei, China
| | - Xuehuizi Peng
- Department of Children's Rehabilitation, Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhi-Guo Chen
- Department of Pharmacy, College of Traditional Chinese Medicine, Yichang Hospital of Traditional Chinese Medicine, Three Gorges University, Yichang, China
| | - Yu-Lin Wang
- Department of Neonatology, The First People's Hospital of Jingmen, Jingmen, Hubei, China
| | - Wen-Jun Liao
- Department of Neonatology, The First People's Hospital of Jingmen, Jingmen, Hubei, China.
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Mundluru T, Saraghi M. Anesthetic Management of a Complex Regional Pain Syndrome (CRPS) Patient With Ketamine. Anesth Prog 2021; 67:219-225. [PMID: 33393601 DOI: 10.2344/anpr-67-02-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/13/2020] [Indexed: 11/11/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a potentially debilitating form of neuropathic pain that may manifest following a traumatic injury or surgery. CRPS is also known as algodystrophy, causalgia, or reflex sympathetic dystrophy (RSD). Patients describe unbearable burning pain from nonnociceptive stimuli, such as when taking a shower or brushing against another object. Regular tactile stimuli encountered during routine dental procedures may not be well-tolerated by a patient with CRPS. Ketamine infusions have been reported to help alleviate acute exacerbations or "flare-ups" of CRPS symptoms. This case report provides a brief overview of CRPS pathophysiology and treatment including data supporting the use of ketamine infusions and a discussion regarding the anesthetic management of a patient with CRPS presenting for dental care under deep sedation utilizing high-dose intravenous ketamine.
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Affiliation(s)
- Tarun Mundluru
- Resident in Orofacial Pain and Oral Medicine, The Herman Ostrow School of Dentistry at the University of Southern California, Los Angeles, California
| | - Mana Saraghi
- Director, Dental Anesthesiology Residency Program, Jacobi Medical Center Bronx, New York
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Ahmed AM, Hassan OG, Khalifa AA. Gabapentin as an adjuvant therapy to splinting in carpal tunnel syndrome (CTS): a systematic review and meta-analysis of randomized controlled trials. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome (CTS) is a common upper limb entrapment neuropathy; severe cases are treated surgically and mild to moderate can be managed conservatively. The purpose of this systematic review and meta-analysis was to define the efficacy of gabapentin as an adjuvant to splinting in the treatment of mild to moderate CTS.
Methods
A systematic search through 13 databases, randomized clinical trials (RCTs) reporting the use of gabapentin with splinting in CTS were included and analyzed.
Results
Three RCTs including 170 patients were eligible. There was no significant difference between gabapentin plus splinting and splinting alone in 5 measured parameters: (1) Symptom Severity Scale (SSS) [MD (95% CI) = − 0.76 (− 2.46–0.93), p = 0.378], (2) Functional Status Scale (FSS) [MD (95% CI) = − 0.23 (− 1.40–0.94), p = 0.701], (3) visual analogue scale (VAS) to assess pain [MD (95% CI) = − 0.6 (− 1.47–0.27), p = 0.174], (4) Grip strength [MD (95% CI) = − 0.11 (− 0.70–0.48), p = 0.718], and (5) pinch strength [MD (95% CI) = 0.72 (− 0.10–1.54), p = 0.083].
Conclusion
This review provides low-quality evidence that gabapentin plus nocturnal splinting is not superior to splinting alone. More high-quality trials are needed to determine the role of this drug as an adjuvant in the management of CTS.
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Billig JI, Sears ED, Gunaseelan V, Santosa KB, Iwashyna TJ, Englesbe MJ, Brummett CM, Waljee JF. Inappropriate Preoperative Gabapentinoid Use Among Patients With Carpal Tunnel Syndrome. J Hand Surg Am 2020; 45:677-689.e5. [PMID: 32487365 PMCID: PMC7453721 DOI: 10.1016/j.jhsa.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/18/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Gabapentinoids are commonly prescribed for the treatment of neuropathic pain but are not recommended for the primary treatment of carpal tunnel syndrome (CTS). We sought (1) to investigate the preoperative use of gabapentinoids for the treatment of CTS and (2) to determine whether preoperative exposure is associated with persistent gabapentinoid and opioid use after carpal tunnel release. METHODS We performed a retrospective cohort study using IBM MarketScan Research Databases (2010-2017) of patients who did not fill a gabapentinoid or opioid prescription within 3 months of a new CTS diagnosis undergoing surgical release. Our primary outcomes included preoperative gabapentinoid prescription fills associated with CTS and persistent prescription fills of gabapentinoids and opioids at 91 to 180 days after surgery. Multivariable logistic regression models were used to evaluate the association between patient-level factors and persistent gabapentinoid and opioid use. RESULTS Of the 56,593 patients without a previous gabapentinoid or opioid prescription prior to diagnosis of CTS, 3,474 patients (6%) filled a gabapentinoid prescription before carpal tunnel release. Overall, 835 patients (24% of the preoperative users) continued to fill gabapentinoid prescriptions at 91 to 180 days after surgery. Of the preoperative gabapentinoid users, 20% (702 patients) continued to fill opioid prescriptions at 91 to 80 days after release. After adjusting for patient characteristics, preoperative gabapentinoid use was associated with increased odds of persistent postoperative gabapentinoid use (preoperative gabapentinoid, 22% adjusted probability; 95% confidence interval [95% CI], 20.3%-23.0%, no preoperative gabapentinoid use, 1%; 95% CI, 1.2%-1.4%) and persistent postoperative opioid use (preoperative gabapentinoid, 18% adjusted probability; 95% CI, 17%-20%), no preoperative gabapentinoid, 9%; 95% CI, 8.6%-9.1%). CONCLUSIONS Despite a lack of evidence to support the use of gabapentinoids for CTS, 6% of patients are prescribed a gabapentinoid prior to surgery, and prolonged use is common. Given the effectiveness of surgical release and the risks associated with gabapentinoids, greater attention is needed to ensure that gabapentinoids are prescribed appropriately, avoided when possible, and stopped after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Jessica I Billig
- VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, Ann Arbor, MI
| | - Erika D Sears
- Section of Plastic Surgery, Department of Surgery, Ann Arbor, MI; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | | | | | | | - Chad M Brummett
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
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Abstract
Neuroma formation occurs because of some degree of nerve injury followed by improper intrinsic nerve repair. The cause of neuroma pain is incompletely understood, but appears to be multifactorial in nature, including local and system changes. A comprehensive understanding of nerve anatomy, injury, and repair techniques should be used when dealing with neuroma formation and its physical manifestations. Diagnosis of neuroma is clinically characterized by pain associated with scar, altered sensation within the given nerve distribution, and a Tinel sign. The pathophysiology of neuroma formation is reviewed.
