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Calafiore D, Marotta N, Curci C, Agostini F, De Socio RI, Inzitari MT, Ferraro F, Bernetti A, Ammendolia A, de Sire A. Efficacy of Rehabilitative Techniques on Pain Relief in Patients With Vulvodynia: A Systematic Review and Meta-Analysis. Phys Ther 2024; 104:pzae054. [PMID: 38564267 DOI: 10.1093/ptj/pzae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Vulvodynia is a chronic clinical condition characterized by provoked or non-provoked vulvar pain for at least 3 months of unknown etiology. The onset of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, such as pelvic floor muscle and autonomic dysfunction, and interpersonal factors. A stepwise approach of pelvic floor physical therapy as medical management is suggested. In this scenario, by this meta-analysis of randomized controlled trials, we aimed to evaluate the efficacy of rehabilitation interventions in patients with vulvodynia. METHODS On October 13, 2022, PubMed, Scopus, and Web of Science were systematically searched for randomized controlled trials that assessed the efficacy of the rehabilitative approach to pain during intercourse in patients with vulvodynia. The quality assessment was performed with the Cochrane risk-of-bias tool for randomized trials. The trial registration number is CRD42021257449. At the end of the search, 9 studies were included for a total of 332 patients. A pairwise meta-analysis was performed to highlight the efficacy of rehabilitative approaches for reducing pain during intercourse, as measured with a visual analog scale or a numerical rating scale. RESULTS Meta-analysis showed that all these rehabilitative approaches had an overall effect size of -1.43 (95% CI = -2.69 to -0.17) in decreasing vulvodynia pain in terms of the visual analog scale. In the subgroup analysis, a significant effect size in acupuncture (effect size = -2.36; 95% CI = -3.83 to -0.89) and extracorporeal shockwave therapy (effect size = -2.94; 95% CI = -4.31 to -1.57; I2 = 58%) was observed. According to the Cochrane risk-of-bias tool, a low risk of bias for outcome selection in 89% of studies. CONCLUSION Findings from this meta-analysis suggested that the physical agent modalities and complementary medicine techniques in people with vulvodynia appear to be more effective than placebo, sham, or waiting list. Further evidence on physical agent modalities and complementary therapies are warranted in the future. IMPACT This was the first systematic review and meta-analysis of randomized controlled trials to provide evidence on the efficacy of rehabilitation interventions in patients with vulvodynia.
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Affiliation(s)
- Dario Calafiore
- Department of Neurosciences, ASST Carlo Poma, Physical Medicine and Rehabilitation Unit, Mantova, Italy
| | - Nicola Marotta
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Claudio Curci
- Department of Neurosciences, ASST Carlo Poma, Physical Medicine and Rehabilitation Unit, Mantova, Italy
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele, Rome, Italy
| | - Rita Ilaria De Socio
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Maria Teresa Inzitari
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Francesco Ferraro
- Department of Neurosciences, ASST Carlo Poma, Physical Medicine and Rehabilitation Unit, Mantova, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Lecce, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
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Zgolli F, Aouinti I, Charfi O, Kaabi W, Hamza I, Daghfous R, Kastalli S, Lakhoua G, Aidli SE. Cutaneous adverse effects of antiepileptic drugs. Therapie 2023:S0040-5957(23)00141-5. [PMID: 37865562 DOI: 10.1016/j.therap.2023.09.005] [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: 03/27/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 10/23/2023]
Abstract
Antiepileptic drugs (AED) are widely used in therapy. They are mainly indicated in the treatment of epilepsy and some psychiatric pathologies as well as for their analgesic action. Their cutaneous adverse effects (CAE) are common, often mild but sometimes serious. The aim of this work was to study the epidemiological and clinical features of CAE occurring in adults and elderly patients (aged over 20 years-old) and to identify the most implicated AED. We conducted a descriptive retrospective study over a period of five years from January 2017 to December 2022 about CAE of AED in adults and elderly patients notified to The National Center Chalbi Belkahia of Pharmacovigilance (Tunis,Tunisia). All cases were analyzed according to the updates French methods of imputability. We collected 71 cases of patients aged over 20 years old who presented CAE to AED. The age ranged from 20 to 79 years (mean age=44.8 years). The sex ratio F/M was 0.7. AED were indicated for neurological pathology in 70.5% of cases, for psychiatric pathology in 15.9% of cases and for their analgesic action in 12.9% of cases. Epilepsy was the first indication (51.1% of cases). The most notified CAE in our study were drug reaction with eosinophilia and systemic symptoms (DRESS syndrome; 34% of cases), maculopapular exanthema (MPE; 26% of cases), erythematous rash (8% of cases) and photosensitivity in 5% of cases. Severe cutaneous adverse reactions were accounted for 37% of all CAE. The most implicated AED were carbamazepine (52%), phenobarbital (24%) and lamotrigine (18%). However, further study with a larger number of patients and in collaboration with prescribing physicians are needed to better clarify features of CAE associated with AED intake and specify the risk factors, specific to our Tunisian population.
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Affiliation(s)
- Fatma Zgolli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia.
| | - Imen Aouinti
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Ons Charfi
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Widd Kaabi
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Imen Hamza
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Riadh Daghfous
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Sarrah Kastalli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Ghozlane Lakhoua
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Sihem El Aidli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
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Ghusn W, Bouchard C, Frye MA, Acosta A. Weight-centric treatment of depression and chronic pain. OBESITY PILLARS (ONLINE) 2022; 3:100025. [PMID: 37990725 PMCID: PMC10661995 DOI: 10.1016/j.obpill.2022.100025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2023]
Abstract
Background Depression and chronic pain are two major chronic non-communicable diseases (CNCD). Considering the bidirectional relationship between obesity and CNCD, it is of the utmost importance to understand the effect of medications utilized to treat these diseases on body weight. Methods This is a clinical review on the effect of medications for depression and chronic pain on body weight. We searched PubMed, Scopus, MEDLINE, and Google Scholar databases for studies on the topic from January 1, 1950 to April 1, 2022 in English language. Additionally, we present expert opinions in the fields of obesity, depression and chronic pain, providing a weight-centric approach to treat depression and chronic pain. Results Several antidepressant and chronic pain medications are associated with weight gain. Selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidases, mirtazapine and trazodone are common antidepressants that can increase body weight while bupropion is significantly associated with weight loss. Gabapentin and pregabalin are common chronic pain medications that are linked to weight gain. On the other hand, topiramate is associated with significant weight loss. Obesity, depression and chronic pain experts recommend avoiding medications that can increase body weight if another effective alternative is available. Conclusion By shifting prescribing practices toward a weight-conscious approach (i.e., switching from weight gain medications to weight loss/neutral), it is possible to mitigate the incidence of drug-induced weight gain.
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Affiliation(s)
- Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Mark A. Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Hu W, Bian Q, Zhou Y, Gao J. Pain management with transdermal drug administration: A review. Int J Pharm 2022; 618:121696. [PMID: 35337906 DOI: 10.1016/j.ijpharm.2022.121696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/08/2022] [Accepted: 03/19/2022] [Indexed: 12/31/2022]
Abstract
Pain management is an urgent issue to solve with complex mechanisms. Localized acute pain requires rapid and accurate delivery of drugs with less distribution in the blood circulation while chronic pain requires controlled release of drugs with long drug retention time. The transdermal route, a promising way with high patient compliance was known for painless delivery, long drug retention time, stable blood concentration, easily controlled dosage and release rate as well as the fewer side effects. This review presents transdermal route for pain management according to the different sites of action which drugs aim to reach, and illustrates different analgesic mechanisms, dosage forms, transdermal enhancements and clinical applications. In addition, the review concludes the difference of pain types and presents the future aims of pain management, thereby providing a reference for researches focusing on percutaneous analgesia.
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Affiliation(s)
- Weitong Hu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Qiong Bian
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yanjun Zhou
- Zhejiang Huanling Pharmaceutical Technology Company, Jinhua 321000, China
| | - Jianqing Gao
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China; Jiangsu Engineering Research Center for New-type External and Transdermal Preparations , Changzhou 213149, China; Jinhua Institute of Zhejiang University, Jinhua 321002, China.
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Sloan G, Alam U, Selvarajah D, Tesfaye S. The Treatment of Painful Diabetic Neuropathy. Curr Diabetes Rev 2022; 18:e070721194556. [PMID: 34238163 DOI: 10.2174/1573399817666210707112413] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
Painful diabetic peripheral neuropathy (painful-DPN) is a highly prevalent and disabling condition, affecting up to one-third of patients with diabetes. This condition can have a profound impact resulting in a poor quality of life, disruption of employment, impaired sleep, and poor mental health with an excess of depression and anxiety. The management of painful-DPN poses a great challenge. Unfortunately, currently there are no Food and Drug Administration (USA) approved disease-modifying treatments for diabetic peripheral neuropathy (DPN) as trials of putative pathogenetic treatments have failed at phase 3 clinical trial stage. Therefore, the focus of managing painful- DPN other than improving glycaemic control and cardiovascular risk factor modification is treating symptoms. The recommended treatments based on expert international consensus for painful- DPN have remained essentially unchanged for the last decade. Both the serotonin re-uptake inhibitor (SNRI) duloxetine and α2δ ligand pregabalin have the most robust evidence for treating painful-DPN. The weak opioids (e.g. tapentadol and tramadol, both of which have an SNRI effect), tricyclic antidepressants such as amitriptyline and α2δ ligand gabapentin are also widely recommended and prescribed agents. Opioids (except tramadol and tapentadol), should be prescribed with caution in view of the lack of definitive data surrounding efficacy, concerns surrounding addiction and adverse events. Recently, emerging therapies have gained local licenses, including the α2δ ligand mirogabalin (Japan) and the high dose 8% capsaicin patch (FDA and Europe). The management of refractory painful-DPN is difficult; specialist pain services may offer off-label therapies (e.g. botulinum toxin, intravenous lidocaine and spinal cord stimulation), although there is limited clinical trial evidence supporting their use. Additionally, despite combination therapy being commonly used clinically, there is little evidence supporting this practise. There is a need for further clinical trials to assess novel therapeutic agents, optimal combination therapy and existing agents to determine which are the most effective for the treatment of painful-DPN. This article reviews the evidence for the treatment of painful-DPN, including emerging treatment strategies such as novel compounds and stratification of patients according to individual characteristics (e.g. pain phenotype, neuroimaging and genotype) to improve treatment responses.
