Pharmacological treatment for pain in Guillain-Barré syndrome

Liu, Jia; Wang, Luning; McNicol, Ewan D

doi:10.1002/14651858.cd009950.pub2

Cited by 18 publications

(8 citation statements)

References 31 publications

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“…Several studies have focused on the management of pain in GBS. [ 2 , 3 ] Only 5 studies investigating pain in GBS patients with long-term following up. The reported frequency of pain in GBS is highly variable (55%–89%), and the intensity of the pain ranges from moderate to severe.…”

Section: Introductionmentioning

confidence: 99%

Pain during the acute phase of Guillain–Barré syndrome

et al. 2018

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In this study, we tried to describe the characteristics of pain and explore the association between the incidence of pain and abnormal laboratory test results in patients during the acute phase of Guillain–Barré syndrome (GBS).This retrospective cohort study enrolled 252 patients with GBS who were in the acute phase of the disease. We collected data regarding the location and type of pain, the onset time, clinical variables and laboratory tests, including the levels of uric acid (UA), albumin, cerebrospinal fluid protein (CSFP), cerebrospinal fluid glucose (CSFG), fasting glucose upon admission, and blood creatinine. The pain descriptors were compared to the severity of disease and laboratory examination results.Around 34.5% of the patients reported pain during the acute phase of GBS. Pain was negatively correlated with the disease severity during the acute phase. In total, 29 of the 87 (33.3%) patients reported pain during the 2 weeks preceding the onset of weakness. The concentration of CSFP was positively associated with the incidence of pain, while the concentrations of UA and albumin were not correlated with the incidence of pain.We found that 33.3% of the GBS patients experienced pain within 2 weeks of onset, and the pain was positively associated with CSFP concentration but was not correlated with disease severity.

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Section: Introductionmentioning

confidence: 99%

Pain during the acute phase of Guillain–Barré syndrome

et al. 2018

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“…In July 2012, the Cochrane Collaboration suggested conducting a review study to be led by Liu et al 41 However, we feel that their findings will be no different from our own due to the scarcity of studies addressing this topic. Literature on this topic is scarce and conclusions cannot therefore be extrapolated to this patient population as a whole.…”

Section: Discussionmentioning

confidence: 70%

Pain management in Guillain–Barre syndrome: A systematic review

Peña

Moreno

Gutiérrez-Álvarez³

2015

Neurología (English Edition)

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“…In previous literature, strong opioids, such as oxycodone, morphine, and methadone, have shown better efficacy in pain relief compared to placebo and TCAs [ 38 , 39 ]. A more recent systematic review by McNicol et al questions the efficacy of opioids in neuropathic pain, stating “considerable uncertainty”, and calls for more studies to be conducted [ 40 ]. Given the increased risk of misuse or abuse, adverse effects such as sedation and constipation, and limited evidence of efficacy in PHN, opioids are considered third-line drugs [ 27 , 41 , 42 ].…”

Section: Treatment and Management Of Phnmentioning

confidence: 99%

Postherpetic Neuralgia: Current Evidence on the Topical Film-Forming Spray with Bupivacaine Hydrochloride and a Review of Available Treatment Strategies

et al. 2020

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Purpose of Review This is a comprehensive review of the literature about the use of bupivacaine hydrochloride for the treatment of post-herpetic neuralgia (PHN). It briefly reviews the background, biology, diagnosis and conventional treatment for PHN, and then introduces and compares the recent evidence for the use of topical bupivacaine. Recent Findings PHN is defined by pain lasting 90 days or more after the initial presentation of herpes zoster (“Shingles”, HZ) rash and is the most common complication of this disease. A product of re-activation of the Varicella-Zoster virus (VZV), HZ is diagnosed more than 1 million times annually in the United States. Approximately 20% of patients with HZ will experience PHN and will continue to suffer intermittent neuropathic symptoms, including itching and pain, that is sharp, stabbing, throbbing or burning, with the pain localized to the site of their original rash. This long-lasting pain compares with the severity of long-standing rheumatics and osteo-arthritis and is accompanied by severe allodynia causing significant suffering, and a financial burden that is manifested in both healthcare costs and loss of quality-adjusted life years. Prevention of PHN may be achieved with the Zoster vaccine, although there is still a large segment of unvaccinated population. Moreover, the Zoster vaccine is not always effective for prevention. Current treatment includes medical (systemic tricyclic antidepressants, anticonvulsants and opioids, topical lidocaine and capsaicin) and interventional (subcutaneous Botox injections, nerve blocks and nerve stimulation) therapies. These therapies are not always effective, and each carries their own profile of side effects and risks. Moreover, up to 50% of patients with PHN are refractory to management. Recent evidence is emerging to support the use of topical local anesthetics for the treatment of PHN. Two small studies recently found topical lidocaine spray to be effective in treating paroxysmal pain attacks associated with PHN. Bupivacaine is a longer-lasting local anesthetic, and a film-forming formulation allows easy and durable application to the affected skin. Recent studies show that topical film-forming bupivacaine is safe and as effective as lidocaine for the treatment of PHN. Summary PHN is an important though common complication of HZ and can cause long-lasting pain and disability. Current treatment for PNH is limited by efficacy and safety profiles of individual therapies. Recent evidence points to topical local anesthetics as an effective and safe alternative to conventional therapy. Film-forming bupivacaine may offer a durable and safe option for this otherwise difficult to treat syndrome.

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Pharmacological treatment for pain in Guillain-Barré syndrome

Cited by 18 publications

References 31 publications

Pain during the acute phase of Guillain–Barré syndrome

Pain during the acute phase of Guillain–Barré syndrome

Pain management in Guillain–Barre syndrome: A systematic review

Postherpetic Neuralgia: Current Evidence on the Topical Film-Forming Spray with Bupivacaine Hydrochloride and a Review of Available Treatment Strategies

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