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9
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El-Awaad E, Pryymachuk G, Fried C, Matthes J, Isensee J, Hucho T, Neiss WF, Paulsson M, Herzig S, Zaucke F, Pietsch M. Direct, gabapentin-insensitive interaction of a soluble form of the calcium channel subunit α 2δ-1 with thrombospondin-4. Sci Rep 2019; 9:16272. [PMID: 31700036 PMCID: PMC6838084 DOI: 10.1038/s41598-019-52655-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/21/2019] [Indexed: 12/31/2022] Open
Abstract
The α2δ‐1 subunit of voltage-gated calcium channels binds to gabapentin and pregabalin, mediating the analgesic action of these drugs against neuropathic pain. Extracellular matrix proteins from the thrombospondin (TSP) family have been identified as ligands of α2δ‐1 in the CNS. This interaction was found to be crucial for excitatory synaptogenesis and neuronal sensitisation which in turn can be inhibited by gabapentin, suggesting a potential role in the pathogenesis of neuropathic pain. Here, we provide information on the biochemical properties of the direct TSP/α2δ-1 interaction using an ELISA-style ligand binding assay. Our data reveal that full-length pentameric TSP-4, but neither TSP-5/COMP of the pentamer-forming subgroup B nor TSP-2 of the trimer-forming subgroup A directly interact with a soluble variant of α2δ-1 (α2δ-1S). Interestingly, this interaction is not inhibited by gabapentin on a molecular level and is not detectable on the surface of HEK293-EBNA cells over-expressing α2δ‐1 protein. These results provide biochemical evidence that supports a specific role of TSP-4 among the TSPs in mediating the binding to neuronal α2δ‐1 and suggest that gabapentin does not directly target TSP/α2δ-1 interaction to alleviate neuropathic pain.
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Affiliation(s)
- Ehab El-Awaad
- Institute II for Pharmacology, Centre of Pharmacology, Medical Faculty, University of Cologne, Gleueler Str. 24, D-50931, Cologne, Germany.,Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Galyna Pryymachuk
- Department of Anatomy I, Medical Faculty, University of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Cora Fried
- Institute II for Pharmacology, Centre of Pharmacology, Medical Faculty, University of Cologne, Gleueler Str. 24, D-50931, Cologne, Germany
| | - Jan Matthes
- Institute II for Pharmacology, Centre of Pharmacology, Medical Faculty, University of Cologne, Gleueler Str. 24, D-50931, Cologne, Germany
| | - Jörg Isensee
- Experimental Anaesthesiology and Pain Research, Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, D-50931, Cologne, Germany
| | - Tim Hucho
- Experimental Anaesthesiology and Pain Research, Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, D-50931, Cologne, Germany
| | - Wolfram F Neiss
- Department of Anatomy I, Medical Faculty, University of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Mats Paulsson
- Institute for Biochemistry II, Centre for Biochemistry, Medical Faculty, University of Cologne, Joseph-Stelzmann-Str. 52, D-50931, Cologne, Germany.,Centre for Molecular Medicine Cologne (CMMC), University of Cologne, Robert-Koch-Str. 21, D-50931, Cologne, Germany
| | - Stefan Herzig
- Institute II for Pharmacology, Centre of Pharmacology, Medical Faculty, University of Cologne, Gleueler Str. 24, D-50931, Cologne, Germany.,President of TH Köln, TH Köln (University of Applied Sciences), Claudiusstr. 1, D-50678, Cologne, Germany
| | - Frank Zaucke
- Institute for Biochemistry II, Centre for Biochemistry, Medical Faculty, University of Cologne, Joseph-Stelzmann-Str. 52, D-50931, Cologne, Germany.,Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopedic University Hospital, Friedrichsheim gGmbH, Marienburgstr. 2, D-60528, Frankfurt/Main, Germany
| | - Markus Pietsch
- Institute II for Pharmacology, Centre of Pharmacology, Medical Faculty, University of Cologne, Gleueler Str. 24, D-50931, Cologne, Germany.
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Chien JL, Baez V, Mody HR. Uncontrolled recurrent myasthenia gravis exacerbations secondary to chronic gabapentin use. J Community Hosp Intern Med Perspect 2019; 9:371-372. [PMID: 31528296 PMCID: PMC6735302 DOI: 10.1080/20009666.2019.1643220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/05/2019] [Indexed: 11/25/2022] Open
Abstract
Gabapentin is an anticonvulsant medication that reduces synaptic transmission by decreasing presynaptic voltage-gated Ca2+ and Na+ channels. It is approved to treat focal seizures but also used to treat post-herpetic and neuropathic pain. Although uncommon, there have been three reported cases of myasthenia gravis exacerbation associated with gabapentin in the literature. We present a patient with uncontrolled recurrent myasthenia gravis exacerbations secondary to chronic gabapentin use and provide a review for the three published cases.
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Affiliation(s)
- Jason L Chien
- Department of Medicine, Medstar Harbor Hospital, Baltimore, MD, USA
| | - Valentina Baez
- Department of Medicine, Medstar Harbor Hospital, Baltimore, MD, USA
| | - Harshad R Mody
- Department of Medicine, Medstar Harbor Hospital, Baltimore, MD, USA
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11
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Gupta MA, Pur DR, Vujcic B, Gupta AK. Use of antiepileptic mood stabilizers in dermatology. Clin Dermatol 2018; 36:756-764. [DOI: 10.1016/j.clindermatol.2018.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Shi T, Hao JX, Wiesenfeld-Hallin Z, Xu XJ. Gabapentin and NMDA receptor antagonists interacts synergistically to alleviate allodynia in two rat models of neuropathic pain. Scand J Pain 2018; 18:687-693. [DOI: 10.1515/sjpain-2018-0083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/12/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
The clinical management of neuropathic pain remains a challenge. We examined the interaction between gabapentin and NMDA receptor antagonists dextromethrophan and MK-801 in alleviating neuropathic pain-like behaviors in rats after spinal cord or sciatic nerve injury.
Methods
Female and male rats were produced with Ischemic spinal cord injury and sciatic nerve injury. Gabapentin, dextromethorphan, MK-801 or drug combinations were injected with increasing doses. Mechanical response thresholds were tested with von Frey hairs to graded mechanical touch/pressure, and ethyl chloride spray was applied to assess the cold sensitivity before and after injuries.
Results
In spinally injured rats, gabapentin and dextromethorphan did not affect allodynia-like behaviors at doses of 30 and 20 mg/kg, respectively. In contrast, combination of 15 or 30 mg/kg gabapentin with dextromethorphan at 10 mg/kg produced total alleviation of allodynia to mechanical or cold stimulation. Further reducing the dose of gapapentin to 7.5 mg/kg and dextromethorphan to 5 mg/kg still produced significant effect. MK-801, another NMDA receptor antagonist, also enhanced the effect of gabapentin in spinally injured rats. Similar synergistic anti-allodynic effect between dextromethorphan and gabapentin was also observed in a rat model of partial sciatic nerve injury. No increased side effect was seen following the combination between gabapentin and dextromethorphan.
Conclusions
In conclusion, the present study suggested that combining NMDA receptor antagonists with gabapentin could provide synergistic effect to alleviate neuropathic pain and reduced side effects.
Implications
Combining NMDA receptor antagonists with gabapentin may provide a new approach in alleviating neuropathic pain with increased efficacy and reduced side effects.
