The use of antineuropathic medications for the treatment of chronic pain

Urits, Ivan; Li, Nathan; Berardino, Kevin; Artounian, Kimberly Aleen; Bandi, Prudhvi; Jung, Jai Won; Kaye, Rachel; Manchikanti, Laxmaiah; Kaye, Adam M.; Simopoulos, Thomas; Kaye, Alan D.; Torres, Monica; Viswanath, Omar

doi:10.1016/j.bpa.2020.08.007

Cited by 14 publications

(6 citation statements)

References 74 publications

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“…Gabapentin and tricyclic antidepressants can provide pain relief to patients with neuropathic pain 25 and have been used prophylactically for anti‐GD2 mAb infusions 20 . Due to the potential for sedation and to allow sufficient time to achieve clinical effects, gabapentin may be started at a low dose several days prior to the infusion and increased gradually to achieve a therapeutic dosage.…”

Section: Strategies For Pain Management During Anti‐gd2 Immunotherapymentioning

confidence: 99%

Pain mitigation and management strategies for anti‐GD2 infusions: An expert consensus

Nysom

Morad

Rafael

et al. 2023

Pediatric Blood & Cancer

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Monoclonal antibodies (mAbs) targeting disialoganglioside 2 (GD2) are an important treatment advance for high‐risk neuroblastoma, including in patients with refractory or relapsed disease. Dinutuximab and dinutuximab beta are administered for ≥8 hours (and up to 10 days for dinutuximab beta), whereas naxitamab is administered over 0.5 to 2 hours as tolerated. As acute pain is a class effect of anti‐GD2 mAbs, effective pain management is crucial to successful treatment. Here, we provide an overview of current pain‐management strategies for anti‐GD2 mAb infusions, with a focus on strategies suitable for naxitamab infusions, which cause a more rapid onset of often severe pain. We discuss opioid analgesics, ketamine, gabapentin, and other similar agents and nonpharmacologic approaches. Potential future pain‐management options are also discussed, in addition to the use of sedatives to reduce the anxiety that may be associated with infusion‐related pain. In this expert consensus paper, specific guidance for pain management during naxitamab infusions is provided, as these infusions are administered over 0.5 to 2 hours and may not need overnight hospitalization based on the physician's assessment, and require rapid‐onset analgesia options suitable for potential outpatient administration.

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Section: Strategies For Pain Management During Anti‐gd2 Immunotherapymentioning

confidence: 99%

Pain mitigation and management strategies for anti‐GD2 infusions: An expert consensus

Nysom

Morad

Rafael

et al. 2023

Pediatric Blood & Cancer

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“…Opioids are commonly prescribed for relieving cancer pain, postoperative pain or severe neuropathic pain. However, patients often continue to consume opioids even though opioids are categorized as a second‐ or third‐line treatment for chronic neuropathic pain (Urits et al, 2020). This is possibly due to persistent painful conditions or post‐surgical opioid overprescription (Neuman et al, 2019).…”

Section: Opioid Epidemicmentioning

confidence: 99%

“…Thus, it is not surprising that the (endo)cannabinoid system has been regarded as a viable alternative pharmacological target for analgesia, although the efficacy of its clinical application remains inconclusive. In some countries, cannabinoids have been suggested as second‐ or third‐line treatments for chronic pain (Urits et al, 2020).…”

Section: Opioids Endorphins and Descending Pain Inhibitionmentioning

confidence: 99%

Alternative pain management via endocannabinoids in the time of the opioid epidemic: Peripheral neuromodulation and pharmacological interventions

Lee

Chiou

2022

British J Pharmacology

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The use of opioids in pain management is hampered by the emergence of analgesic tolerance, which leads to increased dosing and side effects, both of which have contributed to the opioid epidemic. One promising potential approach to limit opioid analgesic tolerance is activating the endocannabinoid system in the CNS, via activation of CB1 receptors in the descending pain inhibitory pathway. In this review, we first discuss preclinical and clinical evidence revealing the potential of pharmacological activation of CB1 receptors in modulating opioid tolerance, including activation by phytocannabinoids, synthetic CB1 receptor agonists, endocannabinoid degradation enzyme inhibitors, and recently discovered positive allosteric modulators of CB1 receptors. On the other hand, as non‐pharmacological pain relief is advocated by the US‐NIH to combat the opioid epidemic, we also discuss contributions of peripheral neuromodulation, involving the electrostimulation of peripheral nerves, in addressing chronic pain and opioid tolerance. The involvement of supraspinal endocannabinoid systems in peripheral neuromodulation‐induced analgesia is also discussed. LINKED ARTICLES This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc

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“…Furthermore, SNRIs are under investigation for new and emerging applications. This is most evident in their use for the treatment of chronic pain conditions, with a particular emphasis on the use of SNRIs in the treatment of neuropathic pain [89][90][91][92]. In particular, duloxetine, as previously discussed, has emerged at the forefront of agents utilized in the treatment of this condition.…”

Section: Emerging Applicationsmentioning

confidence: 99%

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

Fanelli

Weller

Liu

2021

Neurology International

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Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the presynaptic neuronal uptake of serotonin and norepinephrine and prolong the effects of the monoamines in the synaptic cleft within the central nervous system, leading to increased postsynaptic receptor activation and neuronal activities. Serotonin-norepinephrine reuptake inhibitors can have multiple clinical indications, including as the first-line agents for the management of depression and anxiety, and as analgesics in the treatment of chronic pain. The effects of reuptake inhibition of norepinephrine and serotonin are often dose-dependent and agent-dependent. There are five FDA-approved serotonin-norepinephrine reuptake inhibitors (desvenlafaxine, duloxetine, levomilnacipran, milnacipran and sibutramine) currently being marketed in the United States. As the COVID-19 pandemic significantly increased the incidence and prevalence of anxiety and depression across the country, there are significantly increased prescriptions of these medications perioperatively. Thus, anesthesiologists are more likely than ever to have patients administered with these agents and scheduled for elective or emergency surgical procedures. A thorough understanding of these commonly prescribed serotonin-norepinephrine reuptake inhibitors and their interactions with commonly utilized anesthetic agents is paramount. There are two potentially increased risks related to the continuation of SNRIs through the perioperative period: intraoperative bleeding and serotonin syndrome. SNRIs have some off-label uses, more new indications, and ever-increasing new applications in perioperative practice. This article aims to review the commonly prescribed serotonin-norepinephrine reuptake inhibitors and the current clinical evidence regarding their considerations in perioperative anesthesia and analgesia.

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The use of antineuropathic medications for the treatment of chronic pain

Cited by 14 publications

References 74 publications

Pain mitigation and management strategies for anti‐GD2 infusions: An expert consensus

Pain mitigation and management strategies for anti‐GD2 infusions: An expert consensus

Alternative pain management via endocannabinoids in the time of the opioid epidemic: Peripheral neuromodulation and pharmacological interventions

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

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