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Affiliation(s)
- Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, and Liverpool University Hospital, NHS Foundation Trust, Liverpool, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
| | - Dinesh Selvarajah
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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Yamamoto PA, Benzi JRDL, Dach F, Moraes NVD. Therapeutic drug monitoring of gabapentin: the applicability in patients with neuropathic pain. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e191073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chronic Kidney Disease-Associated Itch (CKD-aI) in Children-A Narrative Review. Toxins (Basel) 2021; 13:toxins13070450. [PMID: 34209560 PMCID: PMC8309841 DOI: 10.3390/toxins13070450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease (CKD) is a condition of widespread epidemiology and serious consequences affecting all organs of the organism and associated with significant mortality. The knowledge on CKD is rapidly evolving, especially concerning adults. Recently, more data is also appearing regarding CKD in children. Chronic itch (CI) is a common symptom appearing due to various underlying dermatological and systemic conditions. CI may also appear in association with CKD and is termed chronic kidney disease-associated itch (CKD-aI). CKD-aI is relatively well-described in the literature concerning adults, yet it also affects children. Unfortunately, the data on paediatric CKD-aI is particularly scarce. This narrative review aims to describe various aspects of CKD-aI with an emphasis on children, based on the available data in this population and the data extrapolated from adults. Its pathogenesis is described in details, focusing on the growing role of uraemic toxins (UTs), as well as immune dysfunction, altered opioid transmission, infectious agents, xerosis, neuropathy and dialysis-associated aspects. Moreover, epidemiological and clinical aspects are reviewed based on the few data on CKD-aI in children, whereas treatment recommendations are proposed as well, based on the literature on CKD-aI in adults and own experience in managing CI in children.
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Jacob L, Kaiser M, Kostev K. Incidence of antiepileptic drug therapy and factors associated with their prescribing in outpatients with diabetic polyneuropathy. Prim Care Diabetes 2021; 15:535-540. [PMID: 33422430 DOI: 10.1016/j.pcd.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
AIMS The goal of this retrospective cohort study was to analyze the incidence of, and factors associated with the antiepileptic drug (AED) therapy in the five years following the diagnosis of diabetic polyneuropathy in patients followed in Germany. METHODS The study included patients aged 18-80 years with an initial diagnosis of diabetic polyneuropathy in 1238 general and diabetologist practices in Germany between January 2008 and December 2017 (index date). The main outcome of the study was the incidence of the AED therapy in the five years following the diagnosis of diabetic polyneuropathy. Adjusted Cox regression analyses were conducted to investigate the association between study covariates and the incidence of the AED therapy. RESULTS The present study included 48,324 patients (mean [standard deviation] age 65.8 [10.6] years, 55.6% male). Within five years of the diagnosis of diabetic polyneuropathy, 16.4% of patients were prescribed at least one AED. The three most frequent drugs were pregabalin, gabapentin, and carbamazepine. Female sex (HR = 1.22), private health insurance coverage (HR = 1.22), follow-up in a general practice (HR = 1.85), HbA1c ≥10% (HR = 1.36), previous referral to a neurological practice (HR = 1.47), previous hospital admission (HR = 1.51) and depression (HR = 1.15) were positively associated with the incidence of the AED therapy. CONCLUSIONS The incidence of the AED therapy was low in patients recently diagnosed with diabetic polyneuropathy in Germany. More research is warranted to understand the infrequent use of AEDs in diabetic polyneuropathy patients from this country.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
| | - Marcel Kaiser
- Diabetologische Schwerpunktpraxis, Frankfurt, Germany
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Huang D, Liu YQ, Xia LJ, Liu XG, Ma K, Liu GZ, Xiao LZ, Song T, Yang XQ, Fu ZJ, Yan M. Expert consensus of Chinese Association for the Study of Pain on the non-opioid analgesics for chronic musculoskeletal pain. World J Clin Cases 2021; 9:2068-2076. [PMID: 33850926 PMCID: PMC8017502 DOI: 10.12998/wjcc.v9.i9.2068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic musculoskeletal pain (CMP) is a common occurrence in clinical practice and there are a variety of options for the treatment of it. However, the pharmacological therapy is still considered to be a primary treatment. The recent years have witnessed the emergence of opioid crisis, yet there are no relevant guidelines on how to treat CMP with non-opioid analgesics properly. The Chinese Medical Association for the Study of Pain convened a panel meeting to develop clinical practice consensus for the treatment of CMP with non-opioid analgesics. The purpose of this consensus is to present the application of nonsteroidal anti-inflammatory drugs, serotonin norepinephrine reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, muscle relaxants, ion channel drugs and topical drugs in CMP.
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Affiliation(s)
- Dong Huang
- Department of Algology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medicine University, Beijing 100070, China
| | - Ling-Jie Xia
- Department of Algology, Henan Provincial People's Hospital, Zhengzhou 450008, Henan Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510089, Guangdong Province, China
| | - Ke Ma
- Department of Algology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Guang-Zhao Liu
- Department of Algology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Li-Zu Xiao
- Department of Algology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, Guangdong Province, China
| | - Tao Song
- Department of Algology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiao-Qiu Yang
- Department of Algology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhi-Jian Fu
- Department of Algology, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
| | - Min Yan
- Department of Algology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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Xiao H, Ma K, Huang D, Liu XG, Liu TH, Liu Q, Liu GZ, Song T, Tao W, Wu DS, Wang YX, Yang XQ, Zhang XM, Liu H, Liu YQ. Expert consensus of the Chinese Association for the Study of Pain on ion channel drugs for neuropathic pain. World J Clin Cases 2021; 9:2100-2109. [PMID: 33850929 PMCID: PMC8017507 DOI: 10.12998/wjcc.v9.i9.2100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain (NPP) is a kind of pain caused by disease or damage impacting the somatosensory system. Ion channel drugs are the main treatment for NPP; however, their irregular usage leads to unsatisfactory pain relief. To regulate the treatment of NPP with ion channel drugs in clinical practice, the Chinese Association for the Study of Pain organized first-line pain management experts from China to write an expert consensus as the reference for the use of ion channels drugs . Here, we reviewed the mechanism and characteristics of sodium and calcium channel drugs, and developed recommendations for the therapeutic principles and clinical practice for carbamazepine, oxcarbazepine, lidocaine, bulleyaconitine A, pregabalin, and gabapentin. We hope this guideline provides guidance to clinicians and patients on the use of ion channel drugs for the management of NPP.
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Affiliation(s)
- Hong Xiao
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Tang-Hua Liu
- Department of Algology, The Third People's Hospital of Yibin, Yibin 644000, Sichuan Province, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Guang-Zhao Liu
- Department of Algology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen 518055, Guangdong Province, China
| | - Da-Sheng Wu
- Department of Algology, The People's Hospital of Jilin Province, Changchun 130021, Jilin Province, China
| | - Yun-Xia Wang
- Department of Algology, Hubei Third People’s Hospital of Jianghan University, Wuhan 430033, Hubei Province, China
| | - Xiao-Qiu Yang
- Department of Algology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao-Mei Zhang
- Department of Algology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Murphy D, Lester D, Clay Smither F, Balakhanlou E. Peripheral neuropathic pain. NeuroRehabilitation 2021; 47:265-283. [PMID: 32986619 DOI: 10.3233/nre-208002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neuropathic pain (NP) can have either central nervous system causes or ones from the peripheral nervous system. This article will focus on the epidemiology, classifications, pathology, non-invasive treatments and invasive treatments as a general review of NP involving the peripheral nervous system. NP has characteristic symptomatology such as burning and electrical sensations. It occurs in up to 10% of the general population. Its frequency can be attributed to its occurrence in neck and back pain, diabetes and patients receiving chemotherapy. There are a wide range of pharmacologic options to control this type of pain and when such measures fail, numerous interventional methods can be employed such as nerve blocks and implanted stimulators. NP has a cost to the patient and society in terms of emotional consequences, quality of life, lost wages and the cost of assistance from the medical system and thus deserves serious consideration for prevention, treatment and control.