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Affiliation(s)
- Tiansheng Shi
- Department of Physiology and Pharmacology, Section of Integrative Pain Research, Karolinska Institutet , S-171 77 Stockholm , Sweden
| | - Jing-Xia Hao
- Department of Physiology and Pharmacology, Section of Integrative Pain Research, Karolinska Institutet , Stockholm , Sweden
| | - Zsuzsanna Wiesenfeld-Hallin
- Department of Physiology and Pharmacology, Section of Integrative Pain Research, Karolinska Institutet , Stockholm , Sweden
| | - Xiao-Jun Xu
- Department of Physiology and Pharmacology, Section of Integrative Pain Research, Karolinska Institutet , Stockholm , Sweden
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Lee YH, Lee KM, Kim HG, Kang SK, Auh QS, Hong JP, Chun YH. Orofacial complex regional pain syndrome: pathophysiologic mechanisms and functional MRI. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e164-e170. [PMID: 28522185 DOI: 10.1016/j.oooo.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 01/29/2023]
Abstract
Complex regional pain syndrome (CRPS) is one of the most challenging chronic pain conditions and is characterized by burning pain, allodynia, hyperalgesia, autonomic changes, trophic changes, edema, and functional loss involving mainly the extremities. Until recently, very few reports have been published concerning CRPS involving the orofacial area. We report on a 50-year-old female patient who presented with unbearable pain in all of her teeth and hypersensitivity of the facial skin. She also reported intractable pain in both extremities accompanied by temperature changes and orofacial pain that increased when the other pains were aggravated. In the case of CRPS with trigeminal neuropathic pain, protocols for proper diagnosis and prompt treatment have yet to be established in academia or in the clinical field. We performed functional magnetic resonance imaging for a thorough analysis of the cortical representation of the affected orofacial area immediately before and immediately after isolated light stimulus of the affected hand and foot and concluded that CRPS can be correlated with trigeminal neuropathy in the orofacial area. Furthermore, the patient was treated with carbamazepine administration and stellate ganglion block, which can result in a rapid improvement of pain in the trigeminal region.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea.
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Soo-Kyung Kang
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Jyung-Pyo Hong
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Yang-Hyun Chun
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
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14
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Metin SK, Meydan B, Evman S, Dogruyol T, Baysungur V. The Effect of Pregabalin and Methylcobalamin Combination on the Chronic Postthoracotomy Pain Syndrome. Ann Thorac Surg 2016; 103:1109-1113. [PMID: 27916242 DOI: 10.1016/j.athoracsur.2016.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic postthoracotomy pain (CPTP) consists of different types of pain. Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes. We aimed to determine the safety and efficacy of pregabalin and methylcobalamin combination (PG-B12) in comparison with diclofenac potassium (DP) in patients with CPTP. METHODS One hundred consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospectively randomly assigned and evaluated. Fifty patients were given PG-B12 and another 50 patients were given DP treatment. Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scorings were performed previous to the treatment (day 0) and on the 15th, 30th, 60th, and 90th days. Adverse events were questioned. RESULTS The mean ages were 58.7 ± 12.2 and 54.6 ± 14.5 years, and the mean durations of pain were 4.01 ± 1.04 and 3.8 ± 1.02 months, respectively. The number of patients with a VAS score less than 5 at the latest follow-up (VAS90 < 5) was 44 (88%) and 18 (36%) in the PG-B12 and DP groups, respectively (p < 0.05). Forty-four patients (88%) in the PG-B12 group and 16 patients (32%) in the DP group had a LANSS score less than 12 at the latest follow-up (p < 0.05). Minor adverse events that did not mandate discontinuation of the treatment were observed in 14 patients (28%) in the PG-B12 group and 2 patients (4%) in the DP group. CONCLUSIONS PB-B12 is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance. These results should be supported by multidisciplinary studies with larger sample sizes and longer follow-ups.
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Affiliation(s)
- Serda Kanbur Metin
- Department of Thoracic Surgery, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Burhan Meydan
- Department of Anesthesiology and Algology, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Serdar Evman
- Department of Thoracic Surgery, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Talha Dogruyol
- Department of Thoracic Surgery, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Volkan Baysungur
- Department of Thoracic Surgery, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Marwaha L, Bansal Y, Singh R, Saroj P, Sodhi RK, Kuhad A. Niflumic acid, a TRPV1 channel modulator, ameliorates stavudine-induced neuropathic pain. Inflammopharmacology 2016; 24:319-334. [PMID: 27757590 DOI: 10.1007/s10787-016-0285-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 09/21/2016] [Indexed: 12/27/2022]
Abstract
TRP channels have been discovered as a specialized group of somatosensory neurons involved in the detection of noxious stimuli. Desensitization of TRPV1 located on dorsal root and trigeminal ganglia exhibits analgesic effect and makes it potential therapeutic target for treatment of neuropathic pain. With this background, the present study was aimed to investigate the protective effect of niflumic acid, a TRPV1 modulator, on stavudine (STV)-induced neuropathic pain in rats. Stavudine (50 mg/kg) was administered intravenously via tail vein in rats to induce neuropathic pain. Various behavioral tests were performed to access neuropathic pain (hyperalgesia and allodynia) on 7th, 14th, 21st, and 28th days. Electrophysiology (motor nerve conduction velocity; MNCV) and biochemical estimations were conducted after 28th day. Niflumic acid (10, 15, and 20 mg/kg) was administered intraperitoneally and evaluated against behavioral, electrophysiological (MNCV), and biochemical alterations in stavudine-treated rats. Pregabalin (30 mg/kg) was taken as reference standard and administered intraperitoneally. Four weeks after stavudine injection, rats developed behavioral, electrophysiological (MNCV), and biochemical (oxidative, nitrosative stress, and inflammatory cytokines, TRPV1) alterations. Niflumic acid restored core and associated symptoms of peripheral neuropathy by suppressing oxidative-nitrosative stress, inflammatory cytokines (TNF-α, IL-1β) and TRPV1 level in stavudine-induced neuropathic pain in rats. Pharmacological efficacy of niflumic acid (20 mg/kg) was equivalent to pregabalin (30 mg/kg). In conclusion, niflumic acid attenuates STV-induced behavioral, electrophysiological and biochemical alterations by manipulating TRP channel activity in two manners: (1) direct antagonistic action against TRPV1 channels and (2) indirect inhibition of TRP channels by blocking oxidative and inflammatory surge. Therefore, NA can be developed as a potential pharmacotherapeutic adjunct for antiretroviral drug-induced neuropathy.
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Affiliation(s)
- Lovish Marwaha
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Punjab University, Chandigarh, 160 014, India
| | - Yashika Bansal
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Punjab University, Chandigarh, 160 014, India
| | - Raghunath Singh
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Punjab University, Chandigarh, 160 014, India
| | - Priyanka Saroj
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Punjab University, Chandigarh, 160 014, India
| | - Rupinder Kaur Sodhi
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Punjab University, Chandigarh, 160 014, India
| | - Anurag Kuhad
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Punjab University, Chandigarh, 160 014, India.
