Comparative therapeutic evaluation of intrathecal versus epidural methylprednisolone for long-term analgesia in patients with intractable postherpetic neuralgia*1

Kikuchi, Atsuhiro; Kotani, Naoki; Sato, Tetsumi; Takamura, Kaori; Sakai, Ichiro; Matsuki, Akitomo

doi:10.1016/s1098-7339(99)90101-3

Cited by 48 publications

(23 citation statements)

References 25 publications

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“…Four trials were comparator studies without a placebo group and therefore could not be included in the meta-analysis. These trials compared amitriptyline to nortriptyline [30], amitriptyline to maprotiline [31], and intrathecal steroid to epidural steroid [17] and two doses of levorphanol [21]. Of the remaining 31 trials, we were able to extract dichotomous outcome data for efficacy meta-analysis from 25 (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…In the vast majority of trials, this was only until the end of the treatment period, with the exception of the intrathecal methylprednisolone studies [16,17] that reported follow-up periods to 24 wk and 2 y, and one study that examined amitriptyline and followed ten “good responders” for 2 y [31]. …”

Section: Resultsmentioning

confidence: 99%

“…with lidocaine 2% (5 ml) plus 60 mg of methylprednisolone administered epidurally was identified [17]. The lack of a placebo group dictated that this study could not be included in the meta-analysis, but the data revealed that the intrathecal treatment was associated with efficacy (50% pain reduction) in 92% (12/13) of patients whilst efficacy was seen in 17% (2/12) of patients who received the epidural treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Serial MRI scans were unchanged in all groups, and seven patients failed to complete the 2-y follow-up period, although no reasons were given for these withdrawals [16]. One patient who under went epidural injections had a cerebral haemorrhage 21 wk after injections, thought to be unrelated to treatment [17]. …”

Section: Resultsmentioning

confidence: 99%

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Analgesic Therapy in Postherpetic Neuralgia: A Quantitative Systematic Review

et al. 2005

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BackgroundPostherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic pain in general, the evidence base has been substantially enhanced by the recent publication of several major trials. Therefore, we have conducted a systematic review and meta-analysis for both efficacy and adverse events of analgesic therapy for PHN.Methods and FindingsWe systematically searched databases (MEDLINE 1966–2004, EMBASE 1988–2004, CINAHL 1982–2002, and PubMed [29 October 2004]) for trials of PHN. We also searched references of retrieved studies and review articles for further trials. We included trials that examined adult patients with PHN of greater duration than 3 mo, that were blinded, randomised, and had at least one measure of pain outcome. Dichotomous pain outcome data were extracted for 50% decrease in baseline pain using a hierarchy of pain/pain-relief measurement tools. Where available, dichotomous data were also collected for adverse events. Calculated estimates of efficacy included relative benefit and number needed to treat.Of 62 studies identified, 35 were randomised controlled trials. Of these, 31 were placebo controlled and suitable for meta-analysis, from which it was possible to extract dichotomous efficacy outcome data from 25.This meta-analysis revealed that there is evidence to support the use of the following orally administered therapies: tricyclic antidepressants, “strong” opioids, gabapentin, tramadol, and pregabalin. Topical therapies associated with efficacy were lidocaine 5% patch and capsaicin. Finally, a single study of spinal intrathecal administration of lidocaine and methyl prednisolone demonstrated efficacy, although this has yet to be replicated.Data suggest that the following therapies are not associated with efficacy in PHN: certain NMDA receptor antagonists (e.g., oral memantine, oral dextromethorphan, intravenous ketamine), codeine, ibuprofen, lorazepam, certain 5HT1 receptor agonists, and acyclovir. Topical administration of benzydamine, diclofenac/diethyl ether, and vincristine (iontophoresis) are similarly not associated with efficacy, nor are intrathecal administration of lidocaine alone or epidural administration of lidocaine and methylprednisolone, intravenous therapy with lidocaine, subcutaneous injection of Cronassial, or acupuncture. However, many of the trials that demonstrated a lack of efficacy represented comparatively low numbers of patient episodes or were single-dose studies, so it may be appropriate to regard such interventions as “not yet adequately tested” rather than demonstrating “no evidence of efficacy.” Topical aspirin/diethyl ether has not been adequately tested.ConclusionThe evidence base supports the oral use of tricyclic antidepressants, certain opioids, and gabapentinoids in PHN. Topical therapy with lidocaine patches and capsaicin is similarly supported. Intrathecal administration of m...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Analgesic Therapy in Postherpetic Neuralgia: A Quantitative Systematic Review

