Efficacy and safety of different drug treatments in patients with spinal-cord injury-related neuropathic pain: a network meta-analysis

Li, Mei; Fengqun, Mu; Zhengyao, Zuo; Mingming, Fan; Wang, Qing; Xiaozhuo, Liu; Dongpo, Su; Han, Qinghong; Chen, Tong

doi:10.1038/s41393-022-00804-y

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…160 A recent network meta-analysis found that opioids were more efficacious than placebo, but less efficacious than anticonvulsants, antidepressants, and local anesthetics. 161 The systematic review by Mehta et al 137 found negative evidence for cannabinoids in both spinal cord injury–neuropathic and spasticity-related pain.…”

Section: Treatmentmentioning

confidence: 99%

Pain in the Context of Sensory Deafferentation

Cohen,

Caterina,

Yang

et al. 2024

Anesthesiology

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Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.

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Section: Treatmentmentioning

confidence: 99%

Pain in the Context of Sensory Deafferentation

Cohen,

Caterina,

Yang

et al. 2024

Anesthesiology

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“…8 Although evidence of effective treatment by some drugs is strong, the effect size between desirable and undesirable effects is moderate to low. 8,9 Moreover, when post-SCI pain becomes chronic, treatment becomes further difficult. 10 Replacing or supplementing traditional pharmacological approaches with nonpharmacological interventions may be a potential choice for improving patient outcomes for NP.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…The treatment of NP following SCI is clinically challenging, 6,7 and NP is resistant to treatment with nonsteroidal anti‐inflammatory drugs and opioids 8 . Although evidence of effective treatment by some drugs is strong, the effect size between desirable and undesirable effects is moderate to low 8,9 . Moreover, when post‐SCI pain becomes chronic, treatment becomes further difficult 10 .…”

Section: Introductionmentioning

confidence: 99%

Photobiomodulation reduces neuropathic pain after spinal cord injury by downregulating CXCL10 expression

et al. 2023

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BackgroundMany studies have recently highlighted the role of photobiomodulation (PBM) in neuropathic pain (NP) relief after spinal cord injury (SCI), suggesting that it may be an effective way to relieve NP after SCI. However, the underlying mechanisms remain unclear. This study aimed to determine the potential mechanisms of PBM in NP relief after SCI.MethodsWe performed systematic observations and investigated the mechanism of PBM intervention in NP in rats after SCI. Using transcriptome sequencing, we screened CXCL10 as a possible target molecule for PBM intervention and validated the results in rat tissues using reverse transcription‐polymerase chain reaction and western blotting. Using immunofluorescence co‐labeling, astrocytes and microglia were identified as the cells responsible for CXCL10 expression. The involvement of the NF‐κB pathway in CXCL10 expression was verified using inhibitor pyrrolidine dithiocarbamate (PDTC) and agonist phorbol‐12‐myristate‐13‐acetate (PMA), which were further validated by an in vivo injection experiment.ResultsHere, we demonstrated that PBM therapy led to an improvement in NP relative behaviors post‐SCI, inhibited the activation of microglia and astrocytes, and decreased the expression level of CXCL10 in glial cells, which was accompanied by mediation of the NF‐κB signaling pathway. Photobiomodulation inhibit the activation of the NF‐κB pathway and reduce downstream CXCL10 expression. The NF‐κB pathway inhibitor PDTC had the same effect as PBM on improving pain in animals with SCI, and the NF‐κB pathway promoter PMA could reverse the beneficial effect of PBM.ConclusionsOur results provide new insights into the mechanisms by which PBM alleviates NP after SCI. We demonstrated that PBM significantly inhibited the activation of microglia and astrocytes and decreased the expression level of CXCL10. These effects appear to be related to the NF‐κB signaling pathway. Taken together, our study provides evidence that PBM could be a potentially effective therapy for NP after SCI, CXCL10 and NF‐kB signaling pathways might be critical factors in pain relief mediated by PBM after SCI.

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“…Por la posibilidad de adicción, dependencia o abuso, y empeoramiento de la constipación, no se recomiendan los opioides como tratamiento de primera línea, sino los gabapentinoides que poseen una calidad de la evidencia alta y nivel de recomendación fuerte a favor, seguidos por la amitriptilina o la oxcarbazepina en el caso que los primeros no sean efectivos 31,32 . Con los gabapentinoides se debe tener presente que existe la posibilidad de abuso por parte del paciente, por los efectos eufóricos y las propiedades disociativas de dichos medicamentos 33 .…”

Section: Instauración De Tratamientos Y Pronósticounclassified

Dolor en la persona con lesión medular

Salinas-Durán

2022

Rev Col Med Fis Rehab

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El dolor es una complicación frecuente luego de una lesión medular y afecta la calidad de vida de la persona que lo sufre. Puede ser de causa musculoesquelética, visceral o, el más difícil de tratar, el neuropático. Este artículo resume los distintos tipos de dolor, su fisiopatología y las opciones terapéuticas, tanto farmacológicas como de otros tipos, que se le pueden ofrecer al paciente.

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Efficacy and safety of different drug treatments in patients with spinal-cord injury-related neuropathic pain: a network meta-analysis

Cited by 8 publications

References 37 publications

Pain in the Context of Sensory Deafferentation

Pain in the Context of Sensory Deafferentation

Photobiomodulation reduces neuropathic pain after spinal cord injury by downregulating CXCL10 expression

Dolor en la persona con lesión medular

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