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Gómez-Pérez FJ, Perez-Monteverde A, Nascimento O, Aschner P, Tagle M, Fichtner K, Subbiah P, Mutisya EM, Parsons B. Gabapentin for the treatment of painful diabetic neuropathy: dosing to achieve optimal clinical response. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514040040030601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine whether gabapentin titrated to achieve clinical effect (≥ 50% reduction in pain; 900—3,600 mg/day) provides superior efficacy to a commonly prescribed fixed-dose (900 mg/day) in subjects with PDN. Methods In Latin America, an open-label trial randomised 339 subjects with PDN to gabapentin, 900 mg/day, for seven weeks (n=170), or to 900—3,600 mg/day titrated over four weeks to achieve clinical effect, followed by three weeks at stable dose (n=169). Results Gabapentin produced a significantly greater reduction in final weekly mean pain scores from baseline when titrated to clinical effect than when administered as a fixed-dose regimen (53.6% vs. 43.3%; p=0.009). Responder rate was significantly increased (64.5% vs. 47.5%; p=0.002), mean VAS scores significantly decreased, final weekly sleep interference scores significantly decreased (57% C vs. 37.2%; p=0.013), and trends favouring improvement in global functioning and QOL were seen in the titration to clinical effect group (p<0.001). Both regimens were well-tolerated. Conclusions Titration to clinical effect offered superior efficacy in treating PDN compared to a low fixed-dose treatment. Br J Diabetes Vasc Dis 2004;4:173—8
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Darehkordi A, Zand-Vakili F, Talebizadeh Rafsanjani A. A novel gabapentin based intermolecular Ugi four-center, three-component reaction for preparing N-cyclohexyl-2-(3-oxo-2-azaspiro[4,5]decan-2-yl)-2-aryl acetamide derivatives. Tetrahedron Lett 2016. [DOI: 10.1016/j.tetlet.2015.12.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gabapentin-induced changes of plasma cortisol level and immune status in hysterectomized women. Int Immunopharmacol 2014; 23:530-6. [DOI: 10.1016/j.intimp.2014.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/18/2022]
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Lin X, Cai Y, Yan J, Zhang L, Wu D, Li H. Determination of Gabapentin in Human Plasma and Urine by Capillary Electrophoresis with Laser-Induced Fluorescence Detection. J Chromatogr Sci 2014; 53:986-92. [DOI: 10.1093/chromsci/bmu134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Indexed: 11/12/2022]
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Rosa F, Trevisan G, Rigo FK, Tonello R, Andrade EL, do Nascimento Cordeiro M, Calixto JB, Gomez MV, Ferreira J. Phα1β, a peptide from the venom of the spider Phoneutria nigriventer shows antinociceptive effects after continuous infusion in a neuropathic pain model in rats. Anesth Analg 2014; 119:196-202. [PMID: 24836473 DOI: 10.1213/ane.0000000000000249] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neuropathic pain is a severe painful pathology that is difficult to treat. One option for its management is the continuous intrathecal (i.t.) infusion of ziconotide (the Conus magnus peptide ω-conotoxin MVIIA), which, in addition to being effective, produces serious adverse effects at analgesic doses. Single i.t. administration of Phα1β, a peptide purified from the venom of the spider Phoneutria nigriventer, has antinociceptive effects with a greater therapeutic window than ziconotide in rodents. To further evaluate its analgesic potential, we investigated the antinociceptive and toxic effects of Phα1β after single or continuous i.t. infusion in a rat model of neuropathic pain. METHODS Adult male Wistar rats (200-300 g) bred in-house were used. Chronic constriction injury (CCI) of the sciatic nerve was used as the neuropathic pain model. Nociception was assessed by detecting mechanical hyperalgesia, considering a significant reduction in 50% paw withdrawal threshold values after CCI compared with baseline values. First, we assessed the antinociceptive effect of a single i.t. injection of Phα1β (10, 30, or 100 pmol/site) in a model of neuropathic pain 8 days after nerve injury. In a different experiment, we delivered Phα1β (60 pmol/μL/h) or vehicle (phosphate-buffered saline, 1.0 μL/h) through continuous infusion using an osmotic pump by spinal catheterization for 7 days in rats submitted to nerve injury. Behavioral adverse effects were evaluated after single or continuous Phα1β i.t. administration, and histopathological analysis of spinal cord, brainstem, and encephalon was performed after continuous Phα1β i.t. injection. RESULTS We observed that CCI of the sciatic nerve but not sham surgery caused intense (reduction of approximately 2.5 times in mechanical withdrawal threshold) and persistent (up to 14 days) nociception in rats. The single i.t. injection of Phα1β (30 or 100 pmol/site) reduced neuropathic nociception from 1 to 6 hours after administration, without showing detectable side effects. Similarly, the continuous infusion of Phα1β (60 pmol/μL/h for 7 days) was also able to reverse nerve injury-induced nociception from 1 to 7 days, but did not cause either behavioral side effects or histopathological changes in the central nervous system. CONCLUSIONS Thus, we have shown for the first time that the continuous i.t. delivery of Phα1β produces analgesia disconnected from toxicity in a relevant model of neuropathic pain, indicating that it is an effective and safe drug with a great potential to treat pain.
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Affiliation(s)
- Fernanda Rosa
- From the Graduate Program in Biological Sciences: Toxicological Biochemistry, Department of Chemistry, Center of Natural and Exact Sciences, Federal University of Santa Maria (UFSM), Santa Maria (RS); Laboratory of Molecular and Cellular Biology, Graduate Program of Health Sciences, Department of Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil; Graduate Program in Health Sciences: Medicine and Biomedicine, Institute of Education and Research, Santa Casa de Belo Horizonte, Grupo Santa Casa de Belo Horizonte, Belo Horizonte (MG), Brazil; Department of Pharmacology, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Santa Catarina; and Ezequiel Dias Foundation, Belo Horizonte (MG), Brazil
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Effects of gabapentin on thermal sensitivity following spinal nerve ligation or spinal cord compression. Behav Pharmacol 2013; 24:598-609. [DOI: 10.1097/fbp.0b013e3283656d9b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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On-Nin Wong J, Tan TDM, Leung PO, Tseng KF, Cheu NW, Tzeng CC. Gabapentin for the management of intractable postherpetic neuralgia: Report of 4 cases. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856901753702456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Yildirim K, Şışecıoğlu M, Karatay S, Erdal A, Levent A, Uğur M, Şenel K. The effectiveness of gabapentin in patients with chronic radiculopathy. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856903767650718] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Yan H, Gao W, Pan Z, Zhang F, Fan C. The expression of α-SMA in the painful traumatic neuroma: potential role in the pathobiology of neuropathic pain. J Neurotrauma 2013; 29:2791-7. [PMID: 23020218 DOI: 10.1089/neu.2012.2502] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The exact mechanism of neuroma-associated pain is not yet fully understood, thus contributing to the substantial challenge faced in managing patients with painful neuromas. We aimed to observe the expression of alpha smooth muscle actin (α-SMA) in the painful traumatic neuroma and to investigate its possible roles in the cause of neuroma-associated pain. Its expression is considered to be a useful phenotypic marker for myofibroblast, and may contribute to its increased contractile activity. We collected peripheral neuroma specimens prospectively and subsequently divided them into two groups: painful (n=21) and non-painful (n=27) based on blinded preoperative visual analogue scale (VAS) pain scores. We also harvested normal nerve specimens from the discarded limbs as a control group (n=8). We performed immunohistological studies to observe the expression of α-SMA in each group, and calculated the expression level by a high-resolution pathological image analysis system. There was no positive staining of α-SMA observed in the control group, slight positive staining in the non-painful group, and obviously positive staining in the painful group. Pearson correlation analysis demonstrated that VAS scores were significantly associated with the expression intensity of α-SMA (R=0.831; p<0.001). Linear regression analysis indicated that the expression intensity of α-SMA was positively related to the scale of VAS (R(2)=0.691, p<0.001). These findings suggest that: 1) expression of α-SMA may play certain roles in painful traumatic neuroma, either as a direct cause of neuroma-associated pain or as an indirect marker of local mechanical stimuli, and 2) the presence of α-SMA in the painful group may provide rationale for transpositional procedures in the management of traumatic neuroma. The persistent existence of α-SMA in the painful group and the correlation with VAS scores may provide insight into the development of new therapeutic strategies.
