Central Neuropathic Pain Syndromes: Current and Emerging Pharmacological Strategies

Gurba, Katharine N.; Chaudhry, Rida; Haroutounian, Simon

doi:10.1007/s40263-022-00914-4

Cited by 26 publications

(9 citation statements)

References 248 publications

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“…There are limited data to support the use of levetiracetam, lamotrigine, cannabinoids, lidocaine or mexiletine, or opioid medications. 28 One double-blind placebo randomized controlled trial suggested improvement of peripheral neuropathic pain with subcutaneous botulinum toxin injections, but these results need to be replicated. 29 There is a lack of strong evidence for transcranial magnetic stimulation, acupuncture, cognitive-behavioral therapy, or self-hypnosis, although these modalities can be considered for refractory cases.…”

Section: Key Pointsmentioning

confidence: 99%

“…Gabapentin, pregabalin, serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants are commonly used ( table 10-3 27 ), but pregabalin is the only FDA-approved medication for neuropathic pain due to spinal cord injury. There are limited data to support the use of levetiracetam, lamotrigine, cannabinoids, lidocaine or mexiletine, or opioid medications 28 . One double-blind placebo randomized controlled trial suggested improvement of peripheral neuropathic pain with subcutaneous botulinum toxin injections, but these results need to be replicated 29 .…”

Section: Neuropathic Painmentioning

confidence: 99%

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Symptomatic Treatment of Myelopathy

Chuang

2024

CONTINUUM: Lifelong Learning in Neurology

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Objective This article discusses the effects of myelopathy on multiple organ systems and reviews the treatment and management of some of these effects. Latest Developments Recent advances in functional electrical stimulation, epidural spinal cord stimulation, robotics, and surgical techniques such as nerve transfer show promise in improving function in patients with myelopathy. Ongoing research in stem cell therapy and neurotherapeutic drugs may provide further therapeutic avenues in the future. Essential Points Treatment for symptoms of spinal cord injury should be targeted toward patient goals. If nerve transfer for upper extremity function is considered, the patient should be evaluated at around 6 months from injury to assess for lower motor neuron involvement and possible time limitations of surgery. A patient with injury at or above the T6 level is at risk for autonomic dysreflexia, a life-threatening condition that presents with elevated blood pressure and can lead to emergent hypertensive crisis. Baclofen withdrawal due to baclofen pump failure or programming errors may also be life-threatening. Proper management of symptoms may help avoid complications such as autonomic dysreflexia, renal failure, heterotopic ossification, and fractures.

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Section: Key Pointsmentioning

confidence: 99%

Section: Neuropathic Painmentioning

confidence: 99%

Symptomatic Treatment of Myelopathy

Chuang

2024

CONTINUUM: Lifelong Learning in Neurology

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“…Neuropathic pain medication relives pain through strengthening descending inhibitory circuits [ 12 , 52 – 54 ]. We tested diverse neuropathic pain medications in our pain model.…”

Section: Resultsmentioning

confidence: 99%

Drosophila pain sensitization and modulation unveiled by a novel pain model and analgesic drugs

Jang

Cho

et al. 2023

PLoS ONE

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In mammals, pain is regulated by the combination of an ascending stimulating and descending inhibitory pain pathway. It remains an intriguing question whether such pain pathways are of ancient origin and conserved in invertebrates. Here we report a new Drosophila pain model and use it to elucidate the pain pathways present in flies. The model employs transgenic flies expressing the human capsaicin receptor TRPV1 in sensory nociceptor neurons, which innervate the whole fly body, including the mouth. Upon capsaicin sipping, the flies abruptly displayed pain-related behaviors such as running away, scurrying around, rubbing vigorously, and pulling at their mouth parts, suggesting that capsaicin stimulated nociceptors in the mouth via activating TRPV1. When reared on capsaicin-containing food, the animals died of starvation, demonstrating the degree of pain experienced. This death rate was reduced by treatment both with NSAIDs and gabapentin, analgesics that inhibit the sensitized ascending pain pathway, and with antidepressants, GABAergic agonists, and morphine, analgesics that strengthen the descending inhibitory pathway. Our results suggest Drosophila to possess intricate pain sensitization and modulation mechanisms similar to mammals, and we propose that this simple, non-invasive feeding assay has utility for high-throughput evaluation and screening of analgesic compounds.

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“…The small number of randomized clinical trials in CNP results in extrapolating data from studies conducted in other neuropathic pain syndromes. However, treatment responsiveness and efficacy are likely different [ 78 ]. In central post-stroke neuropathy, amitriptyline [ 79 ] and lamotrigine [ 80 ] have proven efficacy, whereas conflicting results have emerged from pregabalin [ 59 ].…”

Section: Central Neuropathic Pain Syndromesmentioning

confidence: 99%

Neuropathic Pain in the Emergency Setting: Diagnosis and Management

Doneddu,

Pensato,

Iorfida

et al. 2023

JCM

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Neuropathic pain, traditionally considered a chronic condition, is increasingly encountered in the emergency department (ED), accounting for approximately 20% of patients presenting with pain. Understanding the physiology and key clinical presentations of neuropathic pain is crucial for ED physicians to provide optimal treatment. While diagnosing neuropathic pain can be challenging, emphasis should be placed on obtaining a comprehensive medical history and conducting a thorough clinical examination. Patients often describe neuropathic pain as a burning or shock-like sensation, leading them to seek care in the ED after ineffective relief from common analgesics such as paracetamol and NSAIDs. Collaboration between emergency medicine specialists, neurologists, and pain management experts can contribute to the development of evidence-based guidelines specifically tailored for the emergency department setting. This article provides a concise overview of the common clinical manifestations of neuropathic pain that may prompt patients to seek emergency care.

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Central Neuropathic Pain Syndromes: Current and Emerging Pharmacological Strategies

Cited by 26 publications

References 248 publications

Symptomatic Treatment of Myelopathy

Symptomatic Treatment of Myelopathy

Drosophila pain sensitization and modulation unveiled by a novel pain model and analgesic drugs

Neuropathic Pain in the Emergency Setting: Diagnosis and Management

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