1
|
Marcianò G, Vocca C, Evangelista M, Palleria C, Muraca L, Galati C, Monea F, Sportiello L, De Sarro G, Capuano A, Gallelli L. The Pharmacological Treatment of Chronic Pain: From Guidelines to Daily Clinical Practice. Pharmaceutics 2023; 15:pharmaceutics15041165. [PMID: 37111650 PMCID: PMC10144480 DOI: 10.3390/pharmaceutics15041165] [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: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
In agreement with the International Association for the Study of Pain, chronic pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. To date, there are several types of pain: nociceptive, neuropathic, and nociplastic. In the present narrative review, we evaluated the characteristics of the drugs used for each type of pain, according to guidelines, and their effects in people with comorbidity to reduce the development of severe adverse events.
Collapse
Affiliation(s)
- Gianmarco Marcianò
- Operative Unit of Pharmacology and Pharmacovigilance, "Mater Domini" Hospital, 88100 Catanzaro, Italy
| | - Cristina Vocca
- Operative Unit of Pharmacology and Pharmacovigilance, "Mater Domini" Hospital, 88100 Catanzaro, Italy
| | - Maurizio Evangelista
- Department of Anesthesia, Resuscitation and Pain Therapy, Sacred Heart Catholic University, 00100 Rome, Italy
| | - Caterina Palleria
- Operative Unit of Pharmacology and Pharmacovigilance, "Mater Domini" Hospital, 88100 Catanzaro, Italy
| | - Lucia Muraca
- Department of Primary Care, ASP 7, 88100 Catanzaro, Italy
| | - Cecilia Galati
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Francesco Monea
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Giovambattista De Sarro
- Operative Unit of Pharmacology and Pharmacovigilance, "Mater Domini" Hospital, 88100 Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Luca Gallelli
- Operative Unit of Pharmacology and Pharmacovigilance, "Mater Domini" Hospital, 88100 Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
- Medifarmagen Srl, University of Catanzaro and Mater Domini Hospital, 88100 Catanzaro, Italy
| |
Collapse
|
2
|
Pullano SA, Marcianò G, Bianco MG, Oliva G, Rania V, Vocca C, Cione E, De Sarro G, Gallelli L, Romeo P, La Gatta A, Fiorillo AS. FT-IR Analysis of Structural Changes in Ketoprofen Lysine Salt and KiOil Caused by a Pulsed Magnetic Field. Bioengineering (Basel) 2022; 9:bioengineering9100503. [PMID: 36290471 PMCID: PMC9598906 DOI: 10.3390/bioengineering9100503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
High-intensity, low-frequency magnetic fields (MFs) have been widely used in the treatment of diseases and in drug delivery, even though they could induce structural changes in pharmacological molecules. Morphological changes in ketoprofen and KiOil were investigated through Fourier-transform infrared spectroscopy (FT-IR). Unsupervised principal component analysis was carried out for data clustering. Clinical validation on 22 patients with lower back pain was managed using diamagnetic therapy plus topical ketoprofen or KiOil. The Numerical Rating Scale (NRS) and Short-Form Health Survey 36 (SF-36) were used to evaluate clinical and functional response. Ketoprofen showed clear clustering among samples exposed to MF (4000−650 cm−1), and in the narrow frequency band (1675−1475 cm−1), results evidenced structural changes which involved other excipients than ketoprofen. KiOil has evidenced structural modifications in the subcomponents of the formulation. Clinical treatment with ketoprofen showed an average NRS of 7.77 ± 2.25 before and an average NRS of 2.45 ± 2.38 after MF treatment. There was a statistically significant reduction in NRS (p = 0.003) and in SF-36 (p < 0.005). Patients treated with KiOil showed an average NRS of 7.59 ± 2.49 before treatment and an average NRS of 1.90 ± 2.26 after treatment (p < 0.005). SF-36 showed statistical significance for all items except limitations due to emotional problems. A high-intensity pulsed magnetic field is an adjunct to topical treatment in patients with localized pain, and the effect of MF does not evidence significant effects on the molecules.