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Affiliation(s)
- Hede Yan
- Department of Orthopedics, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, China
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Steady-state pharmacokinetics of gabapentin after administration of a novel gastroretentive extended-release formulation in postmenopausal women with vasomotor symptoms. Clin Drug Investig 2012; 32:593-601. [PMID: 22775354 DOI: 10.1007/bf03261914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Approximately 75% of postmenopausal women experience vasomotor symptoms (hot flashes). Currently, hormone replacement therapy is the only approved treatment for hot flashes. However, its use has been associated with an increased risk of invasive breast cancer, coronary heart disease, stroke and venous thromboembolic disease. Gabapentin has also been demonstrated to be efficacious in the treatment of vasomotor symptoms in postmenopausal women when administered three times a day. A gastroretentive extended-release formulation of gabapentin (gabapentin-ER) has recently been demonstrated to be efficacious in the treatment of postmenopausal hot flashes. The objective of this paper is to report the steady-state pharmacokinetics and safety of gabapentin with different dosing regimens of gabapentin-ER in postmenopausal women with hot flashes. METHODS This was a multicentre, randomized, double-blind, dose-escalating, placebo-controlled, parallel group study in 124 postmenopausal women experiencing ≥7 moderate to severe hot flashes per day. The study consisted of two 5-week treatment periods, with each one preceded by a 1-week titration to the assigned dose. Groups A, B and C received gabapentin-ER 600 mg evening (pm), 600 mg morning (am)/600 mg pm and 1200 mg pm in the first period, and then 600 mg am/1200 mg pm, 600 mg am/1800 mg pm and 1200 mg am/1800 mg pm in the second period, respectively. The tablets were taken after a non-specified meal. Pharmacokinetic sampling was conducted over a 24-hour period at the end of each study period. Plasma samples were analysed by a validated liquid chromatography tandem mass spectrometry method. Non-compartmental pharmacokinetic analysis was performed on the concentration-time data to determine area under the plasma concentration versus time curve from time zero to 24 hours (AUC(24)). Maximum (C(max)), minimum (C(min)) and average (C(avg)) drug concentration and time to reach C(max) (t(max)) were determined by inspection of the data. Tolerability was evaluated by physical examination, clinical laboratory measurements and adverse events monitoring. RESULTS Gabapentin exposure at steady state, as measured by AUC(24), increased with doses from 600 mg/day to 3000 mg/day, although there was a slight decrease in gabapentin's relative bioavailability with increasing dose compared with the 600 mg dose. The relative bioavailability compared with the 600 mg dose was 86-88% for the 1200 mg/day doses, 75% for the 1800 mg/day dose, 84% for the 2400 mg/day dose, and 73% for the 3000 mg/day dose. C(max) generally increased with increasing dose as did C(min) and C(avg) for the various treatments in a manner that was consistent with the dosing regimen. The values of t(max) were not different between the various doses, with the median t(max) values relative to the most recent dose ranging from 6 to 8 hours for all dose levels. Gabapentin-ER was generally well tolerated at all doses studied. The most common AEs were headache, dizziness and somnolence, with most being mild in intensity. Seven patients withdrew from the study due to AEs. CONCLUSION The pharmacokinetic profile of gabapentin-ER may allow for once- or twice-daily dosing while maintaining bioavailability and thus efficacy. Gabapentin-ER was well tolerated. CLINICAL TRIAL REGISTRATION Registered as ClinicalTrials.gov Identifier: NCT00511953.
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El-Azab MF, Moustafa YM. Influence of calcium channel blockers on anticonvulsant and antinociceptive activities of valproic acid in pentylenetetrazole-kindled mice. Pharmacol Rep 2012; 64:305-14. [PMID: 22661180 DOI: 10.1016/s1734-1140(12)70769-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 11/21/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comorbidities of epilepsy comprise some pain disorders, including acute nociceptive pain, therefore, antiepileptic drugs can prove efficacy in the management of this kind of pain albeit with several adverse reactions. The current study aimed to evaluate the modulatory effects of calcium channel blockers on the anticonvulsant and antinociceptive effects of valproic acid (VPA) in pentylenetetrazole (PTZ)-kindled mice. METHODS Kindled mice were treated with 20 mg/kg (ip) of diltiazem, nifedipine, or verapamil, then VPA(200 mg/kg, ip) at 30 min intervals before PTZ administration (35 mg/kg, ip). RESULTS Our data demonstrated that the three calcium channel blockers afforded a protection against sub-convulsive doses of PTZ. Their protective effects were comparable to that exerted by the standard antiepileptic drug, VPA. The anticonvulsant activity of VPA was further enhanced by its combination with diltiazem. Also, PTZ-kindling reduced pain-threshold as evaluated by hot plate analgesimeter and acetic acid-induced writhing test. Although the repeated administration of VPA significantly increased pain-threshold in kindled mice, it was not able to normalize it. Similar results were obtained with diltiazem and nifedipine. Interestingly, combination of diltiazem or nifedipine with VPA elicited the most profound antinociceptive effect in kindled mice. CONCLUSIONS These results demonstrate for the first time the beneficial role of some calcium channel blockers in combination with VPA in the management of acute nociceptive pain. Therapeutically, this enhancing profile for calcium channel blockers fosters a safer and more effective drug-combination regimen than valproic acid alone.
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Affiliation(s)
- Mona F El-Azab
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt.
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Cowles VE, Gordi T, Hou SYE. Steady-State Pharmacokinetics of Gabapentin after Administration of a Novel Gastroretentive Extended-Release Formulation in Postmenopausal Women with Vasomotor Symptoms. Clin Drug Investig 2012. [DOI: 10.2165/11634520-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Biphasic effects of chronic intrathecal gabapentin administration on the expression of protein kinase C gamma in the spinal cord of neuropathic pain rats. ACTA ACUST UNITED AC 2011; 49:144-8. [DOI: 10.1016/j.aat.2011.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 12/23/2022]
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Chogtu B, Bairy KL, Smitha D, Dhar S, Himabindu P. Comparison of the efficacy of carbamazepine, gabapentin and lamotrigine for neuropathic pain in rats. Indian J Pharmacol 2011; 43:596-8. [PMID: 22022008 PMCID: PMC3195135 DOI: 10.4103/0253-7613.84980] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/01/2010] [Accepted: 07/01/2011] [Indexed: 11/25/2022] Open
Abstract
Background: Neuropathic pain in cancer patients remain a treatment challenge. Many of the anticancer drugs have to be abandoned because patients develop neuropathic pain. Several antiepileptic drugs like carbamazepine, phenytoin, lamotrigine, felbamate are effective in neuropathic pain and trigeminal neuralgia. However, their efficacy varies. Aim: The aim of this study is to compare the efficacy of antiepileptic drugs in neuropathic pain induced by anticancer drugs. Materials and Methods: Neuropathic pain was induced in rats by injecting 4 doses of paclitaxel. The rats were divided into four groups of six animals each. Group I was treated with oral carbamazepine (cbz) 100 mg/kg, group II received oral gabapentin (gbp) 60 mg/kg, and group III was treated with oral lamotrigine (lam) 40 mg/kg and group IV was the control group. Behavioural testing for thermal hyperalgesia and mechanical hyperalgesia was assessed from 26th day of paclitaxel administration to next five days by hot plate method and Randall Siletto test, respectively, in all the four groups. One way analysis of variance followed by Scheffe's post hoc test was used for statistical analysis. Results: In thermal hyperalgesia lam treated group was found to be significantly (P < 0.001) superior to cbz and gbp treated group. In mechanical hyperalgesia, lam group showed significant response (P
< 0.05) as compared to gbp group. However, the gbp treated group showed a significant (P < 0.01) improvement after three days of treatment. Conclusions: In paclitaxel induced neuropathic pain, lamotrigine appears to be a promising drug. The difference in responses shown by different antiepileptics’ depends on the etiology of the underlying mechanisms in neuropathic pain.
