Conservative Treatment of Peripheral Neuropathy and Neuropathic Pain

Francis, D. A.; Christopher, Anne T.; Beasley, Bradley D

doi:10.1016/j.cpm.2006.04.004

Cited by 5 publications

(3 citation statements)

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“…At present, neuropathic pain is treated by using a variety of different medications (e.g., antidepressants, gabapentin, pregabalin, opioids) with mechanisms of action that include inhibiting serotonin and norepinephrine uptake, altering ion channel transport, and occupying N-methyl-D-aspartate receptors (Nurmikko and Haanpä ä , 2005;Chong and Brandner, 2006;Francis et al, 2006;Gilron et al, 2006;Jackson 2006;Stillman, 2006). The current treatments for neuropathic pain achieve some relief; however, there remains significant room for improvement (Harden and Cohen, 2003).…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic–Pharmacodynamic Analysis of the Static Allodynia Response to Pregabalin and Sildenafil in a Rat Model of Neuropathic Pain

Bender¹,

Florian²,

Bramwell³

et al. 2010

The Journal of Pharmacology and Experimental Therapeutics

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The objective of this study was to develop a pharmacokineticpharmacodynamic (PK-PD) model of the static allodynia response to pregabalin with and without sildenafil in a chronic constriction injury model of neuropathic pain. Six treatment groups were evaluated every 30 min for 6 h. Rats were treated with either 1) a saline infusion; 2) a 2-h pregabalin infusion at 4 mg⅐kg Ϫ1 ⅐h Ϫ1 ; 3) a 2-h pregabalin infusion at 10 mg⅐kg Ϫ1 ⅐h Ϫ1 ; 4) a 2.2-mg loading dose ϩ 12 mg⅐kg Ϫ1 ⅐min Ϫ1 infusion of sildenafil; 5) a 2-h pregabalin infusion at 1.6 mg⅐kg Ϫ1 ⅐h Ϫ1 with sildenafil; and 6) a 2-h infusion of pregabalin at 4 mg⅐kg Ϫ1 ⅐h with sildenafil. The static allodynia endpoint was modeled by using three population PD approaches: 1) the behavior of the injured paw using a three-category ordinal logistic regression model; 2) paw withdrawal threshold (PWT) (g) between the injured and uninjured paw using the Hill equation with a baseline function; and 3) the baseline normalized difference in PWT between the injured and uninjured paw. The categorical model showed a significant shift in the concentration-response relationship of pregabalin to lower concentrations with concomitant sildenafil. Likewise, the continuous PK-PD models demonstrated a reduction in the EC 50 of pregabalin necessary for PD response in the presence of sildenafil. The difference-transformed PD model resulted in a 54.4% (42.3-66.9%) decrease in EC 50 , whereas the percentage-transformed PD model demonstrated a 53.5% (42.7-64.3%) shift. It is concluded from these studies that there is a synergistic PD interaction between pregabalin and sildenafil.Neuropathic pain represents an area of largely unmet medical need with significant impact on health-related quality of life (Jensen et al., 2007). At present, neuropathic pain is treated by using a variety of different medications (e.g., antidepressants, gabapentin, pregabalin, opioids) with mechanisms of action that include inhibiting serotonin and norepinephrine uptake, altering ion channel transport, and occupying N-methyl-D-aspartate receptors (Nurmikko and Haanpä ä , 2005;Chong and Brandner, 2006;Francis et al., 2006;Gilron et al., 2006;Jackson 2006;Stillman, 2006). The current treatments for neuropathic pain achieve some relief; however, there remains significant room for improvement (Harden and Cohen, 2003). An intriguing question is whether increased relief can be obtained by using rational combinations of drugs (Gilron and Max, 2005;Backonja et al., 2006). The optimization of a rational drug combination represents a major challenge, because it involves not only the selection of the appropriate combination of drugs, each with a different mechanism of action, but also the optimal doses for using those drugs. The overall goal of this project was to develop a pharmacokinetic-pharmacodynamic (PK-PD) model describing the interaction between pregabalin and sildenafil in rats.Pregabalin is a ligand to the ␣ 2 ␦ subunit of the voltagegated calcium channel. Avid binding at this site reduces calcium influx at...