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Affiliation(s)
- Douglas Murphy
- Regional Amputation Center, Central Virginia Veterans Health Center, Richmond, VA, USA.,Physical Medicine & Rehabilitation, VCU Medical Center, Richmond, VA, USA
| | - Denise Lester
- Physical Medicine & Rehabilitation, VCU Medical Center, Richmond, VA, USA.,Peripheral Nerve Stimulation and Interventional Pain Research, Central Virginia Veterans Health Center, Richmond, VA, USA.,Anesthesiology, VCU Medical Center, Richmond, VA, USA
| | - F Clay Smither
- Polytrauma and Amputation, MSK/Ultrasound Fellow, Department of Physical Medicine and Rehabilitation, Central Virginia Veterans Health Center, Richmond, VA, USA
| | - Ellie Balakhanlou
- Physical Medicine & Rehabilitation, VCU Medical Center, Richmond, VA, USA
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12
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Socha Hernandez AV, Deeks LS, Shield AJ. Understanding medication safety and Charcot-Marie-Tooth disease: a patient perspective. Int J Clin Pharm 2020; 42:1507-1514. [PMID: 32804316 DOI: 10.1007/s11096-020-01123-z] [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: 01/09/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
Background Charcot-Marie-Tooth disease is a common inherited neuropathy where patients may be sensitive to adverse effects of certain medicines; however, information about medication safety in this group of people is limited. Objective This study aimed to investigate the experience of Australian individuals with Charcot-Marie-Tooth disease in using medications, including perceived impact of drug-induced adverse effects. Secondarily, it aimed to determine whether individuals with Charcot-Marie-Tooth disease feel adequately supported to make decisions about medication safety. Setting Focus groups and interviews (face-to-face or telephone) of individuals with Charcot-Marie-Tooth disease in Australia. Method A mixed methods qualitative study was conducted between September 2015 and August 2016 using semi-structured interviews. Thematic analysis of interview transcripts was conducted independently by two researchers using inductive coding until concept saturation was achieved. Main outcome measure Perceptions of medicines safety in people with Charcot-Marie-Tooth disease, including barriers to making informed decisions about medication safety. Results Twenty-four adults with Charcot-Marie-Tooth disease participated. Anaesthetics (18%) and pregabalin (15%) were the medications most frequently reported as impacting on Charcot-Marie-Tooth symptoms. Participants sought medication information primarily from general practitioners or neurologists. The main barriers identified by participants were a perceived poor understanding in non-specialist health professionals about Charcot-Marie-Tooth disease and lack of attention to medication safety concerns in people with Charcot-Marie-Tooth disease; this resulted in dissatisfaction about the advice provided. Many individuals who faced uncertainty in obtaining and understanding medicines information turned to internet resources, peer groups, and use of complementary and alternative medicines to self-manage Charcot-Marie-Tooth exacerbations. Conclusion Participants reported drug-related adverse effects and a difficulty in obtaining safety information about medication. This study highlights the need for improved evidence about medication safety in people with Charcot-Marie-Tooth disease. Development of evidence-based resources, increased awareness amongst health professionals about Charcot-Marie-Tooth disease and a team-based care approach could facilitate shared decisions about medication use for people with Charcot-Marie-Tooth disease.
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Affiliation(s)
| | - Louise S Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Alison J Shield
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
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13
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Zinc ternary complexes with gabapentin and neurotransmitters: Synthesis, spectral, thermal and molecular docking studies. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2019.126951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Ta PCP, Dinh HQ, Nguyen K, Lin S, Ong YL, Ariyawardana A. Efficacy of gabapentin in the treatment of trigeminal neuralgia: A systematic review of randomized controlled trials. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2019; 10:e12448. [PMID: 31402607 DOI: 10.1111/jicd.12448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/04/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
The aim of this systematic review was to determine the efficacy of gabapentin (GBP) in the treatment of pain of idiopathic trigeminal neuralgia (TN). A comprehensive literature search was conducted using the Cumulative Index of Nursing and Allied Health Literature (EBSCO Industries), Emcare (Ovid), Medline (Ovid), Medline (PubMed), Scopus (Elsevier) and Web of Science (Clarivate Analytics). The inclusion criteria comprised randomized controlled trials of GBP as a monotherapy in the treatment of idiopathic TN in adult participants and publications in English. All other study methodologies were excluded. The search yielded 1472 articles, and after exclusion, 11 full-text articles were eligible for full-text analysis. Only two studies met the inclusion criteria. There is insufficient evidence either to support or refute the efficacy of GBP in the management of idiopathic TN. Therefore, further well-designed placebo-controlled trials are required to confirm the efficacy of GBP in managing TN pain as a single therapy.
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Affiliation(s)
- Patrick Chieu Poa Ta
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Hue Quyen Dinh
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Kim Nguyen
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Samuel Lin
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Yong Li Ong
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia.,Metro South Oral Health, Queensland Health, Brisbane, QLD, Australia
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15
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Ray S, Salzer I, Kronschläger MT, Boehm S. The paracetamol metabolite N-acetylp-benzoquinone imine reduces excitability in first- and second-order neurons of the pain pathway through actions on KV7 channels. Pain 2019; 160:954-964. [PMID: 30601242 PMCID: PMC6430418 DOI: 10.1097/j.pain.0000000000001474] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/14/2022]
Abstract
Paracetamol (acetaminophen, APAP) is one of the most frequently used analgesic agents worldwide. It is generally preferred over nonsteroidal anti-inflammatory drugs because it does not cause typical adverse effects resulting from the inhibition of cyclooxygenases, such as gastric ulcers. Nevertheless, inhibitory impact on these enzymes is claimed to contribute to paracetamols mechanisms of action which, therefore, remained controversial. Recently, the APAP metabolites N-arachidonoylaminophenol (AM404) and N-acetyl-p-benzoquinone imine (NAPQI) have been detected in the central nervous system after systemic APAP administration and were reported to mediate paracetamol effects. In contrast to nonsteroidal anti-inflammatory drugs that rather support seizure activity, paracetamol provides anticonvulsant actions, and this dampening of neuronal activity may also form the basis for analgesic effects. Here, we reveal that the APAP metabolite NAPQI, but neither the parent compound nor the metabolite AM404, reduces membrane excitability in rat dorsal root ganglion (DRG) and spinal dorsal horn (SDH) neurons. The observed reduction of spike frequencies is accompanied by hyperpolarization in both sets of neurons. In parallel, NAPQI, but neither APAP nor AM404, increases currents through KV7 channels in DRG and SDH neurons, and the impact on neuronal excitability is absent if KV7 channels are blocked. Furthermore, NAPQI can revert the inhibitory action of the inflammatory mediator bradykinin on KV7 channels but does not affect synaptic transmission between DRG and SDH neurons. These results show that the paracetamol metabolite NAPQI dampens excitability of first- and second-order neurons of the pain pathway through an action on KV7 channels.
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Affiliation(s)
- Sutirtha Ray
- Division of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Isabella Salzer
- Division of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Mira T. Kronschläger
- Department of Neurophysiology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Stefan Boehm
- Division of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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Mahmoud M, Abbas A, Zaitone S, Ammar A, Sallam S. Copper(II) ternary complexes with gabapentin and neurotransmitters as antiepileptic drug. J Mol Struct 2019. [DOI: 10.1016/j.molstruc.2018.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Martins IL, Nunes J, Charneira C, Morello J, Pereira SA, Telo JP, Marques MM, Antunes AMM. The first-line antiepileptic drug carbamazepine: Reaction with biologically relevant free radicals. Free Radic Biol Med 2018; 129:559-568. [PMID: 30342189 DOI: 10.1016/j.freeradbiomed.2018.10.408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022]
Abstract
Carbamazepine (CBZ) is one of the most widely used antiepileptic drugs by both adults and children. Despite its widespread use, CBZ is associated with central nervous system toxicity and severe hypersensitivity reactions, which raise concerns about its chronic use. While the precise mechanisms of CBZ-induced adverse events are still unclear, metabolic activation to the epoxide (CBZ-EP) has been thought to play a significant role. This work reports first-hand evidence that CBZ reacts readily with biologically relevant thiyl radicals with no need for bioactivation. Using liquid chromatography coupled with high resolution mass spectrometry, multiple products from direct reaction of CBZ with glutathione (GSH) and N-acetyl-L-cysteine (NAC) were unequivocally identified, including the same product obtained upon ring-opening of CBZ-EP. The product profile is complex and consistent with radical-mediated mechanisms. Importantly, side products and adducts compatible with this non-enzymatic pathway were identified in liver extracts from CBZ-treated Wistar rats. The reaction of CBZ with GSH and NAC is more extensive in the presence of oxygen. Taking into consideration that GSH conjugation is, in general, a detoxification pathway, these results suggest that under hyperoxia/oxidative stress conditions the bioavailability of the parent drug may be compromised. Additionally, this non-enzymatic process can be anticipated to play, at least in part, a role in the onset of CBZ-induced adverse reactions due to the concomitant generation of reactive oxygen species. Therefore, the search for causal relationships between the formation of non-enzymatically-driven CBZ products and the occurrence of CBZ-induced adverse events in human patients merits further research, aiming the translation of basic mechanistic findings into a clinical context that may ultimately lead to a safer CBZ prescription.
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Affiliation(s)
- Inês L Martins
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
| | - João Nunes
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
| | - Catarina Charneira
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
| | - Judit Morello
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
| | - Sofia A Pereira
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-006 Lisboa, Portugal
| | - João P Telo
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
| | - M Matilde Marques
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
| | - Alexandra M M Antunes
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal.