et al. 2005

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“…In the first, intrathecal administration of methylprednisolone was more effective than epidural administration [66], but the sample size was only 25 patients divided into the two arms. Subsequently, the same researchers reported efficacy over 1–2 years for four intrathecal injections of methylprednisolone and lidocaine performed over one month compared with lidocaine alone and with a no treatment control group [69].…”

Section: Peripheral Np Conditionsmentioning

confidence: 99%

Interventional management of neuropathic pain: NeuPSIG recommendations

Dworkin

O’Connor

Kent

et al. 2013

Pain

395

288

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Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group (NeuPSIG), the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central post-stroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: (1) epidural injections for herpes zoster; (2) steroid injections for radiculopathy; (3) SCS for FBSS; and (4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor RF lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available of data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials; long-term studies; and head-to-head comparisons among different interventional and non-interventional treatments.

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Platelet‐rich plasma and cytokines in neuropathic pain: A narrative review and a clinical perspective

Bohren

Timbolschi

Müller

et al. 2021

European Journal of Pain

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Background and Objective Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. A number of preclinical studies have provided evidence for the involvement of cytokines, predominantly secreted by a variety of immune cells and by glial cells from the nervous system, in neuropathic pain conditions. Clinical trials and the use of anti‐cytokine drugs in different neuropathic aetiologies support the relevance of cytokines as treatment targets. However, the use of such drugs, in particularly biotherapies, can provoke notable adverse effects. Moreover, it is challenging to select one given cytokine as a target, among the various neuropathic pain conditions. It could thus be of interest to target other proteins, such as growth factors, in order to act more widely on the neuroinflammation network. Thus, platelet‐rich plasma (PRP), an autologous blood concentrate, is known to contain a natural concentration of growth factors and immune system messengers and is widely used in the clinical setting for tissue regeneration and repair. Database and Data Treatment In the present review, we critically assess the current knowledge on cytokines in neuropathic pain by taking into consideration both human studies and animal models. Results This analysis of the literature highlights the pathophysiological importance of cytokines. We particularly highlight the concept of time‐ and tissue‐dependent cytokine activation during neuropathic pain conditions. Conclusion Thus, direct or indirect cytokines modulation with biotherapies or growth factors appears relevant. In addition, we discuss the therapeutic potential of localized injection of PRP as neuropathic pain treatment by pointing out the possible link between cytokines and the action of PRP. Significance Preclinical and clinical studies highlight the idea of a cytokine imbalance in the development and maintenance of neuropathic pain. Clinical trials with anticytokine drugs are encouraging but are limited by a 'cytokine candidate approach' and adverse effect of biotherapies. PRP, containing various growth factors, is a new therapeutic used in regenerative medicine. Growth factors can be also considered as modulators of cytokine balance. Here, we emphasize a potential therapeutic effect of PRP on cytokine imbalance in neuropathic pain. We also underline the clinical interest of the use of PRP, not only for its therapeutic effect but also for its safety of use.

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Comparative therapeutic evaluation of intrathecal versus epidural methylprednisolone for long-term analgesia in patients with intractable postherpetic neuralgia*1

Cited by 48 publications

References 25 publications

Analgesic Therapy in Postherpetic Neuralgia: A Quantitative Systematic Review

Analgesic Therapy in Postherpetic Neuralgia: A Quantitative Systematic Review

Interventional management of neuropathic pain: NeuPSIG recommendations

Platelet‐rich plasma and cytokines in neuropathic pain: A narrative review and a clinical perspective

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