Neuropathic pain

Hurley, Robert W.; Adams, Meredith C.B.; Benzon, Honorio T.

doi:10.1097/aco.0b013e328363b4bf

Cited by 34 publications

(8 citation statements)

References 54 publications

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“…The efficacy of gabapentin in relieving neuropathic pain has been proven in many studies and is recommended as a first-line treatment [22, 23, 25]. Because of this, our study was designed as a noninferiority trial.…”

Section: Discussionmentioning

confidence: 99%

Gabapentin versus Transdermal Fentanyl Matrix for the Alleviation of Chronic Neuropathic Pain of Radicular Origin: A Randomized Blind Multicentered Parallel-Group Noninferiority Trial

Hwang

Lee

Min

et al. 2019

Pain Research and Management

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A number of studies have been published proposing various approaches to the treatment of neuropathic pain; however, to our knowledge, no attempts have been made to compare gabapentin and fentanyl in patients with lumbar radiculopathy. We evaluated the relative efficacy and safety of fentanyl matrix and gabapentin for the treatment of chronic neuropathic pain of radicular origin. The study was designed as a randomized blind multicentered parallel-group noninferiority trial. A total of 108 patients with moderate-to-severe pain (≥4 intensity on an 11-point numeric rating scale) were randomly prescribed either fentanyl matrix or gabapentin over a period of 56 days. In the primary analysis, the noninferiority of fentanyl matrix treatment was evaluated in relation to the efficacy of gabapentin based on the pain intensity difference (PID) at 56 days after the first dose of the drugs. Secondary endpoints included pain relief, improvement in functional status (the Korean-Oswestry Disability Index (K-ODI)), improvement in depressive symptoms (Korean-Beck Depression Index (K-BDI)) between the 28th and 56th day, and adverse events (AEs). Analysis of the primary efficacy endpoint established the noninferiority of fentanyl matrix compared with gabapentin, with no statistically significant difference observed in the PID after 56 days for the two treatment groups. Similarly, analysis of pain relief revealed no significant differences between the groups on days 28 and 56. There was no difference in the K-ODI and K-BDI between the groups during the study period. The overall incidence of at least one AE was similar for fentanyl matrix (67.3%) and gabapentin (69.6%). The most commonly reported AEs for patients treated with fentanyl matrix and gabapentin included dizziness (30.8% vs. 44.6%, respectively), somnolence (26.9% vs. 35.7%), and constipation (15.4% vs. 17.9%). This study demonstrated that the analgesic effect of fentanyl matrix is noninferior in comparison with gabapentin and supports the use of fentanyl matrix as an effective and safe treatment for moderate-to-severe chronic neuropathic pain. This trial is registered with NCT01127100.

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Section: Discussionmentioning

confidence: 99%

Gabapentin versus Transdermal Fentanyl Matrix for the Alleviation of Chronic Neuropathic Pain of Radicular Origin: A Randomized Blind Multicentered Parallel-Group Noninferiority Trial

Hwang

Lee

Min

et al. 2019

Pain Research and Management

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“…The presence of neuropathic pain was predicated on subjects' reports of the above symptoms (e.g. dysesthesia, hyperalgesia, allodynia) together confirmation of frequency, duration and severity together with a plausible anatomic distribution [19,20]. MNPs were diagnosed in patients with a discernible anatomic localization and pattern (e.g.…”

Section: Patient Cohortmentioning

confidence: 99%

Predictive variables for peripheral neuropathy in treated HIV type 1 infection revealed by machine learning

