Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

Haanpää, Maija; Gourlay, Geoffrey K.; Kent, Joel L.; Miaskowski, Christine; Raja, Srinivasa N.; Schmader, Kenneth E.; Wells, Christopher D.

doi:10.4065/mcp.2009.0645

Cited by 91 publications

(56 citation statements)

References 56 publications

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“…Thirdline agents, FDA-approved for the treatment of neuropathic pain, include anticonvulsants such as carbamazepine, lamotrigine, topiramate, phenytoin, and valproic acid and in addition have been observed to have beneficial effect for the modification of emotional lability and irritability during clinical work with Veterans with both PTSD and chronic neuropathic pain. Additional third-line agents include antidepressants such as bupropion, citalopram, and paroxetine, along with topical agents such as capsaicinoid that inhibits the pain-eliciting substance P [86][87][88]. A thorough review of the patient's current medication profile, medical conditions, and potential adverse drug-related effects must be carefully considered and monitored before prescription of any of the above agents.…”

Section: Neuropathic Painmentioning

confidence: 99%

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Gibson¹

2012

JRRD

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Abstract-With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented. Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.

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Section: Neuropathic Painmentioning

confidence: 99%

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Gibson¹

2012

JRRD

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“…Taking experimental studies as a reference, TNF-α and IL-1β were used to evaluate neuroinflammatory cascade in our study, and a significant increase was observed in the trauma group compared to the control group.It cannot be disregarded that myelinization is an important factor in recovery after nerve damage. In the experimental studies made, it was shown that EPO stimulated myelinization quickly after sciatic nerve damage and provided functional recovery [23]. It was also shown that EPO increased white matter myelin thickness, axon diameter, regenerated and myelinated nerve fibers in central nervous system and spinal cord [16,24].…”

Section: Discussionmentioning

confidence: 99%

Anti-inflammatory efficiency of erythropoietin in sciatic nerve damage

Aydın¹

2018

Ann Clin Anal Med

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Aim: Peripheral nerve injuries are the major health problem in the world. Several neurotrophic agents have been evaluated for their efficacy in nerve injury. We aimed to compare the effects of erythropoietin (EPO), known to have neuroprotective, neuroregenerative and anti-inflammatory properties like gabapentin, on the sciatic nerve in experimental crush injury to the sciatic nerve in rats. Material and Method: We classified four groups for this study. Aneurysm clips were used for the sciatic nerve crush injury for trauma groups. Sciatic nerve and blood samples were taken for the experimental procedures. ELISA method was used to evaluate the tissue. Results: Average values of IL-1β and TNF-α levels of the groups and the relationship between the groups are presented. After EPO and gabapentin treatment, IL-1β levels were significantly lower in the trauma group. TNF-α levels were statistically significantly higher in the trauma group than in other groups. According to the EPO and gabapentin treatment, TNF-α levels were significantly lower than those in the trauma group. Discussion: In this study, the effects of EPO and gabapentin on the rat sciatic nerve injury were examined by biochemical methods. EPO is a drug that has an advantage of the treatment of anemia and used for the nerve damage in the experimental studies. We suggest that the EPO has beneficial effects on the trauma models with the blood loss and the nerve damage.

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“…While statistical tests were conducted, we note that there are large and disparate sample In addition to complaints of pain, patients often present with other multiple coexisting chronic diseases. [5][6][7][8] According to the Centers for Disease Control and Prevention, 47% of U.S. adults aged 55 or greater have 2 or more chronic conditions (e.g., arthritis, asthma, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes). 9 These diseases require chronic treatment, often with multiple medications.…”

Section: Discussionmentioning

confidence: 99%

Complexity of Pain Management Among Patients with Nociceptive or Neuropathic Neck, Back, or Osteoarthritis Diagnoses

Kozma¹,

Provenzano²,

Slaton³

et al. 2014

JMCP

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BACKGROUND: Approaches to pain management are diverse, requiring prescribers to evaluate an array of clinical issues and potential solutions. In addition to the difficult task of selecting a treatment option, pain treatment may be further complicated by multiple prescribers, multiple medications, and multiple mechanisms of pain origination.OBJECTIVE: To describe patient demographics (e.g., age, gender); comorbidities; office visits (e.g., physician, chiropractor, physical therapy, psychiatry, allergist); number of different prescribers overall prescription use; pain medications as classified by the World Health Organization's (WHO) pain ladder; adjuvant medications; nonpharmacologic procedures; and potential drug interactions in a broad sample of patients with nociceptive or neuropathic neck or back diagnoses, or osteoarthritis diagnoses, in a commercial population.METHODS: This claims-data analysis used a cross-sectional cohort comparison with a fixed 2-year observation period from September 1, 2006, to August 31, 2008, for patients in the PharMetrics national managed care database. The assigned cohorts were neuropathic-related neck/back diagnoses (NEURO); neuropathic and nociceptive neck/back diagnoses (NEURO/ NOCI); nociceptive neck/back diagnoses without a neuropathic-related diagnosis (NOCI); and only osteoarthritis (OA) diagnoses. All analyses were conducted by cohort. The analysis included the following patientdescriptive variables: patient demographics, comorbidities, office visits, most frequent medical providers and number of different prescribers, all medications, pain medications as classified by the WHO pain ladder, adjuvant medications, adjuvant procedures and potential drug interactions. The goal for selecting these variables was to describe a range of data that might provide insight into the complexity of pain management decisions faced by clinicians.RESULTS: The study included 85,014 patients, classified as NEURO (n = 2,375), NEURO/NOCI (n = 37,019), NOCI (n = 39,496), and OA (n = 6,124). The most frequently occurring comorbidities (observed in > 40% of patients) included cardiovascular and neuropathic pain conditions. Considering all types of medication claims observed among all cohorts, the overall mean prescription claim count for the 2-year observation period was 57.9 claims (standard deviation 56.2). Weak opioids (WHO pain relief ladder rung 2) accounted for the majority of pain medication claims across all cohorts. Across cohorts, 25.7% of patients had 10 or more days of overlapping drug availability (for inducers or inhibitors of the cytochrome P450 system concomitantly), a measure of potential for drug interactions.CONCLUSIONS: Choosing the appropriate pain treatment involves assessing currently used medications for existing illnesses and deciding on the appropriate types of pain medications. However, potentially serious drug-drug interactions are a consequence of multiple drug use, and such a potential requires thoughtful consideration by those involved in patient care.

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Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

Cited by 91 publications

References 56 publications

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Anti-inflammatory efficiency of erythropoietin in sciatic nerve damage

Complexity of Pain Management Among Patients with Nociceptive or Neuropathic Neck, Back, or Osteoarthritis Diagnoses

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