Basal Heat Pain Thresholds Predict Opioid Analgesia in Patients with Postherpetic Neuralgia

Abstract

These findings, which will require replication, suggest that pretreatment assessment of heat pain sensitivity might prove useful in identifying those patients most likely to respond to opioids.

Lidocaine Patch (5%) in Treatment of Persistent Inguinal Postherniorrhaphy Pain

“…13,[24][25][26] Thus, Wasner et al 14 demonstrated a statistically significant pain relief of lidocaine patches in postherpetic neuralgia patients with impaired nociceptor function (heat hypoalgesia), but not in patients with preserved/sensitized nociceptor function. Results from the current study on the contrary suggest a possible analgesic effect of lidocaine patches in the subgroup of patients with preserved nociceptors (without thermal "hyposensitivity"), although statistical significance was not achieved.…”

Pain sensitivity: a feasible way to predict the intensity of stress reaction caused by endotracheal intubation and skin incision?

“…Edwards et al [6] reported that African Americans showed a lower pain threshold than White Americans, thus reporting a high frequency of chronic pain. In patients with post-herpetic neuralgia, heat pain threshold could predict the consumption of opioids and the response to opioid treatment [7]. Granot et al [8] also reported that a simple pre-operative test for pain can predict the intensity of pain after surgery and the use of analgesics, indicating that pain sensitivity can predict personalized medicine as a quantitative index.…”

A Paradigm-Shift in Pain Medicine

“…Taken together, these findings suggest that opioids given before nociceptive surgical input starts are able to sufficiently inhibit nociception (perhaps together with acute endogenous inhibitory responses) to prevent subsequent spinal central sensitisation and its progression up the neuraxis to become visible as spreading hyperalgesia. Conversely, opioids started after surgery are not sufficiently potent with regard to depressing established central sensitisation 103 to prevent its subsequent neuraxial spread and expression as spreading or generalised hyperalgesia. These results are in keeping with the neurophysiological evidence from animal experiments for the phenomenon of pre-emptive analgesia 25,72,175,184, and represent the first true clinical proof of its reality.…”

“…from skin to deeper tissues such as muscles. A further reason for detecting central sensitisation is therapeutic: there is accumulating evidence that central sensitisation, once established, responds increasingly poorly to "classic" analgesic measures such as opioid analgesia or peripheral nerve blockade, thus requiring own specific and targeted treatment approaches 103 . Thus the first alteration of pain processing which I considered the NASQ paradigm should target is the presence and spread of central sensitisation.…”