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Antiepileptic drugs as analgesics/adjuvants in inflammatory pain: current preclinical evidence. Pharmacol Ther 2018; 192:42-64. [PMID: 29909236 DOI: 10.1016/j.pharmthera.2018.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/04/2018] [Indexed: 12/20/2022]
Abstract
Inflammatory pain is the most common type of pain that is treated clinically. The use of currently available treatments (classic analgesics - NSAIDs, paracetamol and opioids) is limited by insufficient efficacy and/or side effects/tolerance development. Antiepileptic drugs (AEDs) are widely used in neuropathic pain treatment, but there is substantial preclinical evidence on their efficacy against inflammatory pain, too. In this review we focus on gabapentinoids (gabapentin and pregabalin) and dibenzazepine AEDs (carbamazepine, oxcarbazepine, and recently introduced eslicarbazepine acetate) and their potential for relieving inflammatory pain. In models of somatic, visceral and trigeminal inflammatory pain, that have a translational value for inflammatory conditions in locomotor system, viscera and head/face, AEDs have demonstrated analgesic activity. This activity was mostly consistent, dependent on the dose and largely independent on the site of inflammation and method of its induction, nociceptive stimuli, species, specific drug used, its route of administration and dosing schedule. AEDs exerted comparable efficacy with classic analgesics. Effective doses of AEDs are lower than toxic doses in animals and, when expressed as equivalent human doses, they are largely overlapping with AEDs doses already used in humans for treating epilepsy/neuropathic pain. The main mechanism of antinociceptive/antihyperalgesic action of gabapentinoids in inflammatory pain models seems to be α2δ-dependent suppression of voltage-gated calcium channels in primary sensory neurons that leads to reduced release of neurotransmitters in the spinal/medullar dorsal horn. The suppression of NMDA receptors via co-agonist binding site primarily at spinal sites, activation of various types of K+ channels at spinal and peripheral sites, and activation of noradrenergic and serotonergic descending pain modulatory pathways may also contribute. Inhibition of voltage-gated sodium channels along the pain pathway is probably the main mechanism of antinociceptive/antihyperalgesic effects of dibenzazepines. The recruitment of peripheral adrenergic and purinergic mechanisms and central GABAergic mechanisms may also contribute. When co-administered with classic/other alternative analgesics, AEDs exerted synergistic/additive interactions. Reviewed data could serve as a basis for clinical studies on the efficacy/safety of AEDs as analgesics/adjuvants in patients with inflammatory pain, and contribute to the improvement of the treatment of various inflammatory pain states.
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Abstract
BACKGROUND Several anticonvulsant drugs are used in the management of neuropathic pain. Oxcarbazepine is an anticonvulsant drug closely related to carbamazepine. Oxcarbazepine has been reported to be efficacious in the treatment of neuropathic pain, but evidence from randomised controlled trials (RCTs) is conflicting. Oxcarbazepine is reportedly better tolerated than carbamazepine. This is the first update of a review published in 2013. OBJECTIVES To assess the benefits and harms of oxcarbazepine for different types of neuropathic pain. SEARCH METHODS On 21 November 2016, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE and Embase. We searched the Chinese Biomedical Retrieval System (January 1978 to November 2016). We searched the US National Institutes of Health (NIH) databases and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials in January 2017, and we wrote to the companies who make oxcarbazepine and to pain experts requesting additional information. SELECTION CRITERIA All RCTs and randomised cross-over studies of oxcarbazepine for the treatment of people of any age or sex with any neuropathic pain were eligible. We planned to include trials of oxcarbazepine compared with placebo or any other intervention with a treatment duration of at least six weeks, regardless of administration route and dose. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Five multicentre, randomised, placebo-controlled, double-blind trials with a total of 862 participants were eligible for inclusion in this updated review. Three trials involved participants with painful diabetic peripheral neuropathy (DPN) (n = 634), one included people with neuropathic pain due to radiculopathy (n = 145), and one, which was newly identified at this update, involved participants with peripheral neuropathic pain of mixed origin (polyneuropathy, peripheral nerve injury or postherpetic neuralgia) (n = 83). Some studies did not report all outcomes of interest. For painful DPN, compared to the baseline, the proportion of participants who reported at least a 50% or 30% reduction of pain scores after 16 weeks of treatment in the oxcarbazepine group versus the placebo group were: at least 50% reduction: 34.8% with oxcarbazepine versus 18.2% with placebo (risk ratio (RR) 1.91, 95% confidence interval (CI) 1.08 to 3.39, number of people needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 3 to 41); and at least 30% reduction: 44.9% with oxcarbazepine versus 28.6% with placebo (RR 1.57, 95% CI 1.01 to 2.44; NNTB 6, 95% CI 3 to 114; n = 146). Both results were based on data from a single trial, since two trials that found little or no benefit did not provide data that could be included in a meta-analysis. Although these trials were well designed, incomplete outcome data and possible unblinding of participants due to obvious adverse effects placed the results at a high risk of bias. There was also serious imprecision and a high risk of publication bias. The radiculopathy trial reported no benefit for the outcome 'at least 50% pain relief' from oxcarbazepine. In mixed neuropathies, 19.3% of people receiving oxcarbazepine versus 4.8% receiving placebo had at least 50% pain relief. These small trials had low event rates and provided, at best, low-quality evidence for any outcome. The proportion of people with 'improved' or 'very much improved' pain was 45.9% with oxcarbazepine versus 30.1% with placebo in DPN (RR 1.46, 95% CI 1.13 to 1.88; n = 493; 2 trials; very-low-quality evidence) and 23.9% with oxcarbazepine versus 14.9% with placebo in radiculopathy (RR 1.61, 95% CI 0.81 to 3.20; n = 145).We found no trials in other types of neuropathic pain such as trigeminal neuralgia.Trial reports stated that most adverse effects were mild to moderate in severity. Based on moderate-quality evidence from the three DPN trials, serious adverse effects occurred in 8.3% with oxcarbazepine and 2.5% with placebo (RR 3.65, 95% CI 1.45 to 9.20; n = 634; moderate-quality evidence). The number needed to treat for an additional harmful (serious adverse effect) outcome (NNTH) was 17 (95% CI 11 to 42). The RR for serious adverse effects in the radiculopathy trial was 3.13 (95% CI 0.65 to 14.98, n = 145). The fifth trial did not provide data.More people withdrew because of adverse effects with oxcarbazepine than with placebo (DPN: 25.6% with oxcarbazepine versus 6.8% with placebo; RR 3.83, 95% CI 2.29 to 6.40; radiculopathy: 42.3% with oxcarbazepine versus 14.9% with placebo; RR 2.84, 95% CI 1.55 to 5.23; mixed neuropathic pain: 13.5% with oxcarbazepine versus 1.2% with placebo; RR 11.51, 95% CI 1.54 to 86.15). AUTHORS' CONCLUSIONS This review found little evidence to support the effectiveness of oxcarbazepine in painful diabetic neuropathy, neuropathic pain from radiculopathy and a mixture of neuropathies. Some very-low-quality evidence suggests efficacy but small trials, low event rates, heterogeneity in some measures and a high risk of publication bias means that we have very low confidence in the measures of effect. Adverse effects, serious adverse effects and adverse effects leading to discontinuation are probably more common with oxcarbazepine than placebo; however, the numbers of participants and event rates are low. More well-designed, multicentre RCTs investigating oxcarbazepine for various types of neuropathic pain are needed, and selective publication of studies or data should be avoided.
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Affiliation(s)
- Muke Zhou
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Ning Chen
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Li He
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Mi Yang
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Cairong Zhu
- School of Public Health, Sichuan UniversityEpidemic Disease & Health Statistics DepartmentChengduChina
| | - Fengbo Wu
- West China Hospital, Sichuan UniversityDepartment of PharmacyNo. 37, Guo Xue XiangChengduSichuanChina60041
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André V, Quaresma S, da Silva JLF, Duarte MT. Exploring mechanochemistry to turn organic bio-relevant molecules into metal-organic frameworks: a short review. Beilstein J Org Chem 2017; 13:2416-2427. [PMID: 29234469 PMCID: PMC5704760 DOI: 10.3762/bjoc.13.239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/29/2017] [Indexed: 12/16/2022] Open
Abstract
Mechanochemistry is a powerful and environmentally friendly synthetic technique successfully employed in different fields of synthetic chemistry. Application spans from organic to inorganic chemistry including the synthesis of coordination compounds. Metal-organic frameworks (MOFs) are a class of compounds with numerous applications, from which we highlight herein their application in the pharmaceutical field (BioMOFs), whose importance has been growing and is now assuming a relevant and promising domain. The need to find cleaner, greener and more energy and material-efficient synthetic procedures led to the use of mechanochemistry into the synthesis of BioMOFs.
