The state-of-the-art pharmacotherapeutic options for the treatment of chronic non-cancer pain

D’Souza, Ryan S; Langford, Brendan; Wilson, Rachel; Her, Yeng F.; Schappell, Justin B; Eller, Jennifer; Evans, Timothy C.; Hagedorn, Jonathan M

doi:10.1080/14656566.2022.2060741

Cited by 21 publications

(13 citation statements)

References 96 publications

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“…Accompanying high chronic pain prevalence, studies also highlight that inadequate and ineffective pain management pose a serious public health crisis particularly in this era of the opioid epidemic. 3 Thus, there has been an increasing emphasis on multimodal analgesia 4–6 with use of non-opioid analgesics in addition to implementing personalized approaches to treating pain based on type, location, severity, and chronicity. 4 Obstacles to effective pain management may include provider level of education and comfort with prescribing analgesics, cultural barriers in pain assessment, stringency and inconsistency across state prescription drug monitoring programs, and importantly lack of healthcare access.…”

Section: Introductionmentioning

confidence: 99%

Pain and Analgesic Utilization in Medically Underserved Areas: Five-Year Prevalence Study from the Rochester Epidemiology Project

D’Souza¹,

Eller²,

Hoffmann³

2022

JPR

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Purpose There is a paucity of data on pain diagnoses and analgesic utilization in medically underserved areas (MUAs). This study compared the prevalence of pain diagnoses and analgesic medication use between MUAs and non-medically underserved areas (N-MUAs) in Southern Minnesota and Western Wisconsin using the Rochester Epidemiology Project (REP) database. Methods Five-year prevalence per 100 people (January 1, 2011 to January 1, 2016) was extracted from the REP database for multiple pain diagnosis variables and analgesic medications. Primary outcomes included comparison of five-year prevalence of each pain diagnosis and analgesic between MUA and N-MUA; and association between index of medical underservice (IMU) score and five-year prevalence for each pain diagnosis and analgesic. Linear regression models were performed to assess associations and significance thresholds were adjusted per the Bonferroni approach to account for multiplicity. Results The prevalence per 100 people for a diagnosis of chronic pain was similar between MUAs and N-MUAs (13.8 ± 2.5 vs 14.6 ± 2.0, P = 0.543). Similarly, prevalence per 100 people for other specific pain diagnoses including nonspecific chest pain, abdominal pain, lumbago, somatoform disorder, and painful respiration did not differ based on MUA status. In terms of analgesic use, prevalence per 100 people for use of opioids, non-opioid analgesics, salicylates, and NSAIDs did not differ based on MUA status. An association between higher IMU scores and lower prevalence of painful respiration was identified, although this was not significant after significance threshold adjustment per the Bonferroni method. Conclusion Our data suggest that there are no differences in several pain diagnoses and analgesic utilization between MUAs versus N-MUAs, and that the IMU score did not predict changes in prevalence of pain diagnoses or analgesic utilization. Future powered and national database studies are warranted to increase validity of findings to other populations outside of Southern Minnesota and Western Wisconsin.

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Section: Introductionmentioning

confidence: 99%

Pain and Analgesic Utilization in Medically Underserved Areas: Five-Year Prevalence Study from the Rochester Epidemiology Project

D’Souza¹,

Eller²,

Hoffmann³

2022

JPR

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“…The authors still recommend offering first-line conventional therapy prior to DRG-S or other neuromodulation options. This involves incorporating a multimodal pharmacologic approach for chronic neuropathic pain [ 71 ] such as non-steroidal anti-inflammatory agents, gabapentinoids, antidepressants, and other pharmacotherapeutics. If conservative and pharmacologic options fail to provide adequate pain relief, pain specialists may consider offering neuromodulation options including dorsal column SCS, DRG-S, or peripheral nerve stimulation (PNS).…”

Section: Discussionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

et al. 2022

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Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The primary outcome was change in pain intensity after DRG-S compared to baseline. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). Future powered randomized controlled trials with homogeneous participants are warranted.

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“…Importantly, the ASCO guidelines recommended against the use of other commonly used neuropathic agents such as amitriptyline, gabapentin, pregabalin, and venlafaxine due to no evidence of efficacy or low-level efficacy. Importantly, many neuropathic medications may have a high prevalence of side effects such as somnolence, dizziness, difficulty in concentration, and other drug-specific side effects [ 7 ]. Further evidence is warranted for other conservative treatment options such as scrambler therapy, acupuncture, and exercise [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…Current pharmacologic therapy for CIPN includes a multimodal strategy consisting of the following regimen: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), topical agents (e.g., lidocaine and capsaicin), anti-convulsants (e.g., gabapentinoid and carbamazepine), anti-depressants (e.g., selective norepinephrine reuptake inhibitors and tricyclic anti-depressants), opioids, and cannabinoids [ 1 , 7 ]. However, their effectiveness may be limited.…”

Section: Introductionmentioning

confidence: 99%

Neuromodulation Therapy for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review

et al. 2022

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Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and painful condition in patients who have received chemotherapy. The role of neuromodulation therapy in treating pain and improving neurological function in CIPN remains unclear and warrants evidence appraisal. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review to assess change in pain intensity and neurological function after implementation of any neuromodulation intervention for CIPN. Neuromodulation interventions consisted of dorsal column spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), or peripheral nerve stimulation (PNS). In total, 15 studies utilized SCS (16 participants), 7 studies utilized DRG-S (7 participants), and 1 study utilized PNS (50 participants). Per the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria, there was very low-quality GRADE evidence supporting that dorsal column SCS, DRG-S, and PNS are associated with a reduction in pain severity from CIPN. Results on changes in neurological function remained equivocal due to mixed study findings on thermal sensory thresholds and touch sensation or discrimination. Future prospective, well-powered, and comparative studies assessing neuromodulation for CIPN are warranted.

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The state-of-the-art pharmacotherapeutic options for the treatment of chronic non-cancer pain

Cited by 21 publications

References 96 publications

Pain and Analgesic Utilization in Medically Underserved Areas: Five-Year Prevalence Study from the Rochester Epidemiology Project

Pain and Analgesic Utilization in Medically Underserved Areas: Five-Year Prevalence Study from the Rochester Epidemiology Project

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

Neuromodulation Therapy for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review

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