Johnson

Fujiwara

et al. 2021

Aids

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Objective: Peripheral neuropathies (PNPs) in HIV-infected patients are highly debilitating because of neuropathic pain and physical disabilities. We defined prevalence and associated predictive variables for PNP subtypes in a cohort of persons living with HIV.Design: Adult persons living with HIV in clinical care were recruited to a longitudinal study examining neurological complications.Methods: Each patient was assessed for symptoms and signs of PNP with demographic, laboratory, and clinical variables. Univariate, multiple logistic regression and machine learning analyses were performed by comparing patients with and without PNP.Results: Three patient groups were identified: PNP (n ¼ 111) that included HIVassociated distal sensory polyneuropathy (n ¼ 90) or mononeuropathy (n ¼ 21), and non-neuropathy (n ¼ 408). Univariate analyses showed multiple variables differed significantly between the non-neuropathy and PNP groups including age, estimated HIV type 1 (HIV-1) duration, education, employment, neuropathic pain, peak viral load, polypharmacy, diabetes, cardiovascular disorders, AIDS, and prior neurotoxic nucleoside antiretroviral drug exposure. Classification algorithms distinguished those with PNP, all with area under the receiver operating characteristic curve values of more than 0.80. Random forest models showed greater accuracy and area under the receiver operating characteristic curve values compared with the multiple logistic regression analysis. Relative importance plots showed that the foremost predictive variables of PNP were HIV-1 duration, peak plasma viral load, age, and low CD4 þ T-cell levels.Conclusion: PNP in HIV-1 infection remains common affecting 21.4% of patients in care. Machine-learning models uncovered variables related to PNP that were undetected by conventional analyses, emphasizing the importance of statistical algorithmic approaches to understanding complex neurological syndromes.

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“…The appropriate management of neuropathic pain, which should be specific to each patient, has proven difficult [ 2 ]. Many different treatments have been investigated; however, the literature is sizable, rapidly evolving, and lacks practical information about clinical aspects of managing patients [ 3 ]. Neuropathic pain can be caused by a number of different diseases (e.g., diabetes mellitus, herpes zoster, cancer, spinal disorders, and human immunodeficiency virus infection) as well as by interventions (e.g., chemotherapy and surgery) and trauma (e.g., spinal cord injury).…”

Section: Introductionmentioning

confidence: 99%

“…Spinal disorders, including radiculopathy due to disc herniation, spinal stenosis, or spinal cord injury, are common causes of neuropathic pain. However, most treatment guidelines [ 3 4 ] have included all etiologies that can cause neuropathic pain, and it has been rare for a review article to deal with neuropathic pain related only to spinal disorders. The purpose of the present review was to consider high-quality evidence from extensive reviews on the treatment for neuropathic pain, focusing only on spinal disorders, including radiculopathy due to disc herniation, spinal stenosis, and spinal cord injury.…”

Section: Introductionmentioning

confidence: 99%

Neuropathic Pain Related with Spinal Disorders: A Systematic Review

et al. 2017

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Systematic literature review. To review the evidence from high-quality studies regarding the treatment of neuropathic pain originating specifically from spinal disorders. In general, treatment guidelines for neuropathic pain cover all its various causes, including medical disease, peripheral neuropathy, and cancer. However, the natural history of neuropathic pain originating from spinal disorders may differ from that of the pain originating from other causes or lesions. An expert research librarian used terms related to neuropathic pain and spinal disorders, disc herniation, stenosis, and spinal cord injury to search in MEDLINE, Embase, and Cochrane CENTRAL for primary research from January 2000 to October 2015. Among 2,313 potential studies of interest, 25 randomized controlled trials (RCTs) and 21 systematic reviews (SRs) were included in the analysis. The selection was decided based on the agreement of two orthopedic surgeons. There was a lack of evidence about medication for radiculopathy arising from disc herniation and stenosis, but intervention procedures, including epidural block, showed positive efficacy in radiculopathy and also limited efficacy in spinal stenosis. There was some evidence based on the short-term follow-up regarding surgery being superior to conservative treatments for radiculopathy and stenosis. There was limited evidence regarding the efficacy of pharmacological and electric or magnetic stimulation therapies for neuropathic pain after spinal cord injury. This review of RCTs and SRs with high-quality evidence found some evidence regarding the efficacy of various treatment modalities for neuropathic pain related specifically to spinal disorders. However, there is a need for much more supportive evidence.

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Neuropathic pain

Cited by 34 publications

References 54 publications

Gabapentin versus Transdermal Fentanyl Matrix for the Alleviation of Chronic Neuropathic Pain of Radicular Origin: A Randomized Blind Multicentered Parallel-Group Noninferiority Trial

Gabapentin versus Transdermal Fentanyl Matrix for the Alleviation of Chronic Neuropathic Pain of Radicular Origin: A Randomized Blind Multicentered Parallel-Group Noninferiority Trial

Predictive variables for peripheral neuropathy in treated HIV type 1 infection revealed by machine learning

Neuropathic Pain Related with Spinal Disorders: A Systematic Review

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