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Affiliation(s)
- Vânia André
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
| | - Sílvia Quaresma
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
| | - João Luís Ferreira da Silva
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
| | - M Teresa Duarte
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
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21
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The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the UK. J Invest Dermatol 2017; 137:1240-1247. [PMID: 28202399 DOI: 10.1016/j.jid.2017.01.031] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 11/21/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening mucocutaneous diseases. SJS/TEN mostly manifest as a reaction to new drug use, but little is known about their incidence and epidemiology. We conducted a large observational study on the epidemiology of SJS/TEN using data from the UK-based Clinical Practice Research Datalink. Among 551 validated SJS/TEN patients, we calculated an incidence rate of 5.76 SJS/TEN cases per million person-years between 1995 and 2013, which was consistent throughout the study period and was highest in patients aged 1-10 years and 80 years or older. Within a 1:4 matched case-control analysis, black and Asian patients were at a 2-fold risk of SJS/TEN when compared with white patients. Among patients with epilepsy and gout, odds ratios for SJS/TEN were significantly increased only in the presence of recent new drug treatment with antiepileptics or allopurinol, respectively. We observed statistically significant associations between SJS/TEN and pre-existing depression, lupus erythematosus, recent pneumonia, chronic kidney disease, and active cancer, but confounding by drug use needs to be followed up. This large and longitudinal observational study on the epidemiology of SJS/TEN contributes to the understanding of this still underinvestigated severe skin disease in a European and largely white study population.
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Botz B, Bölcskei K, Helyes Z. Challenges to develop novel anti-inflammatory and analgesic drugs. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2016; 9. [PMID: 27576790 DOI: 10.1002/wnan.1427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/21/2016] [Accepted: 07/30/2016] [Indexed: 12/11/2022]
Abstract
Chronic inflammatory diseases and persistent pain of different origin represent common medical, social, and economic burden, and their pharmacotherapy is still an unresolved issue. Therefore, there is a great and urgent need to develop anti-inflammatory and analgesic agents with novel mechanisms of action, but it is a very challenging task. The main problem is the relatively large translational gap between the preclinical experimental data and the clinical results due to characteristics of the models, difficulties with the investigational techniques particularly for pain, as well as species differences in the mechanisms. We summarize here the current state-of-the-art medication and related ongoing strategies, and the novel targets with lead molecules under clinical development. The first members of the gold-standard categories, such as nonsteroidal anti-inflammatory drugs, glucocorticoids, and opioids, were introduced decades ago, and since then very few drugs with novel mechanisms of action have been successfully taken to the clinics despite considerable development efforts. Several biologics targeting different key molecules have provided breakthrough in some autoimmune/inflammatory diseases, but they are expensive, only parenterally available, their long-term side effects often limit their administration, and they do not effectively reduce pain. Some kinase inhibitors and phosphodiesterase-4 blockers have recently been introduced as new directions. There are in fact some promising novel approaches at different clinical stages of drug development focusing on transient receptor potential vanilloid 1/ankyrin 1 channel antagonism, inhibition of voltage-gated sodium/calcium channels, several enzymes (kinases, semicarbazide-sensitive amine oxidases, and matrix metalloproteinases), cytokines/chemokines, transcription factors, nerve growth factor, and modulation of several G protein-coupled receptors (cannabinoids, purinoceptors, and neuropeptides). WIREs Nanomed Nanobiotechnol 2017, 9:e1427. doi: 10.1002/wnan.1427 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Bálint Botz
- Department of Radiology, Faculty of Medicine, University of Pécs, Pécs, Hungary.,János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Kata Bölcskei
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Zsuzsanna Helyes
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary.,MTA-PTE NAP B Chronic Pain Research Group, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Guo Z, Wu B, Du C, Cheng M, Tian Y. Stereotactic Approach Combined with 3D CT Reconstruction for Difficult-to-Access Foramen Ovale on Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia. PAIN MEDICINE 2016; 17:1704-16. [DOI: 10.1093/pm/pnv108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/20/2015] [Indexed: 01/08/2023]
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Agbaje JO, Van de Casteele E, Hiel M, Verbaanderd C, Lambrichts I, Politis C. Neuropathy of Trigeminal Nerve Branches After Oral and Maxillofacial Treatment. J Maxillofac Oral Surg 2015; 15:321-327. [PMID: 27752201 DOI: 10.1007/s12663-015-0843-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report the incidence of trigeminal neuropathy seen among new patients in a referral center within a period of 1 year (2013). The cause of damage, method of management and treatment outcome was assessed after 1-year follow-up. MATERIALS AND METHODS The records of all new patients visiting the oral and maxillofacial unit of the University hospital of Leuven in 2013 were screened for a history of damage to branches of the trigeminal nerve. The selected records were examined and the duration of nerve damage, received treatment as well as the outcome of the neuropathy after treatment was noted after 1-year follow-up. RESULTS 56 patients (21 males, 35 females) from 7602 new patients had symptoms of damage to the trigeminal nerve branch. These symptoms persist in more than one-third of the patients [21/56 (37.5 %)] after 1-year follow-up. The least recovery is seen from oral surgery, implant placement, orthognathic surgery and tooth extraction. After 1 year 85 % (12/14) of neuropathic pain cases still have their symptoms as compared to 19 % (5/26) of patients with hypoesthesia. CONCLUSION This study shows a low incidence of nerve damage among the new patients presenting in oral and maxillofacial surgery clinic (<1 %); however, one-third of patients who sustain nerve damage never recover fully. Early diagnosis of the cause of neuropathy is essential. There is a need to objectively assess all patients with symptoms of trigeminal nerve damage before, during and after treatment.
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Affiliation(s)
- Jimoh Olubanwo Agbaje
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Elke Van de Casteele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Marjolein Hiel
- Faculty of Medicine, Hasselt University, Diepenbeek, Belgium
| | | | - Ivo Lambrichts
- Faculty of Medicine, Hasselt University, Diepenbeek, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium ; Faculty of Medicine, Hasselt University, Diepenbeek, Belgium
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The effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement in patients undergoing laparatomy. Pain Res Manag 2015; 20:179-82. [PMID: 25950425 PMCID: PMC4532202 DOI: 10.1155/2015/509474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For the treatment of postoperative pain, multimodal analgesia can reduce the side effects and required dose of opioids by combining drugs and methods with different modes of action. This study evaluated the efficacy of preoperative oral pregabalin and perioperative intravenous lidocaine in patients undergoing laparotomy. OBJECTIVES: To evaluate and compare the effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement, adverse effects, patients’ satisfaction, mobilization, time to first defecation and time to discharge in patients undergoing laparotomy. METHODS: Eighty patients (18 to 65 years of age) undergoing elective laparotomy were randomly divided into four groups (n=20 in each group): group C, placebo capsules and normal saline infusion perioperatively (control); group L, placebo capsules and lidocaine 1 mg/kg intravenous bolus dose followed by 2 mg/kg/h infusion until skin closure; group P, 150 mg oral pregabalin and normal saline infusion perioperatively; and group PL, 150 mg oral pregabalin and lidocaine 2 mg/kg/h infusion until skin closure. Hemodynamic parameters, visual analogue scale (VAS) scores, analgesic consumption, side effects, time to mobilization, time to first defecation, time to discharge and patients’ satisfaction were recorded. RESULTS: VAS scores of group L, group P and group PL were lower than group C (P<0.05). Morphine consumption of group P and group PL was lower than group C (P<0.05). Incidence of nausea in group C was higher than group L and group PL. Time to first defecation and mobilization were shorter in group L and group PL compared with group C (P<0.05). CONCLUSION: Preoperative oral pregabalin and perioperative intravenous lidocaine infusion decreased postoperative VAS scores. Preoperative oral pregabalin decreased morphine requirement and perioperative intravenous lidocaine infusion hastened gastrointestinal motility and mobilization, and decreased the incidence of nausea in patients undergoing laparotomy. Therefore, preoperative pregabalin with or without lidocaine provides superior pain relief in patients undergoing laparatomy.
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Pruskowski J, Arnold RM. Pregabalin in Palliative Care #288. J Palliat Med 2015; 18:299-300. [DOI: 10.1089/jpm.2015.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Donato F, Pavin NF, Goes ATR, Souza LC, Soares LC, Rodrigues OED, Jesse CR, Savegnago L. Antinociceptive and anti-hyperalgesic effects of bis(4-methylbenzoyl) diselenide in mice: evidence for the mechanism of action. PHARMACEUTICAL BIOLOGY 2015; 53:395-403. [PMID: 25489627 DOI: 10.3109/13880209.2014.922590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT The organoselenium compounds have been described to demonstrate several biological activities, including pain management. OBJECTIVE This study investigated the antinociceptive, hyperalgesic, and toxic effects of oral administration of bis(4-methylbenzoyl) diselenide (BMD) in mice. MATERIALS AND METHODS The antinociceptive and anti-hyperalgesic effects of BMD (1, 5, 10, 25, and 50 mg/kg, p.o.) were evaluated using models of nociception: formalin, capsaicin, bradykinin (BK), cinnamaldehyde, phorbol myristate acetate (PMA), 8-bromo-cAM, and glutamate-induced nociception; and mechanical hyperalgesia induced by carrageenan (Cg) or complete Freund's adjuvant (CFA). The acute toxicity was evaluated by biochemical markers for hepatic and renal damages. RESULTS BMD significantly inhibited the licking time of the injected paw in the early and late phases of a formalin test with ED50 values of 14.2 and 10.8 mg/kg, respectively. This compound reduced nociception produced by capsaicin (ED50 of 32.5 mg/kg), BK (ED50 of 24.6 mg/kg), glutamate (ED50 of 28.7 mg/kg), cinnamaldehyde (ED50 of 18.9 mg/kg), PMA (ED50 of 9.6 mg/kg), and 8-bromo-cAMP (ED50 of 24.8 mg/kg). In the glutamate test, the pretreatment with nitric oxide (NO) precursor, L-arginine, reversed antinociception caused by BMD or N(ω)-nitro-L-arginine (L-NOARG), but the effect of BMD was not abolished by naloxone. Mechanical hyperalgesia induced by Cg and CFA was attenuated by BMD, 70 ± 4% and 65 ± 4%, respectively. Furthermore, a single oral dose of BMD did not change plasma aspartate (AST) and alanine aminotransferase (ALT) activities or urea and creatinine levels. CONCLUSION BMD demonstrated as a promising compound because of the antinociceptive and anti-hyperalgesic properties in mice.