Collapse
Affiliation(s)
- Salvatore Andrea Pullano
- BATS Laboratory, Department of Health Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Gianmarco Marcianò
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, “Magna Græcia” University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy
| | - Maria Giovanna Bianco
- Department of Surgical and Medical Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Giuseppe Oliva
- BATS Laboratory, Department of Health Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Rania
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, “Magna Græcia” University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy
| | - Cristina Vocca
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, “Magna Græcia” University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy
| | - Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018–2022, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, Italy
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, Italy
- Medifarmagen SRL, University of Catanzaro, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, “Magna Græcia” University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy
- FAS@UMG Research Center, Department of Health Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, “Magna Græcia” University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018–2022, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, Italy
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, Italy
- Medifarmagen SRL, University of Catanzaro, 88100 Catanzaro, Italy
- FAS@UMG Research Center, Department of Health Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Pietro Romeo
- Department of Orthopedics, Istituto di Ricovero E Cura A Carattere Scientifico, Istituto Ortopedico Galeazzi, 20123 Milan, Italy
| | - Antonio La Gatta
- BATS Laboratory, Department of Health Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Antonino S. Fiorillo
- BATS Laboratory, Department of Health Sciences, “Magna Græcia” University of Catanzaro, 88100 Catanzaro, Italy
- Correspondence:
| |
Collapse
|
3
|
High-Intensity Low Frequency Pulsed Electromagnetic Fields Treatment Stimulates Fin Regeneration in Adult Zebrafish—A Preliminary Report. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Low-Intensity electromagnetic fields (LI-PEMFs) are known to induce a trophic stimulus on bone tissue and therefore have been largely used for the treatment of several musculoskeletal disorders. High intensity (HI) PEMFs add interesting features to bio-stimulation such as electroporation, a phenomenon characterized by transient increased cell permeabilization to molecules, and diamagnetism, a water-repulsive effect based on the diamagnetic properties of water and transmembrane ions gradients. Despite the rapid evolution of technology, the biological mechanisms underlying it are still poorly understood. In order to evaluate the effectiveness of this particular stimulation, HI LF-PEMFs were used to stimulate the caudal fin rays of adult zebrafish. Actually, the zebrafish fin regeneration is a simple, well understood, and widely adopted model for studying bone regeneration. A controlled amputation fin experiment was then conducted. Regenerated bone matrix of fin rays was dyed with calcein and then analysed under fluorescence microscopy. Both the length and the area of regenerated fin’s rays treated with HI LF-PEMFs resulted significantly increased when compared with non-treated.
Collapse
|
4
|
Giovale M, Novelli L, Persico L, Motta F, Rampoldi S, Galli R, Monteforte P, Doveri M, Bianchi G, Selmi C, Bottaro LC. Low-energy Pulsed Electromagnetic Field Therapy Reduces Pain in Fibromyalgia: A Randomized Single-blind Controlled Pilot Study. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:77-83. [PMID: 36465321 PMCID: PMC9524818 DOI: 10.2478/rir-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Fibromyalgia symptoms have a significant impact on the quality of life and respond poorly to medications. It has been hypothesized that the use of low-energy pulsed electromagnetic field (PEMF) induces neuroprotective effects that may interfere with pain perception. We explored the efficacy of PEMF in patients affected by fibromyalgia. METHODS Twenty-one females (median age 59 years, interquartile range [IQR] 16.5) affected by fibromyalgia were randomized to receive pulsed electromagnetic field-triple energy pain treatment (PEMF-TEPT) or placebo at T0 and at 4 weeks and 8 weeks. Fibromyalgia impact questionnaire (FIQ), widespread pain index (WPI), visual analog score (VAS) pain, symptom severity (SS) scale, and short form 36 (SF-36) health survey questionnaire have been evaluated. RESULTS Patients in the PEMF-TEPT group had a significantly higher reduction of WPI compared to placebo (mean difference -12.90 ± standard deviation [SD] 5.32 vs. -1.91 ± 4.55, difference in difference [DD] of -10.99; P < 0.001), of SS score (-4.10 ± 4.85 vs. -2.00 ± 2.32; DD = -2.1; P < 0.05), of VAS pain (-48 ± 30.75 vs. -16.82 ± 23.69; DD = -31.18; P < 0.01). They also reported a higher improvement of FIQ and SF-36, albeit not reaching statistical significance. CONCLUSION In our pilot controlled study, PEMF-TEPT appeared to be safe and improved fibromyalgia symptoms.