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Affiliation(s)
- Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Dose-dependent opposite effects of gabapentin on the depressive action of morphine on a C-fibre reflex in the rat. Neuropharmacology 2011; 61:551-7. [DOI: 10.1016/j.neuropharm.2011.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/13/2011] [Accepted: 04/15/2011] [Indexed: 11/19/2022]
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Hui ACF, Wong SM, Leung HW, Man BL, Yu E, Wong LKS. Gabapentin for the treatment of carpal tunnel syndrome: a randomized controlled trial. Eur J Neurol 2010; 18:726-30. [PMID: 21143704 DOI: 10.1111/j.1468-1331.2010.03261.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Based on its efficacy in treating neuropathic pain, gabapentin may be effective for the treatment of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the efficacy of gabapentin for symptom relief in CTS. METHODS We conducted a randomized, double-blinded, placebo-controlled trial recruiting patients with newly diagnosed idiopathic CTS of more than a period of three months. Diagnosis was based on characteristic symptoms with electrophysiological confirmation. Patients were randomly assigned to an active group receiving gabapentin (starting dose 300 mg once daily to a target of 900 mg daily) or a placebo group. Primary end-point was the global symptom score (GSS), which was measured at baseline, two, and eight weeks. RESULTS There was no significant difference in baseline variables between the two treatment groups. Hundred and forty patients were enrolled in the study, of whom 71 were randomly assigned to gabapentin group and 69 assigned to placebo group. Both gabapentin and placebo produced significant improvement in symptoms at two and eight weeks. The GSS at 2 and 8 weeks was 16.4 (SD 9.4) and 13.4 (SD 9.7), respectively, in the active group versus 14.9 (SD 9.0) and 12.5 (SD 8.9) in the control group (P < 0.01). But by eight weeks, the mean reduction in symptom severity of patients on gabapentin [-10.4 (SD 10.8)] was not significant when compared with placebo [-8.7 (SD 8.1), P < 0.39]. Adverse events were not severe and included dizziness, somnolence, and headache. CONCLUSIONS Gabapentin did not produce a significant reduction in symptom severity compared with placebo over an eight-week period.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Electrodiagnostic Unit, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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Żesławska E, Oleksyn BJ, Korohoda MJ, Stadnicka K. The Crystal and Molecular Structure of 3-Methyl-5-p-methylbenzylidene-2-selenohydantoin. PHOSPHORUS SULFUR 2010. [DOI: 10.1080/10426500307936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain. Clin J Pain 2010; 26:381-5. [PMID: 20473044 DOI: 10.1097/ajp.0b013e3181cb406e] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Postmastectomy pain syndrome is a neuropathic pain syndrome that is known to develop after breast surgery. Preemptive analgesia has been shown to be efficacious in reducing postoperative pain, and may be effective in reducing the incidence of certain types of neuropathic pain. We investigated the analgesic efficacy of Venlafaxine and gabapentin on acute and chronic pain associated with cancer breast surgery. PATIENTS AND METHODS The study was carried out on 150 patients scheduled for either partial or radical mastectomy with axillary dissection. They were randomized in a double-blinded manner to receive, extended release Venlafaxine 37.5 mg/d, gabapentin 300 mg/d, or placebo for 10 days starting the night before operation. Pain scores were recorded at rest and movement (visual analog scale) at 4, 12, and 24 hours on the first day postoperatively, daily from the second to tenth day postoperatively and visual analog scale in addition to pain character 6 months later. Analgesic requirements were compared between the 3 groups. RESULTS Pain after movement was reduced by gabapentin from the second to tenth postoperative day and venlafaxine group in the last 3 days but no difference was found between the groups regarding pain during rest. Gabapentin reduced morphine consumed in the first 24 hours postoperatively. The analgesic requirements from the second to tenth days for codeine and paracetamol were reduced in venlafaxine and gabapentin groups compared to the control group. Six months later, the incidence of chronic pain, its intensity, and need for analgesics were reduced in venlafaxine compared to gabapentin and the placebo group. However, burning pain was more frequent in the control groups than in the gabapentin. CONCLUSION Venlafaxine 37.5 mg/d extended release or gabapentin 300 mg/d have equipotent effects (except on the first day in venlafaxine group) in reducing analgesic requirements, although gabapentin is more effective in reducing pain after movement. Venlafaxine significantly reduced the incidence of postmastectomy pain syndromes (chronic pain) 6 months in women having breast cancer surgery. Gabapentin had no effect on chronic pain except decreasing incidence of burning pain.
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Ermis N, Gullu H, Caliskan M, Unsal A, Kulaksizoglu M, Muderrisoglu H. Gabapentin therapy improves heart rate variability in diabetic patients with peripheral neuropathy. J Diabetes Complications 2010; 24:229-33. [PMID: 19195912 DOI: 10.1016/j.jdiacomp.2008.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 09/26/2008] [Accepted: 12/03/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE Diabetic cardiac neuropathy, which is characterized by reduced heart rate variability (HRV), frequently coexists with peripheral neuropathy. Gabapentin has been used for the treatment of diabetic neuropathy. We aimed to evaluate the possible effect of gabapentin treatment on autonomic function in patients with type 2 diabetes via HRV. METHODS Thirty patients with type 2 diabetes mellitus and peripheral neuropathy and 28 age- and sex-matched healthy controls were consecutively registered. Each patient underwent HRV measurements, and diabetic patients were administered gabapentin. After 3 months of gabapentin therapy, HRV parameters were measured again. RESULTS Baseline HRV parameters were blunted in patients with diabetes mellitus according to the controls [standard deviation of all NN intervals (SDNN, ms): 106.3+/-29.9 vs. 148.8+/-36.5, P=.001; power spectrum of the high-frequency band (HF, ms(2)): 133.6+/-98.3 to 231.4+/-197.6, P=.02; power spectrum of the low-frequency band (LF, ms(2)): 341.8+/-247.8 to 511.5+/-409.4, P=.048; LF/HF ratio: 3.3+/-2.4 to 2.6+/-1.5, P=.33]. After 3 months of treatment with gabapentin, some HRV parameters showed some improvement. SDNN (106.2+/-29.8 to 119.4 +/- 25, P=.016) and HF (133.6+/-98.3 to 167.6+/-118.3, P=.021) increased significantly. LF/HF ratio decreased (from 3.3+/-2.4 to 2.3+/-1.9, P=.039) and LF remained unchanged (341.8+/-247.8 to 352.3+/-228.9, P=.88). CONCLUSIONS Therapeutic doses of gabapentin not only alleviate neuropathic symptoms but also improve cardiac autonomic function in diabetic patients with peripheral neuropathy.
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Affiliation(s)
- Necip Ermis
- Cardiology Department, Baskent University Medical School, Ankara, Turkey.
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Chen C, Cowles VE, Hou E. Pharmacokinetics of gabapentin in a novel gastric-retentive extended-release formulation: comparison with an immediate-release formulation and effect of dose escalation and food. J Clin Pharmacol 2010; 51:346-58. [PMID: 20484610 DOI: 10.1177/0091270010368411] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objectives of the 3 phase I studies described herein were (1) to compare the pharmacokinetics of gabapentin delivered from a novel gastric-retentive dosage form vs an immediate-release formulation, (2) to assess the dose proportionality of the gastric-retentive extended-release formulation, and (3) to determine the effect of food on the pharmacokinetics of gabapentin delivered from this formulation. The time to reach maximum plasma concentration (t(max)) was extended for gabapentin delivered from the gastric-retentive extended-release formulation compared with the immediate-release formulation. A dose-related increase in both the maximum plasma concentration (C(max)) and the area under the plasma concentration-time curve (AUC) was observed as the gabapentin dose increased from 600 to 2400 mg. Fed status and increased fat content delayed t(max) and enhanced C(max) and AUC in proportion to the fat content. The pharmacokinetics of gabapentin delivered from this extended-release formulation allows a reduced dosing frequency while maintaining bioavailability and possibly diminishing the occurrence of adverse events attributable to a slower increase to the peak concentration compared with the immediate-release dosage form.