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Affiliation(s)
- Franciele Donato
- Departamento de Bioquímica, Universidade Federal do Pampa (UNIPAMPA), Campus Uruguaiana , Uruguaiana, RS , Brazil
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Abstract
Depression, anxiety, delirium, and other psychiatric symptoms are highly prevalent in the cancer setting, and pharmacological intervention is an important component in the overall psychosocial care of the patient. Psychopharmacology is also used as a primary or adjuvant treatment for the management of cancer-related symptoms stemming from the disease itself and/or its treatment, including sleep disturbance, loss of appetite, neuropathic pain, nausea, fatigue, and hot flashes. Psychiatrists, oncologists, and palliative care physicians working as members of a multidisciplinary team have the opportunity to target multiple symptoms that negatively affect a patient's quality of life with the strategic use of psychotropic medications when deemed appropriate. This article aims to review the indications for use of antidepressants, psychostimulants, anxiolytics, antipsychotics, and mood stabilizers in oncology. An updated review of the relevant literature is discussed and referenced in each section.
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Affiliation(s)
- Seema M Thekdi
- The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1454, Houston, TX, 77230-1402, USA,
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Zúñiga-Romero A, Ponce-Chávez MK, Gauthereau-Torres MY, Ortega-Varela LF. Combination of diacerhein and antiepileptic drugs after local peripheral, and oral administration in the rat formalin test. Drug Dev Res 2014; 75:510-20. [PMID: 25418935 DOI: 10.1002/ddr.21232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/06/2014] [Indexed: 11/07/2022]
Abstract
Preclinical Research The present study was designed to evaluate the possible antinociceptive interaction between diacerhein and some antiepileptic drugs (carbamazepine, topiramate and gabapentin) on formalin-induced nociception. Diacerhein, each of the antiepileptics or a fixed dose-ratio combination of these drugs was assessed after local peripheral and oral administration in rats. lsobolographic analyses were used to define the interaction between drugs. Diacerhein, antiepileptic drugs (carbamazepine, topiramate and gabapentin) or their combinations yielded a dose-dependent antinociceptive effect when administered by both routes. Theoretical ED30 values for the combination estimated from the isobolograms were obtained as follows: diacerhein-carbamazepine (85.99 ± 7.07 μg/paw; 56.53 ± 4.56 mg/kg po), diacerhein-topiramate (197.97 ± 22.90 μg/paw; 13.06 ± 2.44 mg/kg po) and diacerhein-gabapentin (96.87 ± 17.73 μg/paw; 17.90 ± 4.70 mg/kg p.o.) for the local peripheral and oral administration routes, respectively. These values were significantly higher than the experimentally obtained ED30 values: diacerhein-carbamazepine (49.33 ± 3.37 μg/paw; 35.49 ± 7.91 mg/kg po), diacerhein-topiramate (133.00 ± 39.10 μg/paw; 8.87 ± 1.46 mg/kg po) and diacerhein-gabapentin (70.98 ± 14.73 μg/paw; 10.95 ± 3.23 mg/kg po). The combinations produced their antinociceptive effects without motor impairment in the rotarod test indicating synergistic interactions with a good side effect profile.
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Affiliation(s)
- Angel Zúñiga-Romero
- Facultad de Químico-Farmacobiología, Universidad Michoacana de San Nicolás de Hidalgo, 58240, Morelia, Michoacán, México
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Face-to-face comparison of the predictive validity of two models of neuropathic pain in the rat: analgesic activity of pregabalin, tramadol and duloxetine. Eur J Pharmacol 2014; 735:17-25. [PMID: 24726848 DOI: 10.1016/j.ejphar.2014.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/24/2022]
Abstract
We compared the preclinical analgesic activity of three marketed drugs with different pharmacological properties, pregabalin, tramadol and duloxetine, described as effective against neuropathic pain in the clinic. These drugs were tested against evoked pain in two different neuropathic models in the rat, the Bennett (CCI) and the Chung (SNL) models. The selected endpoints were tactile allodynia, tactile hyperalgesia, heat hyperalgesia and cold allodynia. Although all three drugs displayed analgesic activity, the effects observed varied according to the behavioral evaluation. Pregabalin showed clear analgesic effects against cold allodynia and tactile hyperalgesia in both the CCI and Chung models. Tramadol was active against all four endpoints in the Chung model with similar effects in the CCI model, apart from tactile allodynia. Duloxetine inhibited tactile allodynia and heat hyperalgesia in both neuropathic pain models. It also displayed efficacy against tactile hyperalgesia in the CCI model and against cold allodynia in the Chung model. These data confirm that the CCI and the Chung models of neuropathic pain do not detect the activity of analgesics with the same sensitivity. Furthermore, the mode of stimulation (tactile or thermal) and the type of endpoint (allodynia or hyperalgesia) can further influence the observed efficacy of gold standards as well as novel compounds developed for treating neuropathic pain symptoms.
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Cummins TR, Rush AM. Voltage-gated sodium channel blockers for the treatment of neuropathic pain. Expert Rev Neurother 2014; 7:1597-612. [DOI: 10.1586/14737175.7.11.1597] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Guven M, Kahraman I, Koc F, Bozdemir H, Sarica Y, Gunay I. The conduction block produced by oxcarbazepine in the isolated rat sciatic nerve: a comparison with lamotrigine. Neurol Res 2013; 33:68-74. [DOI: 10.1179/016164110x12714125204191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sałat K, Librowski T, Nawiesniak B, Gluch-Lutwin M. Evaluation of analgesic, antioxidant, cytotoxic and metabolic effects of pregabalin for the use in neuropathic pain. Neurol Res 2013; 35:948-58. [PMID: 23816319 DOI: 10.1179/1743132813y.0000000236] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this research was to evaluate analgesic, antioxidant, metabolic, and cytotoxic effects of pregabalin (PGB), which is widely applied for the treatment of neuropathic pain syndromes in diabetic patients. METHODS We used the streptozotocin (STZ) model of painful diabetic neuropathy (PDN) in mice and we measured the effect of intraperitoneally administered PGB on tactile and thermal nociceptive thresholds in the von Frey and hot plate assays, respectively. The influence of PGB on the motor coordination of diabetic animals was investigated in the rotarod test. In vitro in HepG2 and 3T3-L1 cell lines cytotoxicity of PGB, its influence on glucose utilization, and lipid accumulation were assessed. The antioxidant capacity of PGB was evaluated spectrophotometrically using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical method. RESULTS Pregabalin was a very efficacious antiallodynic and analgesic drug capable of increasing the pain thresholds for tactile allodynia and thermal hyperalgesia in diabetic mice. In the von Frey test at a dose of 30 mg/kg it elevated the pain threshold for 168% versus diabetic control and in the hot plate test this dose prolonged the latency time to pain reaction for 130% versus control value of diabetic mice. No motor deficits were observed in PGB-treated diabetic animals. In vitro PGB did not influence glucose utilization or lipid accumulation. No antioxidant or cytotoxic effects of PGB were observed at concentrations 1-100 μM. DISCUSSION AND CONCLUSION Our experiments demonstrated significant antiallodynic and analgesic properties of PGB in mice. In vitro studies showed that this drug is metabolically neutral. It did not cause motor coordination impairments in diabetic animals either. These effects might be of great importance for diabetic patients.
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Lau W, Dykstra C, Thevarkunnel S, Silenieks LB, de Lannoy IAM, Lee DKH, Higgins GA. A back translation of pregabalin and carbamazepine against evoked and non-evoked endpoints in the rat spared nerve injury model of neuropathic pain. Neuropharmacology 2013; 73:204-15. [PMID: 23747575 DOI: 10.1016/j.neuropharm.2013.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 11/27/2022]
Abstract
The purpose of the present study was twofold. First to characterize endpoints distinct to the reflexive responses to sensory stimuli typically used in neuropathic pain models. A second aim was to evaluate two clinically approved drugs carbamazepine (Tegretol) and pregabalin (Lyrica) against these endpoints with the purpose to backtranslate from the clinical to preclinical setting. The selected neuropathic pain model was the spared nerve injury (SNI) model and the endpoints were burrowing and measures of paw posture in Sprague Dawley rats. As previously described, SNI surgery produced a robust heightened sensitivity to tactile and thermal (cold) stimuli. SNI surgery also produced robust decreases in burrowing and affected multiple measures of paw position. There was no correlation between magnitude of change in burrowing and sensory allodynia within SNI operated rats. Pregabalin (10-30 mg/kg IP) produced a reliable reversal of both tactile and cold allodynia and also the burrowing deficit, with minimal effect on neurological function evaluated using rotorod, beam walking and open field activity. Pregabalin did not affect any measure of paw position. Pharmacokinetic studies conducted in satellite animals identified plasma levels of pregabalin at the 10 mg/kg IP dose to be equivalent to clinically efficacious levels recorded in neuropathic patients (3-6 μg/ml). In contrast carbamazepine (10-60 mg/kg IP) had only a very modest effect against a reflexive (tactile) measure, and no effect against the burrowing deficit. Carbamazepine also affected various measures of neurological function, complicating interpretation of the reflexive measure. Measurement of burrowing appears to detect a behavioural deficit associated with the SNI model, that may be attenuated by pregabalin but not carbamazepine. Overall the present findings support an advantage of pregabalin over carbamazepine in terms of both efficacy and tolerability which is consistent with clinical experience. The inclusion of additional endpoints beyond traditional reflexive behaviours further supports the value of rodent neuropathic pain models, such as the SNI, as behavioural assays to detect new chemical entities to treat this pain condition.
