Intravenous patient-controlled analgesia hydromorphone combined with pregabalin for the treatment of postherpetic neuralgia: a multicenter, randomized controlled study

Investigational Drugs for the Treatment of Postherpetic Neuralgia: Systematic Review of Randomized Controlled Trials

The pharmacological treatment of postherpetic neuralgia (PHN) is unsatisfactory, and there is a clinical need for new approaches. Several drugs under advanced clinical development are addressed in this review. A systematic literature search was conducted in three electronic databases (Medline, Web of Science, Scopus) and in the ClinicalTrials.gov register from 1 January 2016 to 1 June 2023 to identify Phase II, III and IV clinical trials evaluating drugs for the treatment of PHN. A total of 18 clinical trials were selected evaluating 15 molecules with pharmacological actions on nine different molecular targets: Angiotensin Type 2 Receptor (AT2R) antagonism (olodanrigan), Voltage-Gated Calcium Channel (VGCC) α2δ subunit inhibition (crisugabalin, mirogabalin and pregabalin), Voltage-Gated Sodium Channel (VGSC) blockade (funapide and lidocaine), Cyclooxygenase-1 (COX-1) inhibition (TRK-700), Adaptor-Associated Kinase 1 (AAK1) inhibition (LX9211), Lanthionine Synthetase C-Like Protein (LANCL) activation (LAT8881), N-Methyl-D-Aspartate (NMDA) receptor antagonism (esketamine), mu opioid receptor agonism (tramadol, oxycodone and hydromorphone) and Nerve Growth Factor (NGF) inhibition (fulranumab). In brief, there are several drugs in advanced clinical development for treating PHN with some of them reporting promising results. AT2R antagonism, AAK1 inhibition, LANCL activation and NGF inhibition are considered first-in-class analgesics. Hopefully, these trials will result in a better clinical management of PHN.

Endogenous opiates and behavior: 2021

This paper is the forty-fourth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2021 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonizts and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).

Effect of Foot and Hand Massage on Abdominal Pain of Cesarean Section Incision under Ultrasound Guidance

In order to relieve the pain of incision after cesarean section, a method of foot and hand massage for abdominal pain of cesarean section incision under ultrasound guidance was proposed in this paper. In this paper, the experimental control method and retrospective analysis were used to relax the patients through massage, so that the pregnant women could focus on the reaction caused by hand and foot massage, distract their attention, and reduce the pain. The results showed that 60 cases of puerpera after cesarean section were divided into two groups with 30 cases in each group. The control group was only given routine care. The intervention group received 20 min hand and foot massage on the basis of routine care. The visual analog scale (VAS) of pain before, immediately after, 30 min after, and 60 min after massage in the intervention group was evaluated and recorded, and the VAS scores of the control group at the corresponding time points were recorded. The VAS score of the intervention group at each time point after massage was significantly lower than that before massage (P < 0.05), and the VAS score of the intervention group at each time point was significantly lower than that of the control group (P < 0.01). Hand and foot massage can effectively relieve incision pain after cesarean section.

Efficacy and Safety of Electroacupuncture for Pain Control in Herpes Zoster: A Systematic Review and Meta-Analysis

Introduction

Herpes zoster is caused by the reactivation of the latent varicella-zoster virus, which leads to acute pain that may disturb routine activities and affect patients' quality of life. Electroacupuncture (EA) has been commonly used for treating herpetic pain in clinical treatment. However, no relevant studies have been performed to evaluate the efficacy and safety of EA for acute control in herpetic neuralgia patients. The purpose of the current study was to conduct a systematic review and meta-analysis to address the deficiencies of the current research.

Methods

Three English (PubMed, Cochrane Library, and Web of Science) and four Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature database (CBM), Wan-fang database, and the Chinese Scientific Journals Full-text Database (VIP)) were comprehensively searched from inception to 31 December 2021. Two independent reviewers evaluated the retrieved data based on the eligibility criteria in advance. In addition, the Cochrane Risk of Bias Tool was used to assess the methodological quality of the included studies. Outcome indexes in this study included the visual analog scale, the time to cessation of pustules, the time to scabs, the time to rash healing, adverse reactions, and the incidence of postherpetic neuralgia. Sensitivity and subgroup analyses were also performed to evaluate the intervention effect specifically. In addition, publication bias was analyzed.

Results

Six randomized controlled trials (167 participants in the experimental groups and 174 participants in the control groups) were identified as reporting the application of EA for acute herpes zoster pain and were included in this study. The results from our meta-analysis revealed that EA was superior to control treatment according to visual analog scale, the time of rash healing, and the incidence of postherpetic neuralgia. However, in terms of the time to cessation of pustules, scabs, and adverse reactions, the results showed that EA compared with the control group showed no significant difference. In addition, subgroup analyses indicated that 2/100 Hz-EA has more significant effects on herpetic pain. Sensitivity analyses revealed that the results of EA for acute pain control and the rash healing time in herpetic neuralgia patients were stable. However, a publication bias was observed.

Conclusion

Our meta-analysis results showed that EA could offer certain advantages in treating acute pain in herpetic neuralgia patients. However, small sample sizes, heterogeneity in study design, and variable methodological quality weaken these inferences. In addition, weak evidence was found for the safety of EA.