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Section: Introductionmentioning

confidence: 99%

Pharmacokinetic–Pharmacodynamic Analysis of the Static Allodynia Response to Pregabalin and Sildenafil in a Rat Model of Neuropathic Pain

Bender¹,

Florian²,

Bramwell³

et al. 2010

The Journal of Pharmacology and Experimental Therapeutics

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“…Консервативное лечение нейропатии седалищного нерва является методом выбора при сохранении анатомической целостности нерва [3], однако при его неэффективности прибегают к оператив-ному вмешательству -невролизу и ревизии седалищного нерва, который, как правило, выполняется открытым способом. Открытый доступ к седалищному нерву в области подгрушевидного отверстия является достаточно травматичным, что обусловлено значительным кожным разрезом и отсечением большой ягодичной мышцы от большого вертела.…”

Section: обоснованиеunclassified

A rare complication after endoscopic neurolysis of the sciatic nerve: а clinical case

Belyak

2023

Journal of Clinical Practice

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Introduction: еndoscopic neurolysis of sciatic nerve has recommended itself as a low traumatic and effective technique of treatment of deep gluteal pain syndrome and sciatic nerve neuropathy. There were no publications dedicated to parietal peritoneum damage after endoscopic sciatic nerve decompression till now. Goal of the study: analyze and describe clinical case from practice related to complication after endoscopic sciatic nerve decompression. Material and methods: 70-years old female patient with deep gluteal pain syndrome and sciatic nerve neuropathy on the right side. Conservative treatment was uneffective. According to VAS scale severity of pain syndrome was 10 cm. Severity of motor dysfunction according to BMRC scale was 4 points. Severity of sensitive dysfunction according to Seddon scale was 3 points. Functional activity of the lower limb according to LEFS scale was 48 points. Instrumental investigation of the sciatic nerve were MRI, ultrasound, ENMG. Surgical technique: endoscopic sciatic nerve decompression was performed in prone position with saline irrigation using the technique which was published before. Post-surgery situation: ultrasound and CT-scan were performed to the patient after the surgery, what determined presence of free fluid in abdominal cavity, edema of right retroperitoneal space. The patient underwent laparoscopy, where was found the area of parietal peritoneum damage in lower floor, free saline fluid was detached in abdominal cavity, which was evacuated. Results: the patient was discharged from the hospital at 10th day after surgery. 6 months after surgery functional activity of the lower extremity according to LEFS scale was 52 points. Pain syndrome according to VAS scale was 8 points. Severity of motor dysfunction according to BMRC scale was 4 points. Severity of sensitive dysfunction according to Seddon scale was 3 points. The ineffective result of surgical endoscopic treatment was stated. Conclusion: method of endoscopic sciatic nerve decompression with saline pumping is effective and low-traumatic technique but, however, has a risk of complications. We described a rare complication case of damaging parietal peritoneum, penetrating saline to abdominal cavity, edema of retroperitoneal space. For decreasing the risk of this complication it is necessary to follow special surgical conditions.

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“…This kind of disease is relatively common in life, and it not only brings a great economic burden to the patient's family but also affects the patient's physical and psychological health. NOP can be treated with minimally invasive therapy [ 7 ], surgery [ 8 ], and adjuvant analgesics [ 9 ], but people tend to be more receptive to treatments that are noninvasive and nondrug dependent [ 10 ]. In the vast majority of cases, neuropathic pain is not satisfactorily treated with traditional analgesics and is often resistant to opioids, so most patients are reluctant to receive such treatment [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation on Patients with Neuropathic Orofacial Pain: A Systematic Review of Randomized Controlled Trials

et al. 2022

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Background. Repetitive transcranial magnetic stimulation (rTMS) has been widely used in the treatment of neuropathic orofacial pain (NOP). The consistency of its therapeutic efficacy with the optimal protocol is highly debatable. Objective. To assess the effectiveness of rTMS on pain intensity, psychological conditions, and quality of life (QOL) in individuals with NOP based on randomized controlled trials (RCTs). Methods. We carefully screened and browsed 5 medical databases from inception to January 1, 2022. The study will be included that use of rTMS as the intervention for patients with NOP. Two researchers independently completed record retrieval, data processing, and evaluation of methodological quality. Quality and evidence were assessed using the PEDro scores and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results. Six RCTs with 214 participants were included in this systematic review: 2 studies were considered level 1 evidence, and 4 were considered level 2 evidence. Six studies found that high-frequency rTMS had a pain-relieving effect, while 4 studies found no improvement in psychological conditions and QOL. Quality of evidence (GRADE system) ranged from moderate to high. No significant side effects were found. Conclusions. There is moderate-to-high evidence to prove that high-frequency rTMS is effective in reducing pain in individuals with NOP, but it has no significant positive effect on psychological conditions and QOL. High-frequency rTMS can be used as an alternative treatment for pain in individuals with NOP, but further studies will be conducted to unify treatment parameters, and the sample size will be expanded to explore its influence on psychological conditions and QOL.

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Conservative Treatment of Peripheral Neuropathy and Neuropathic Pain

Cited by 5 publications

References 53 publications

Pharmacokinetic–Pharmacodynamic Analysis of the Static Allodynia Response to Pregabalin and Sildenafil in a Rat Model of Neuropathic Pain

Pharmacokinetic–Pharmacodynamic Analysis of the Static Allodynia Response to Pregabalin and Sildenafil in a Rat Model of Neuropathic Pain

A rare complication after endoscopic neurolysis of the sciatic nerve: а clinical case

The Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation on Patients with Neuropathic Orofacial Pain: A Systematic Review of Randomized Controlled Trials

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