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Affiliation(s)
- W Lau
- InterVivo Solutions Inc., 120 Carlton Street, Toronto, ON M5A 4K2, Canada
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Abstract
BACKGROUND Neuropathic pain is difficult to treat. Oxcarbazepine is an anticonvulsant drug closely related to carbamazepine and is reportedly better tolerated. Oxcarbazepine has been reported to be efficacious in the treatment of neuropathic pain. OBJECTIVES To determine the benefits and harms of oxcarbazepine for different forms of neuropathic pain. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (30 October 2012), CENTRAL (2012, Issue 10), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012) and the Chinese Biomedical Retrieval System (January 1978 to October 2012) for trials. We also searched the National Institutes of Health (NIH) databases and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials, and wrote to the companies who make oxcarbazepine and to pain experts asking for additional information. SELECTION CRITERIA All randomised controlled trials and cross-over studies of oxcarbazepine for the treatment of people of any age or sex with any neuropathic pain were eligible. We planned to include trials of oxcarbazepine compared with placebo or any other intervention, regardless of administration route, dosage or length of treatment. DATA COLLECTION AND ANALYSIS Two review authors independently selected the studies for inclusion, assessed their risk of bias, extracted data and typed the data onto forms. The authors resolved any disagreements through discussion. MAIN RESULTS Four multicentre, randomised, placebo-controlled, double-blind trials with a total of 779 participants were eligible for inclusion. These were from a series of studies funded by the manufacturer. Three of them investigated oxcarbazepine in people with painful diabetic neuropathy (634 participants) and one was a trial of oxcarbazepine for neuropathic pain due to radiculopathy (145 participants). Although these trials were well designed, the imbalanced and large amount of incomplete outcome data led to a risk of bias in the results. Results for painful diabetic neuropathy showed that compared to the baseline the proportion of participants who reported a 50% or 30% reduction of pain scores after 16 weeks of treatment was significantly higher in the oxcarbazepine group than the placebo group (50% reduction: risk ratio (RR) 1.91, 95% confidence interval (CI) 1.08 to 3.39, number of people needed to treat for an additional beneficial outcome (NNTB) 6.0, 95% CI 3.3 to 41.0; 30% reduction: RR 1.57, 95% CI 1.01 to 2.44, NNTB 6.1, 95% CI 3.1 to 113.6). However, both results were based on data from the single positive trial (146 participants) since the two negative trials did not provide data that could be included in a meta-analysis. For participants with neuropathic pain due to radiculopathy, the trial demonstrated no significant efficacy for oxcarbazepine. Although trial reports stated that most side effects were mild to moderate in severity, the proportion of events leading to withdrawals was statistically higher in the oxcarbazepine group than in the placebo group both for painful diabetic neuropathy (RR 3.86, 95% CI 2.29 to 6.40) and radiculopathy (RR 2.84, 95% CI 1.55 to 5.23). AUTHORS' CONCLUSIONS On the basis of moderate quality evidence from one trial in diabetic peripheral neuropathy, oxcarbazepine is effective in reducing pain for this condition. However, this conclusion does not take into account negative results from other trials in diabetic peripheral neuropathy that could not be included in our meta-analysis. We did not find any evidence from randomised controlled trials to determine the efficacy or safety of oxcarbazepine for other kinds of neuropathic pain. Most adverse effects related to oxcarbazepine are rated as mild to moderate in severity, but adverse events leading to discontinuation of drug administration or serious adverse events are not uncommon. More well designed randomised controlled trials investigating oxcarbazepine for various types of neuropathic pain are needed.
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Affiliation(s)
- Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Monsalve GA. Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature. Surg Neurol Int 2012; 3:S290-311. [PMID: 23230534 PMCID: PMC3514920 DOI: 10.4103/2152-7806.103023] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 09/11/2012] [Indexed: 11/05/2022] Open
Abstract
Background: Facial chronic neuropathic pain (FCNP) is a disabling clinical entity, its incidence is increasing within the chronic pain population. There is indication for neuromodulation when conservative treatment fails. Motor cortex stimulation (MCS) has emerged as an alternative in the advanced management of these patients. The aim of this work is to review the worldwide literature on MCS for FCNP. Methods: A PubMed search from 1990 to 2012 was conducted using established MeSH words. A total of 126 relevant articles on MCS focused on chronic pain were selected and analysed. Series of cases were divided in (1) series focused on MCS for FCNP, and (2) MCS series of FCNP mixed with other chronic pain entities. Results: A total of 118 patients have been trialed for MCS for FCNP, 100 (84.7%) pursued permanent implantation of the system, and 84% of them had good pain control at the end of the study. Male: female ratio was about 1:2 in the whole group of studies; mean age was 58 years (range, 28–83), and mean pain duration was 7 years (range, 0.6–25). Four randomized controlled studies have been reported, all of them not focused on MCS for FCNP. The most common complication was seizure followed by wound infection. Preoperative evaluation, surgical techniques, and final settings varied among the series. Conclusion: MCS for FNCP is a safe and efficacious treatment option when previous managements have failed; however, there is still lack of strong evidence (larger randomized controlled multicentre studies) that MCS can be offered in a regular basis to FNCP patients.
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Zachariah JR, Rao AL, Prabha R, Gupta AK, Paul MK, Lamba S. Post burn pruritus—A review of current treatment options. Burns 2012; 38:621-9. [DOI: 10.1016/j.burns.2011.12.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 11/01/2011] [Accepted: 12/10/2011] [Indexed: 11/29/2022]
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Abstract
Many dermatological disorders have a psychosomatic or behavioral aspect. Skin and brain continually interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly affect the initiation or flaring of skin disorders. It is important to consider these mind-body interactions when planning treatments for specific skin disorders in individual patients. Mind-influencing therapeutic options that can enhance treatment of skin disorders include standard psychotropic drugs, alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When individual measures do not produce the desired results, combinations of drugs or addition of non-drug therapies may be more successful. Psychophysiological skin disorders may respond well to non-drug and drug therapies that counteract stress. Treatment of primary psychiatric disorders often results in improvement of associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment. Therapeutic options for each of these are discussed.
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Affiliation(s)
- Philip D Shenefelt
- Department of Dermatology and Cutaneous Surgery, College of Medicine, University of South Florida, Tampa, FL 33612, USA.
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Analgesic, anticonvulsant and antioxidant activities of 3-[4-(3-trifluoromethyl-phenyl)-piperazin-1-yl]-dihydrofuran-2-one dihydrochloride in mice. Pharmacol Biochem Behav 2011; 101:138-47. [PMID: 22227221 DOI: 10.1016/j.pbb.2011.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 11/21/2022]
Abstract
Recently we have shown that 3-[4-(3-trifluoromethyl-phenyl)-piperazin-1-yl]-dihydrofuran-2-one dihydrochloride (LPP1) is an antinociceptive and local anesthetic agent in rodents. Below an extended study of the pharmacological activity of LPP1 is described. In vitro LPP1 has no affinity for GABA(A), opioidergic μ and serotonergic 5-HT(1A) receptors. The total antioxidant capacity of LPP1 (1-10mM) measured as ABTS radical cation-scavenging activity showed that LPP1 has dose-dependent antioxidant properties in vitro. Low plasma concentration of this compound detected by means of HPLC method 30min after its intraperitoneal administration suggests a rapid conversion to metabolite(s) which may be responsible for its analgesic and anticonvulsant activities in vivo. In vivo the compound's influence on the electroconvulsive threshold and its activity in the maximal electroshock seizure test (MES) were evaluated. The results demonstrated that LPP1 had an anticonvulsant activity in the MES model (ED(50)=112mg/kg) and at a dose of 50mg/kg was able to elevate the electroconvulsive threshold for 8mA as compared to the vehicle-treated mice. The analgesic activity of LPP1 was investigated in the acetic acid-induced writhing test in two groups of mice: animals with sensory C-fibers ablated, and mice with C-fibers unimpaired. It proved the potent activity of this compound in both groups (approximately 85% as compared to the vehicle-treated mice). The adverse effects of LPP1 were evaluated as acute toxicity (LD(50)=747.8mg/kg) and motor coordination impairments in the rotarod and chimney tests. The results from these tests show that LPP1 at doses higher than 100mg/kg is likely to impair the motor performance of experimental animals. Concluding, LPP1 is an analgesic and anticonvulsant compound which has antioxidant properties in vitro. Further studies are necessary to assess whether the antioxidant activity and the receptor profiling demonstrated in vitro can be confirmed for its metabolite(s) that are formed in vivo.