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Affiliation(s)
- Cuiping Chen
- Depomed, 1360 O'Brien Drive, Menlo Park, CA 94025, USA.
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Watson J, Gonzalez M, Romero A, Kerns J. Neuromas of the hand and upper extremity. J Hand Surg Am 2010; 35:499-510. [PMID: 20193866 DOI: 10.1016/j.jhsa.2009.12.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 12/14/2009] [Indexed: 02/02/2023]
Abstract
The painful neuroma is an often debilitating sequela of nerve injury about the hand. The exact pathophysiology of this condition is poorly understood. After sharp trauma to a peripheral nerve, as nerve ends try to connect with their end organs and "find" the distal nerve stump, fascicular escape and scarring can lead to the development of a painful neuroma. Painful neuromas can even be associated with blunt trauma or retraction of a nerve when the nerve is not actually divided. Green's definition of a neuroma is "the inevitable, unavoidable, and biologic response of the proximal stump after it has been divided in situations where regenerating axons are impeded from re-entering the distal stump."(1) A number of unknown factors make certain patients more susceptible to neuroma formation. In addition, certain nerves such as the superficial radial nerve are more prone to the development of a painful neuroma. Treatment of neuromas of the hand is important because they can be quite debilitating and painful, often preventing patients from continuing with their normal daily activities. There are a number of approaches to the painful neuroma, and the treatment plan must be tailored to the individual patient.
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Perret D, Luo ZD. Targeting voltage-gated calcium channels for neuropathic pain management. Neurotherapeutics 2009; 6:679-92. [PMID: 19789072 PMCID: PMC2755636 DOI: 10.1016/j.nurt.2009.07.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 07/09/2009] [Indexed: 01/08/2023] Open
Abstract
Voltage-gated calcium channels (VGCC) play obligatory roles in diverse physiological functions. Pathological conditions leading to changes in their biophysical properties and expression levels may cause malfunctions of VGCC-mediated activities, resulting in disease states. It is believed that changes in VGCC properties under pain-inducing conditions may play a causal role in the development of chronic pain, including nerve injury-induced pain or neuropathic pain. For the past several decades, preclinical and clinical research in developing VGCC blockers or modulators for chronic pain management has been fruitful, leading to some U.S. Food and Drug Administration-approved drugs currently available for chronic pain management. However, their efficacy in pain relief is limited in some patients, and their long-term use is limited by their side-effect profiles. Certainly, there is room for improvement in developing more subtype-specific VGCC blockers or modulators for chronic pain conditions. In this review, we summarized the most recent preclinical and clinical studies related to chronic pain medications acting on the VGCC. We also included clinical trials aiming to expand the application of approved VGCC drugs to different pain states derived from various pathological conditions, as well as drug combination therapies trying to improve the efficacies and side-effect profiles of current pain medications.
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Affiliation(s)
- Danielle Perret
- grid.266093.80000000106687243Department of Anesthesiology & Perioperative Care, University of California Irvine, 92697 Irvine, California
- grid.266093.80000000106687243Department of Physical Medicine & Rehabilitation, School of Medicine, University of California Irvine, 92697 Irvine, California
| | - Z. David Luo
- grid.266093.80000000106687243Department of Anesthesiology & Perioperative Care, University of California Irvine, 92697 Irvine, California
- grid.266093.80000000106687243Department of Pharmacology, University of California Irvine, 92697 Irvine, California
- grid.417319.9000000040434883XDepartment of Anesthesiology & Perioperative Care, University of California, Irvine Medical Center, Bldg 53, Room 227, 101 The City Dr. South, 92868 Orange, CA
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Zin CS, Nissen LM, Smith MT, O'Callaghan JP, Moore BJ. An update on the pharmacological management of post-herpetic neuralgia and painful diabetic neuropathy. CNS Drugs 2008; 22:417-42. [PMID: 18399710 DOI: 10.2165/00023210-200822050-00005] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neuropathic pain is a persistent pain condition that develops secondary to nerve injury. The two most common types of peripheral neuropathic pain are post-herpetic neuralgia (PHN) and painful diabetic neuropathy (PDN). Amitriptyline, nortriptyline, desipramine and imipramine are TCAs that have been shown to be effective for the symptomatic relief of PHN and PDN. Serotonin noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine have been shown to be very promising for the treatment of PDN with fewer adverse effects than TCAs. Selective serotonin reuptake inhibitors (SSRIs) were shown in a number of studies to have some efficacy in relieving PDN-related pain, yet other studies of the SSRIs have demonstrated conflicting outcomes. Most of the older antiepileptic studies were performed in patients with PDN; consequently, little is known about the efficacy of these drugs in patients with PHN. Carbamazepine, phenytoin and valproic acid were shown to be effective in ameliorating PDN-related pain. Other antiepileptic agents, including lamotrigine, oxcarbazepine and topiramate, have demonstrated some beneficial effects for the treatment of PDN, although they were also found to be ineffective in some PDN studies. alpha2delta Ligands such as gabapentin and pregabalin have been proven to be effective for the treatment of PHN and PDN in a number of large placebo-controlled trials. These drugs are useful not only in relieving pain but also in improving quality of life. Although the use of opioids for the treatment of neuropathic pain is controversial, a number of studies support the efficacy and safety of opioids in the treatment of neuropathic pain. Of these, oxycodone and tramadol have been shown to be superior to placebo for the treatment of PHN and PDN. A number of small studies have shown that dextromethorphan was effective in patients with PDN but not in patients with PHN. Topical agents such as lidocaine 5% patches and topical capsaicin are useful in ameliorating pain in patients with PHN but these agents are unsatisfactory for use as a sole agent. Although a number of drug treatments are available for the symptomatic relief of neuropathic pain symptoms, these agents do not provide satisfactory relief in all patients. For these patients, other treatment alternatives such as combination drug therapy that produces pain relief via distinctly different mechanisms may be successful. The purpose of this review is to compare the efficacy and limitations of currently available pharmacological treatments for the symptomatic relief of PHN and PDN, and to discuss the potential of combination therapy in PHN and PDN.
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Affiliation(s)
- Che S Zin
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
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Gordi T, Hou E, Kasichayanula S, Berner B. Pharmacokinetics of gabapentin after a single day and at steady state following the administration of gastric-retentive- extended-release and immediate-release tablets: A randomized, open-label, multiple-dose, three-way crossover, exploratory study in healthy subjects. Clin Ther 2008; 30:909-16. [DOI: 10.1016/j.clinthera.2008.05.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2008] [Indexed: 10/21/2022]
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Abstract
Painful limbs/moving extremities (PLME) is a disorder characterized by spontaneous, complex, slow (1-2 Hz) involuntary toe or finger movements. The movements that can be bilateral or unilateral are usually accompanied by pain in the affected limbs. Painless variants are less common. PLME has been associated with peripheral and central nervous system disease although idiopathic cases have been reported. Its etiopathogenesis is unknown and treatment approaches remain largely empirical. Nerve blocks and botulinum toxin type A injections as well as oral medication have had some measure of success. Current theories suggest that central oscillator(s) at the spinal or supraspinal levels may be involved. Future research in PLME should include prospective electrophysiological and functional imaging studies as well as clinical trials with botulinum toxin injections and oral pharmacological agents.