Collapse
Affiliation(s)
| | - Lucia Novelli
- Rheumatology and Clinical Immunology; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Persico
- Department of Economics, University of Genova, Genoa, Italy
| | - Francesca Motta
- Rheumatology and Clinical Immunology; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Rossana Galli
- Division of Rheumatology, ASL3 Genovese, Genoa, Italy
| | | | - Marica Doveri
- Division of Rheumatology, ASL3 Genovese, Genoa, Italy
| | | | - Carlo Selmi
- Rheumatology and Clinical Immunology; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | |
Collapse
|
5
|
Diamagnetic Therapy in a Patient with Complex Regional Pain Syndrome Type I and Multiple Drug Intolerance: A Case Report. REPORTS 2022. [DOI: 10.3390/reports5020018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a neurologic chronic pain condition hard to diagnose and treat, and able to significantly impact the quality of life. Currently, the available multimodal, individualized treatments (i.e., pharmacological and non-pharmacological therapies including invasive procedures) are aimed only at symptom control. Herein, we report a 69-year-old Caucasian female who came to our attention due to a 3-year history of severe (10/10) burning pain in her right ankle, along with oedema and local changes in skin color and temperature, which occurred after the ankle sprain. Previous pharmacological attempts failed due to multiple drug intolerance. Clinical examination confirmed the CRPS type I diagnosis, and a weekly diamagnetic therapy protocol was started since the patient refused further medications and interventional procedures. After 10 weeks of treatment, a significant (p < 0.01) reduction in pain severity and absence of oedema (difference in ankles’ circumference: from 3 cm to 0) were observed, with consequent improvements in quality of life and no adverse events. Although high-quality clinical evidence is still lacking, our case report suggests further investigating the potential use of diamagnetic therapy as a non-invasive and safe adjunctive treatment for CRPS, and as an alternative when patients did not benefit from drugs and/or refuse invasive procedures.
Collapse
|
6
|
High-Intensity, Low-Frequency Pulsed Electromagnetic Field as an Odd Treatment in a Patient with Mixed Foot Ulcer: A Case Report. REPORTS 2022. [DOI: 10.3390/reports5010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lower-extremity ulcers are associated with an increasing prevalence and significant economic and social costs. To date, there is no high-quality evidence related to an optimal treatment algorithm. A multimodal approach is needed particularly in patients with comorbidity and polytherapy. Herein, we report the case of a 94-year-old Caucasian female with comorbidity and polytherapy who was admitted to our observation for a history (1 year) of chronic painful malleolar mixed ulcer. After clinical evaluation, she was treated with a twice daily pain relief therapy and with a weekly diamagnetic therapy protocol plus a local treatment. During the clinical examination, we documented a statistically significant improvement in both pain (VAS score from 8 to 2 p < 0.01) and foot ulcer (surface reduction from 6 cm × 4 cm to 2 cm × 2 cm, p < 0.01) at the sixth week of combined treatment. The ulcer completely healed at the ninth week. This is the first study to document the effect of diamagnetic therapy as an add-on therapy in the management of wound healing. In conclusion, even if high-quality evidence is still lacking, diamagnetic therapy might represent an interesting option as an add-on treatment for ulcer.
Collapse
|
7
|
Capone F, Salati S, Vincenzi F, Liberti M, Aicardi G, Apollonio F, Varani K, Cadossi R, Di Lazzaro V. Pulsed Electromagnetic Fields: A Novel Attractive Therapeutic Opportunity for Neuroprotection After Acute Cerebral Ischemia. Neuromodulation 2021; 25:1240-1247. [PMID: 34480781 DOI: 10.1111/ner.13489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Acute cerebral ischemia is characterized by several pathological processes evolving during time, which contribute to the final tissue damage. Secondary processes, such as prolonged inflammatory response, impaired mitochondrial function and oxidative stress, are responsible for the progression of brain injury to the peri-infarct area, called "penumbra." Adenosine has been shown to play a crucial role in regulating the inflammatory cascade following brain ischemia. Pulsed electromagnetic fields (PEMFs) act as modulators of adenosine receptors, increasing the functionality of the endogenous adenosine. In particular, PEMF exposure induces a significant upregulation of A2A and A3 adenosine receptors in different neuronal cell types. Several lines of evidence suggest that PEMF exposure might play a neuroprotective role after ischemic damage. MATERIALS AND METHODS This review summarizes the current knowledge on the mechanism of action of PEMFs and their biological effects on neuronal damage both in preclinical and clinical studies. RESULTS PEMFs counteract hypoxia-induced apoptosis and ROS production in neuronal-like cells and exert a strong anti-inflammatory effect on microglial cells. Data from stroke animal models showed that PEMFs exposure is able to reduce the size of the infarct area and decrease the levels of pro-inflammatory mediators. In clinical studies, PEMFs stimulation proved to be safe and well tolerated. Preliminary results on acute ischemic stroke patients showed a dose-dependent reduction in the lesion size. CONCLUSIONS Altogether, these data demonstrate the efficacy of PEMFs against several mechanisms underlying ischemic damage and suggest that PEMFs might represent a novel noninvasive adjunctive treatment for acute ischemic stroke, providing neuroprotection and reducing functional deficits following ischemia.
