Management of Chronic Neuropathic Pain with Single and Compounded Topical Analgesics

Knežević, Nebojša Nick; Tverdohleb, Tatiana; Nikibin, Farid; Knezevic, Ivana; Candido, Kenneth D.

doi:10.2217/pmt-2017-0020

Cited by 44 publications

(29 citation statements)

References 111 publications

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“…Neuropathic pain, a type of chronic and potentially disabling pain caused by disease or injury to the somatosensory nervous system and spinal cord, can be accompanied by various chronic conditions, such as viral infections (e.g., postherpetic neuralgia), autoimmune diseases, cancers, and metabolic disorders (e.g., diabetes mellitus); neuropathic pain is one of the most intense types of chronic pain, resulting in a major economic burden and a serious public health issue, with an estimated prevalence of 7-10% adults worldwide (Cohen and Mao, 2014;Knezevic et al, 2017). According to the underlying etiology and the anatomical location of the specific lesion, clinical neuropathic pain is divided into four main types, namely, painful peripheral neuropathies, central pain syndromes, complex painful neuropathic disorders, and mixed-pain syndromes (Baron, 2009;Binder and Baron, 2016).…”

Section: Neuropathic Painmentioning

confidence: 99%

Mechanisms of Dexmedetomidine in Neuropathic Pain

Zhao

et al. 2020

Front. Neurosci.

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Dexmedetomidin is a new-generation, highly selective α2 adrenergic receptor agonist with a large number of advantages, including its sedative and analgesic properties, its ability to inhibit sympathetic nerves, its reduced anesthetic dosage, its hemodynamic stability, its mild respiratory depression abilities, and its ability to improve postoperative recognition. Its safety and effectiveness, as well as its ability to provide a certain degree of comfort to patients, make it a useful anesthetic adjuvant for a wide range of clinical applications. For example, dexmedetomidine is commonly used in patients undergoing general anesthesia, and it also exerts sedative effects during tracheal intubation or mechanical ventilation in intensive care unit patients. In recent years, with the deepening of clinical research on dexmedetomidine, the drug is still applied in the treatment of spastic pain, myofascial pain, neuropathic pain, complex pain syndrome, and chronic headache, as well as for multimodal analgesia. However, we must note that the appropriateness of patient and dose selection should be given attention when using this drug; furthermore, patients should be observed for adverse reactions such as hypotension and bradycardia. Therefore, the safety and effectiveness of this drug for long-term use remain to be studied. In addition, basic experimental studies have also found that dexmedetomidine can protect important organs, such as the brain, heart, kidney, liver, and lung, through various mechanisms, such as antisympathetic effects, the inhibition of apoptosis and oxidative stress, and a reduction in the inflammatory response. Moreover, the neuroprotective properties of dexmedetomidine have received the most attention from scholars. Hence, in this review, we mainly focus on the characteristics and clinical applications of dexmedetomidine, especially the role of dexmedetomidine in the nervous system and the use of dexmedetomidine in the relief of neuropathic pain.

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Section: Neuropathic Painmentioning

confidence: 99%

Mechanisms of Dexmedetomidine in Neuropathic Pain

Zhao

et al. 2020

Front. Neurosci.

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“…Ketamine, in sub-anesthetic doses, produces a systemic analgesic effect in chronic pain, mainly due to the blockade of N-methyl-D-aspartate (NMDA) receptors in the central nervous system and inhibition of central sensitization processes [ 55 ]. NMDA receptors are also located in peripheral sensory afferent nerve endings and can contribute to pain signaling [ 56 ].…”

Section: Topical Agentsmentioning

confidence: 99%

Topical agents: a thoughtful choice for multimodal analgesia

Choi

Nahm

Han

et al. 2020

Korean J Anesthesiol

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For over a thousand years, various substances have been applied to the skin to treat pain. Some of these substances have active ingredients that we still use today. However, some have been discontinued due to their harmful effect, while others have been long forgotten. Recent concerns regarding the cardiovascular and renal risk from nonsteroidal anti-inflammatory drugs, and issues with opioids, have resulted in increasing demand and attention to non-systemic topical alternatives. There is increasing evidence of the efficacy and safety of topical agents in pain control. Topical analgesics are great alternatives for pain management and are an essential part of multimodal analgesia. This review aims to describe essential aspects of topical drugs that physicians should consider in their practice as part of multimodal analgesia. This review describes the mechanism of popular topical analgesics and also introduces the most recently released and experimental topical medications.

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“…A maximum of four patches are recommended. A patient must be informed that reactions, such as pain or burning, erythema, itch, and edema, may appear in the area where the patch is applied [11]. The adverse effects or disadvantages of capsaicin are as follows:

Transient burning pain, erythema, and itch in the area of patch application.

Adverse reactions are transient, self–limiting, and usually of mild or moderate intensity.

No neurologic function limitations were found, apart from periodic disturbed hot sensation in the area of patch application.

High price of the drug.

The lengthy time duration of a procedure (approximately 3 h).

…”

Section: Analgesics Administered Topicallymentioning

confidence: 99%

Transdermal and Topical Drug Administration in the Treatment of Pain

et al. 2018

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The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients’ age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non–steroidal anti–inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti–inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.

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Management of Chronic Neuropathic Pain with Single and Compounded Topical Analgesics

Cited by 44 publications

References 111 publications

Mechanisms of Dexmedetomidine in Neuropathic Pain

Mechanisms of Dexmedetomidine in Neuropathic Pain

Topical agents: a thoughtful choice for multimodal analgesia

Transdermal and Topical Drug Administration in the Treatment of Pain

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