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Chopra K, Kuhad A, Arora V. Neoteric pharmacotherapeutic targets in fibromyalgia. Expert Opin Ther Targets 2011; 15:1267-81. [DOI: 10.1517/14728222.2011.617366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fournier-Charrière E, Marec-Berard P, Schmitt C, Delmon P, Ricard C, Rachieru P. Prise en charge des douleurs neuropathiques chez l’enfant : recommandations de bonne pratique clinique. Arch Pediatr 2011; 18:905-13. [DOI: 10.1016/j.arcped.2011.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/10/2011] [Indexed: 01/21/2023]
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Pregabalin in severe burn injury pain: A double-blind, randomised placebo-controlled trial. Pain 2011; 152:1279-1288. [DOI: 10.1016/j.pain.2011.01.055] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 11/23/2022]
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Antiepileptic drugs in the treatment of psychiatric disorders. Epilepsy Behav 2011; 21:1-11. [PMID: 21498130 DOI: 10.1016/j.yebeh.2011.03.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/05/2011] [Accepted: 03/08/2011] [Indexed: 11/20/2022]
Abstract
The clinical interface between psychiatry and neurology is epilepsy; the pharmacological expression of this interface is antiepileptic drugs (AEDs), as they are used to treat both epilepsy and psychiatric disorders, especially bipolar disorders. The prevalence of psychiatric comorbidity and the risk of suicidal behavior/ideation/suicide are markedly increased in patients with epilepsy (PWE). Though AEDs receive initial indications for the treatment of epilepsy, currently the majority of AEDs are used to treat pain and psychiatric disorders. Thus in selecting the appropriate AEDs for treatment of PWE, consideration should be given to which AEDs best treat the epileptic disorder and the psychiatric comorbidity. This review is an overview of 21 AEDs in which negative psychotropic properties, approved indications in psychiatry, off-label studied uses in psychiatry, and principal uses in psychiatry are presented with literature review. A total of 40 psychiatric uses have been identified. Of the 21 AEDs reviewed, only 5 have U.S. Food and Drug Administration and/or European Medicines Agency psychiatric approval for limited uses; the majority of AEDs are used off-label. Many of these off-label uses are based on case reports, open-label studies, and poorly controlled or small-sample-size studies. In some instances, off-label use persists in the face of negative pivotal trials. Further placebo-controlled (augmentation and monotherapy) parallel-arm research with active comparators is required in the complex field of AED treatment of psychiatric disorders to minimize the treatment gap not only for PWE with psychiatric disorders, but also for psychiatric patients who would benefit from properly studied AEDs while minimizing adverse effects.
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Balaban CD, Jacob RG, Furman JM. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Rev Neurother 2011; 11:379-94. [PMID: 21375443 PMCID: PMC3107725 DOI: 10.1586/ern.11.19] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The comorbidity among balance disorders, anxiety disorders and migraine has been studied extensively from clinical and basic research perspectives. From a neurological perspective, the comorbid symptoms are viewed as the product of sensorimotor, interoceptive and cognitive adaptations that are produced by afferent interoceptive information processing, a vestibulo-parabrachial nucleus network, a cerebral cortical network (including the insula, orbitofrontal cortex, prefrontal cortex and anterior cingulate cortex), a raphe nuclear-vestibular network, a coeruleo-vestibular network and a raphe-locus coeruleus loop. As these pathways overlap extensively with pathways implicated in the generation, perception and regulation of emotions and affective states, the comorbid disorders and effective treatment modalities can be viewed within the contexts of neurological and psychopharmacological sites of action of current therapies.
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Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet 2011; 49:661-9. [PMID: 20818832 DOI: 10.2165/11536200-000000000-00000] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pregabalin and gabapentin share a similar mechanism of action, inhibiting calcium influx and subsequent release of excitatory neurotransmitters; however, the compounds differ in their pharmacokinetic and pharmacodynamic characteristics. Gabapentin is absorbed slowly after oral administration, with maximum plasma concentrations attained within 3-4 hours. Orally administered gabapentin exhibits saturable absorption--a nonlinear (zero-order) process--making its pharmacokinetics less predictable. Plasma concentrations of gabapentin do not increase proportionally with increasing dose. In contrast, orally administered pregabalin is absorbed more rapidly, with maximum plasma concentrations attained within 1 hour. Absorption is linear (first order), with plasma concentrations increasing proportionately with increasing dose. The absolute bioavailability of gabapentin drops from 60% to 33% as the dosage increases from 900 to 3600 mg/day, while the absolute bioavailability of pregabalin remains at > or = 90% irrespective of the dosage. Both drugs can be given without regard to meals. Neither drug binds to plasma proteins. Neither drug is metabolized by nor inhibits hepatic enzymes that are responsible for the metabolism of other drugs. Both drugs are excreted renally, with elimination half-lives of approximately 6 hours. Pregabalin and gabapentin both show dose-response relationships in the treatment of postherpetic neuralgia and partial seizures. For neuropathic pain, a pregabalin dosage of 450 mg/day appears to reduce pain comparably to the predicted maximum effect of gabapentin. As an antiepileptic, pregabalin may be more effective than gabapentin, on the basis of the magnitude of the reduction in the seizure frequency. In conclusion, pregabalin appears to have some distinct pharmacokinetic advantages over gabapentin that may translate into an improved pharmacodynamic effect.
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Treatment of post-burn neuropathic pain: Evaluation of pregablin. Burns 2010; 36:769-72. [DOI: 10.1016/j.burns.2009.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 05/04/2009] [Accepted: 05/29/2009] [Indexed: 11/18/2022]
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Kaufman KR. Lamotrigine and hemodialysis in bipolar disorder: case analysis of dosing strategy with literature review. Bipolar Disord 2010; 12:446-9. [PMID: 20636643 DOI: 10.1111/j.1399-5618.2010.00818.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Medical conditions and associated procedures/treatments may impact therapeutic blood levels of pharmacologic agents in the illnesses we treat. The use of anti-epileptic drugs in the treatment of psychiatric disorders, most commonly bipolar disorders, and epilepsy is a case in point. This report addresses the impact of hemodialysis on lamotrigine efficacy in bipolar disorder. METHOD Case analysis with literature review. RESULTS A bipolar disorder patient stabilized on lamotrigine 200 mg total daily dose was admitted to the hospital with end-stage renal disease. With three consecutive days of hemodialysis, treatment-emergent hypomanic features were noted by the patient and confirmed in psychiatric consultation. When lamotrigine was increased to 250 mg total daily dose, the bipolar features remitted. CONCLUSION Lamotrigine titration may be required in bipolar disorder patients undergoing hemodialysis secondary to the associated hemodialysis extraction factor. Therapeutic drug monitoring is recommended in these patients.
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Affiliation(s)
- Kenneth R Kaufman
- Departments of Psychiatry, Neurology, and Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
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Scrivani S, Wallin D, Moulton EA, Cole S, Wasan AD, Lockerman L, Bajwa Z, Upadhyay J, Becerra L, Borsook D. A fMRI evaluation of lamotrigine for the treatment of trigeminal neuropathic pain: pilot study. PAIN MEDICINE 2010; 11:920-41. [PMID: 20492571 DOI: 10.1111/j.1526-4637.2010.00859.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Using functional magnetic resonance imaging (fMRI) methods, we evaluated the effects of lamotrigine vs placebo in a double-blind 1:1 randomized trial. Six patients with neuropathic pain were recruited for the study. All subjects had baseline pain >4/10 on a visual analog scale (VAS) and allodynia to brush as inclusion criteria for the study. Patients underwent two fMRI sessions, with half of the subjects receiving placebo first and half receiving drug first (based on the blinding protocol). Lamotrigine decreased their average pain intensity level from 5.6 to 3.5 on a VAS. All subjects had brush, cold, and heat applied to the affected and mirror-unaffected sides of their face. The results show: 1) in a small cohort, lamotrigine had a significant effect on heat VAS but not on the other stimuli; and 2) contrast analysis of fMRI results for heat stimuli applied to the affected face for lamotrigine vs placebo produced an overall decrease in blood oxygen dependent level signal, suggesting a potential inhibitory effect of the drug on predominantly cortical regions (frontal, parietal, and temporal).
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Affiliation(s)
- Steven Scrivani
- P.A.I.N. Group, Brain Imaging Center, McLean Hospital, Belmont, MA 02478, USA.
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Abstract
Neuropathic pain, a severe chronic pain condition characterized by a complex pathophysiology, is a largely unmet medical need. Ion channels, which underlie cell excitability, are heavily implicated in the biological mechanisms that generate and sustain neuropathic pain. This review highlights the biological evidence supporting the involvement of voltage-, proton- and ligand-gated ion channels in the neuropathic pain setting. Ion channel modulators at different research or development stages are reviewed and referenced. Ion channel modulation is one of the main avenues to achieve novel, improved neuropathic pain treatments. Voltage-gated sodium and calcium channel and glutamate receptor modulators are likely to produce new, improved agents in the future. Rationally targeting subtypes of known ion channels, tackling recently discovered ion channel targets or combining drugs with different mechanism of action will be primary sources of new drugs in the longer term.
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