Collapse
Affiliation(s)
- Fioravante Capone
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | | | | | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome "La Sapienza", Roma, Italy
| | - Giorgio Aicardi
- Neurophysiology Research Unit, Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome "La Sapienza", Roma, Italy
| | - Katia Varani
- Department of Translational Medicine, University of Ferrara, Italy
| | | | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| |
Collapse
|
8
|
Karateev AE, Lila AM, Vertkin AL, Alekseeva LI, Gerasimenko MY, Arkov VV, Smirnova SN, Sukhareva ML, Tsykunov MB. Efficiency and safety of magnetotherapy in the treatment of osteoarthritis. Expert council (3 june 2020, Moscow). RHEUMATOLOGY SCIENCE AND PRACTICE 2021. [DOI: 10.47360/1995-4484-2020-734-742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - A. L. Vertkin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - M. Yu. Gerasimenko
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - V. V. Arkov
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department
| | - S. N. Smirnova
- Moscow Regional Research and Clinical Institute (“MONIKI”)
| | | | - M. B. Tsykunov
- N.N. Priorov Central Research Institute of Traumatology and Orthopedics; N.I. Pirogov Russian National Research Medical University
| |
Collapse
|
9
|
Repeated electromagnetic field stimulation lowers amyloid-β peptide levels in primary human mixed brain tissue cultures. Sci Rep 2021; 11:621. [PMID: 33436686 PMCID: PMC7804462 DOI: 10.1038/s41598-020-77808-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Late Onset Alzheimer’s Disease is the most common cause of dementia, characterized by extracellular deposition of plaques primarily of amyloid-β (Aβ) peptide and tangles primarily of hyperphosphorylated tau protein. We present data to suggest a noninvasive strategy to decrease potentially toxic Aβ levels, using repeated electromagnetic field stimulation (REMFS) in primary human brain (PHB) cultures. We examined effects of REMFS on Aβ levels (Aβ40 and Aβ42, that are 40 or 42 amino acid residues in length, respectively) in PHB cultures at different frequencies, powers, and specific absorption rates (SAR). PHB cultures at day in vitro 7 (DIV7) treated with 64 MHz, and 1 hour daily for 14 days (DIV 21) had significantly reduced levels of secreted Aβ40 (p = 001) and Aβ42 (p = 0.029) peptides, compared to untreated cultures. PHB cultures (DIV7) treated at 64 MHz, for 1 or 2 hour during 14 days also produced significantly lower Aβ levels. PHB cultures (DIV28) treated with 64 MHz 1 hour/day during 4 or 8 days produced a similar significant reduction in Aβ40 levels. 0.4 W/kg was the minimum SAR required to produce a biological effect. Exposure did not result in cellular toxicity nor significant changes in secreted Aβ precursor protein-α (sAPPα) levels, suggesting the decrease in Aβ did not likely result from redirection toward the α-secretase pathway. EMF frequency and power used in our work is utilized in human magnetic resonance imaging (MRI, thus suggesting REMFS can be further developed in clinical settings to modulate Aβ deposition.
Collapse
|
10
|
Effects of Exercise on Long-Term Potentiation in Neuropsychiatric Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:439-451. [PMID: 32342476 DOI: 10.1007/978-981-15-1792-1_30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Various neuropsychiatric conditions, such as depression, Alzheimer's disease, and Parkinson's disease, demonstrate evidence of impaired long-term potentiation, a cellular correlate of episodic memory function. This chapter discusses the mechanistic effects of these neuropsychiatric conditions on long-term potentiation and how exercise may help to attenuate these detrimental effects.
Collapse
|