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Affiliation(s)
- S Papapetropoulos
- Division of Movement Disorders, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Abstract
Antiepileptic drugs are an effective treatment for various forms of neuropathic pain of peripheral origin, although they rarely provide complete pain relief. Multiple multicentre randomised controlled trials have shown clear efficacy of gabapentin and pregabalin for postherpetic neuralgia and painful diabetic neuropathy. Theses drugs can be rapidly titrated and are well tolerated. Topiramate, lamotrigine, carbamazepine and oxcarbazepine are alternatives for the treatment of painful diabetic neuropathy, but should be titrated slowly. Carbamazepine remains the drug of choice for trigeminal neuralgia; however, oxcarbazepine and lamotrigine are potential alternatives. There is an apparent need for large-scale randomised controlled trials on the efficacy of antiepileptic drugs in neuropathic pain in general, and in cancer-related neuropathic pain and neuropathic pain of central origin in particular. Trials with long-term follow-up are required to establish the long-term efficacy of antiepileptic drugs in neuropathic pain. There is only limited scientific evidence to support the idea that drug combinations are likely to be more efficacious and safer than each drug alone; further studies are warranted in this area.
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Abstract
The distribution of ion channels in neurons associated with pain pathways is becoming better understood. In particular, we now have insights into the molecular nature of the channels that are activated by tissue-damaging stimuli, as well as the mechanisms by which voltage-gated channels alter the sensitivity of peripheral neurons to change pain thresholds. This chapter details the evidence that individual channels may be associated with particular pain states, and describes genetic approaches to test the possible utility of targeting individual channels to treat pain.
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Affiliation(s)
- Tamara Rosenbaum
- Departamento de Biofísica, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, México
- Correspondence should be addressed to León D. Islas or Tamara Rosenbaum, León D. Islas, Departamento de Fisiología, Facultad de Medicina, Apartado Postal 70-600. Circuito Escolar S/N; Ciudad Universitaria, Universidad Nacional Autónoma de México, México, D.F., 04510, México, Phone +(52) 55 5623 2132; Fax +(52) 55 5623 2241, , Tamara Rosenbaum, Departamento de Biofísica, Instituto de Fisiología Celular, Apartado Postal 70-600. Circuito Exterior S/N, Ciudad Universitaria, Universidad Nacional Autónoma de México, México, D.F., 04510, México. Phone +(52) 55 5622 5624; Fax +(52) 55 5622 5607,
| | - Sidney A. Simon
- Department of Neurobiology and Center of Neuroengineering Duke University Medical Center, Durham, NC 27710, USA
| | - Leon D. Islas
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, México
- Correspondence should be addressed to León D. Islas or Tamara Rosenbaum, León D. Islas, Departamento de Fisiología, Facultad de Medicina, Apartado Postal 70-600. Circuito Escolar S/N; Ciudad Universitaria, Universidad Nacional Autónoma de México, México, D.F., 04510, México, Phone +(52) 55 5623 2132; Fax +(52) 55 5623 2241, , Tamara Rosenbaum, Departamento de Biofísica, Instituto de Fisiología Celular, Apartado Postal 70-600. Circuito Exterior S/N, Ciudad Universitaria, Universidad Nacional Autónoma de México, México, D.F., 04510, México. Phone +(52) 55 5622 5624; Fax +(52) 55 5622 5607,
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Heckmann SM, Heckmann JG, Ungethüm A, Hujoel P, Hummel T. Gabapentin has little or no effect in the treatment of burning mouth syndrome - results of an open-label pilot study. Eur J Neurol 2006; 13:e6-7. [PMID: 16834694 DOI: 10.1111/j.1468-1331.2006.01294.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Patients suffering from neuropathic pain continue to pose challenges in clinical practice. This descriptive review discusses the continuing debate on the definition and concerns about increasing incidence of neuropathic pain. The clinical features of neuropathic pain are outlined, and the current understanding of the possible mechanisms of neuropathic pain is highlighted. Current management strategies are reviewed, and future advances in our understanding of the mechanisms, accurate clinical diagnosis and more effective treatment strategies are eagerly awaited.
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Affiliation(s)
- J Cavenagh
- Department of Palliative Care, Mater Misericordiae Hospital, Newcastle, New South Wales, Australia.
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Ortiz MI, Medina-Tato DA, Sarmiento-Heredia D, Palma-Martínez J, Granados-Soto V. Possible activation of the NO-cyclic GMP-protein kinase G-K+ channels pathway by gabapentin on the formalin test. Pharmacol Biochem Behav 2006; 83:420-7. [PMID: 16630650 DOI: 10.1016/j.pbb.2006.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 02/13/2006] [Accepted: 03/05/2006] [Indexed: 10/24/2022]
Abstract
The effect of modulators of the nitric oxide-cyclic GMP-protein kinase G-K+ channels pathway on the local peripheral antinociceptive action induced by gabapentin was assessed in the rat 1% formalin test. Local peripheral administration of gabapentin produced a dose-dependent antinociception in the second phase of the test. Gabapentin-induced antinociception was due to a local action as its administration in the contralateral paw was ineffective. Local peripheral pretreatment of the paws with NG-L-nitro-arginine methyl ester (L-NAME, a nitric oxide synthesis inhibitor), 1H-(1,2,4)-oxadiazolo(4,2-a)quinoxalin-1-one (ODQ, a soluble guanylyl cyclase inhibitor) and KT-5823 (a protein kinase G inhibitor) dose-dependently reduced gabapentin-induced antinociception. Likewise, glibenclamide or tolbutamide (ATP-sensitive K+ channel inhibitors), 4-aminopyridine or tetraethylammonium (non-selective inward rectifier K+ channel inhibitors) or charybdotoxin (large-conductance Ca2+-activated-K+ channel blocker), but not apamin (small-conductance Ca2+-activated-K+ channel blocker) or naloxone (opioid receptor antagonist), reduced the antinociception induced by gabapentin. Our data suggest that gabapentin could activate the nitric oxide-cyclic GMP-protein kinase G-K+ channels pathway in order to produce its peripheral antinociceptive effect in the rat 1% formalin test.
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Affiliation(s)
- Mario I Ortiz
- Area Académica de Medicina del Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico.
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Phatak S, Foster HE. The management of interstitial cystitis: an update. ACTA ACUST UNITED AC 2006; 3:45-53. [PMID: 16474494 DOI: 10.1038/ncpuro0385] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 11/21/2005] [Indexed: 11/08/2022]
Abstract
Treating interstitial cystitis (IC) is one of the greatest challenges facing physicians and other health care providers who manage patients with this condition. The symptoms of urinary frequency and urgency, dysuria, and chronic pelvic pain characterize IC, but it is the debilitating pelvic pain associated with IC that is most difficult to control. The pathophysiology of IC pain is poorly understood, but is thought to be a complex entity including nociceptive, visceral, and neuropathic components. There are currently no universally effective therapies available. Oral treatments, however, are frequently used, including nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate, all of which have shown varying degrees of efficacy. Recognition that IC pain is multifactorial, and probably has a neuropathic component, has led to the use of some of these agents, previously prescribed for other neurologic conditions associated with chronic pain. Intravesical and surgical options are also available, which expands the armamentarium for those who treat pain secondary to IC. Treating IC requires managing all of the symptoms of this disease. This review aims to cover standard and novel treatment options, while concentrating on the management of pain.
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Affiliation(s)
- Sagar Phatak
- Section of Urology, Yale University School of Medicine, New Haven, CT 06520-8041, USA
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