A brief, high-dose remifentanil infusion partially reverses neuropathic pain in a subgroup of post herpetic neuralgia patients

Prosenz, Julian; Kloimstein, Herwig; Thaler, Ulrich; Drdla-Schutting, Ruth; Sandkühler, Jürgen; Gustorff, Burkhard

doi:10.1016/j.jocn.2017.02.048

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…It is exactly this dissection which was missing in the Teva strategy so far reported and was perhaps one of the reasons for a failed study. This is supported by data from a different study, the remifentanil infusion study in PHN, where the compound could partially reverse neuropathic pain, also in a subgroup of patients only, probably in those with relevant inhibition of the signal amplification at the spinal level (perhaps corresponding to the subgroup 3 of Peng) [15]. In a study evaluating the efficacy of oxcarbamazepine in various types of peripheral neuropathic pain, including PHN, oxcarbazepine was more efficacious in patients with the irritable vs the nonirritable nociceptor phenotype [16].…”

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confidence: 58%

Topical phenytoin formulations for pain in small fiber neuropathy, a pathogenetic approach

Hesselink¹,

Notermans²

2018

Gen Int Med Clin Innov

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Peripheral neuropathic localized pain as for instance in PDN and SFN, is characterized by hyperexcitability of nociceptors, which can be inhibited by sodium channel blockers. Such hyperexcitability is based on reduced receptor threshold of the C nociceptor, leading to spontaneous discharges and to intensified nociceptor responses in response to stimulation. These phenomena lead to the classical symptoms of mechanical and heat allodynia and spontaneous burning or stinging pain [1]. These symptoms reduce the quality of sleep and life of patients suffering from painful peripheral neuropathies. The burning sensations in general seems to suggest involvement of small fibers, even in forms of compression neuropathy [2]. SFN is increasingly recognized as one of the major pathogenetic disturbances leading to burning and stinging pain in many peripheral neuropathic syndromes. Diabetes mellitus is the main cause of SFN. Glucose intolerance and the metabolic syndrome are also associated with SFN. In CIAP, sarcoidosis, Lyme disease, HIV and amyloidosis, SFN can develop [3]. Alcohol is the main toxic agent inducing SFN. SFN is therefore a secondary complication in many internal and neurological disorders. The diagnosis CIAP is dependent on the clinical impression, a length dependent neuropathy, including disturbances of the electromyography. In many CIAP patients there are complaints of burning pain, comparable to patients suffering from SNF. This supports a possible comparable pathogenesis in both groups. The diagnosis SFN rests on the clinical impression, a normal electromyography and a reduction of the small nerve fibers, as detected via a skin biopsy [4]. In indications as PDN, CIAP and perhaps also in PHN subgroups of patients therefore might be identified as suffering from SFN.

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mentioning

confidence: 58%

Topical phenytoin formulations for pain in small fiber neuropathy, a pathogenetic approach

Hesselink¹,

Notermans²

2018

Gen Int Med Clin Innov

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Dorsal Horn Pain Mechanisms

Zeilhofer

Ganley

2019

The Oxford Handbook of the Neurobiology of Pain

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The spinal dorsal horn and its equivalent structure in the brainstem constitute the first sites of synaptic integration in the pain pathway. A huge body of literature exists on alterations in spinal nociceptive signal processing that contribute to the generation of exaggerated pain states and hence to what is generally known as “central sensitization.” Such mechanisms include changes in synaptic efficacy or neuronal excitability, which can be evoked by intense nociceptive stimulation or by inflammatory or neuropathic insults. Some of these changes cause alterations in the functional organization of dorsal horn sensory circuits, leading to abnormal pathological pain sensations. This article reviews the present state of this knowledge. It does not cover the contributions of astrocytes and microglia in detail as their functions are the subject of a separate chapter.

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A brief, high-dose remifentanil infusion partially reverses neuropathic pain in a subgroup of post herpetic neuralgia patients

Cited by 2 publications

References 16 publications

Topical phenytoin formulations for pain in small fiber neuropathy, a pathogenetic approach

Topical phenytoin formulations for pain in small fiber neuropathy, a pathogenetic approach

Dorsal Horn Pain Mechanisms

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