Best Practices in the Treatment of Neuropathic Pain

Elmofty, Dalia; Anitescu, Magdalena; Buvanendran, Asokumar

doi:10.2217/pmt.13.50

Cited by 4 publications

(3 citation statements)

References 58 publications

(53 reference statements)

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“…208 SNBs have been used to treat neuropathic pain, Complex Regional Pain Syndrome" 1 (reflex sympathetic dystrophy), and CRPS 2 (causalgia) as well as manage chronic abdominal, pelvic, and perineal pain. [209][210][211] Neuromodulation techniques use device-based electrical or magnetic stimulation to activate central or peripheral nervous system tissue associated with pain pathways to produce analgesia or reduce sensitivity to pain. This is an area of growth and innovation for chronic pain treatment, including neuropathic pain, and for both the central and peripheral nervous systems.…”

Section: Figure 12: Interventional Procedures Vary By Degree Of Complmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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Section: Figure 12: Interventional Procedures Vary By Degree Of Complmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

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“…Several treatment options for PN are available, including pharmacological, non-pharmacological, and alternative options [31][32][33][34]. Patients suffering from severe and disabling symptoms (e.g.…”

Section: Treatment Of Peripheral Neuropathymentioning

confidence: 99%

A Review on Prevalence and Causes of Peripheral Neuropathy and Treatment of Different Etiologic Subgroups with Neurotropic B Vitamins

Hakim¹,

Kurniani²,

Pinzon³

et al. 2019

J Clin Exp Pharmacol

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Peripheral neuropathy (PN) is the most common disorder of the peripheral nervous system in adults, and its prevalence increases with age. Because PN is often poorly documented and strongly underdiagnosed, estimating its prevalence in the general population is difficult. Only few epidemiological studies on the prevalence of PN in the general population are available, mostly from industrialized countries. Especially in developing countries, figures from different sources vary considerably. Available data often focus on certain etiological subgroups-particularly diabetics-or on neuropathic pain (NeP), which contributes to this variation. More epidemiological prevalence studies from the general population are required to gain a better picture on sizes of patient groups and cause patterns. To provide an overview of current prevalence data, we performed a selective literature search in PubMed, Cochrane and Google Scholar and used relevant examples along with comprehensive reviews covering the past 15+ years identified through the use of the authors' own files. These data indicate that PN is frequent and often undiagnosed for a long time.Although diabetes is the number one cause of PN worldwide, there are various causes beyond, making it hard for physicians to gain a clear patient picture and recognize symptoms. Most clinical studies also focus on diabetic PN treatment only; thus, data comparing the treatment of PN of several etiologies are rare, which contributes to the lack of awareness of PN causes. In order to demonstrate that different PN subgroups can benefit from treatment with B vitamins progressively over time-regardless of underlying PN causes, we also present some subgroup results of a recent non-interventional study (Neurobion non-interventional; NENOIN) herein. The NENOIN study showed that treating PN of different etiologies including idiopathic neuropathy is possible with a fixed dose of neurotropic B vitamins. Therefore, we conclude that this is an effective treatment option for different PN subgroups from which even patients with unknown PN causes can benefit.

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“…With these, the response is variable and side effects sometimes limit adherence to treatment. The approach with the best results is the multidisciplinary approach combining pharmacological, physical, and psychological interventions [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review on Cannabinoids for Neuropathic Pain Administered by Routes Other than Oral or Inhalation

Quintero

Pulido

Giraldo

et al. 2022

Plants

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The use of cannabis and cannabinoid products for the treatment of neuropathic pain is a growing area of research. This type of pain has a high prevalence, limited response to available therapies and high social and economic costs. Systemic cannabinoid-based therapies have shown some unwanted side effects. Alternative routes of administration in the treatment of neuropathic pain may provide better acceptance for the treatment of multiple pathologies associated with neuropathic pain. To examine the efficacy, tolerability, and safety of cannabinoids (individualized formulations, phytocannabinoids, and synthetics) administered by routes other than oral or inhalation compared to placebo and/or conventional medications in the management of neuropathic pain. This systematic review of the literature reveals a lack of clinical research investigating cannabis by routes other than oral and inhalation as a potential treatment for neuropathic pain and highlights the need for further investigation with well-designed clinical trials. There is a significant lack of evidence indicating that cannabinoids administered by routes other than oral or inhaled may be an effective alternative, with better tolerance and safety in the treatment of neuropathic pain. Higher quality, long-term, randomized controlled trials are needed to examine whether cannabinoids administered by routes other than inhalation and oral routes may have a role in the treatment of neuropathic pain.

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Best Practices in the Treatment of Neuropathic Pain

Cited by 4 publications

References 58 publications

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

A Review on Prevalence and Causes of Peripheral Neuropathy and Treatment of Different Etiologic Subgroups with Neurotropic B Vitamins

A Systematic Review on Cannabinoids for Neuropathic Pain Administered by Routes Other than Oral or Inhalation

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