Clinical trial of propranolol in post-traumatic neuralgia

Scadding, John W; Wall, Patrick D.; Parry, C. B. Wynn; Brooks, Donal

doi:10.1016/0304-3959(82)90135-x

Cited by 52 publications

(17 citation statements)

References 20 publications

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“…Topical application of the a2 adrenergic receptor agonist, clonidine, relieves hyperalgesia in SMP patients . Blockade of adrenergic receptors with phentolamine Treede et al, 1991), phenoxybenzamine or prasozin have also shown efficacy in aUeviating SMP (Abram and Lightfoot, 1981;Ghostine et al, 1984), while the ~-adrenergic receptor antagonist, propanolol, does not show as much efficacy in SMP (Scadding et al, 1982;Raja et al, 1991). Peripheral application of NE can cause exacerbation of the hyperalgesia from complete Freund's adjuvantinduced neuritis (Baik et al, 2003), while intradermal injection of NE or a-adrenergic agonists can rekindle pain and hyperalgesia in patients and animaIs which had been relieved by sympathectomy or sympathetic block (Wallin et al, 1976;Xie et a1., 1995;Moon et al, 1999).Results from Ali et al (1999), suggest it is the uninjured C-fibres that develop a-adrenergic sensitivity and hyperactivity after nerve injury.…”

Section: Role Of Adrenergic Sensitivity In Neuropathic Pain After CCImentioning

confidence: 99%

Sympathetic sprouting and changes in nociceptive sensory innervation in the glabrous skin of the rat hind paw following partial peripheral nerve injury

Yen

Bennett

Ribeiro‐da‐Silva

2006

J of Comparative Neurology

103

102

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Previous studies have suggested that sympathetic sprouting in the periphery may contribute to the development and persistence of sympathetically maintained pain in animal models of neuropathic pain. In the present study, we examined changes in the cutaneous innervation in rats with a chronic constriction injury to the sciatic nerve. At several periods postinjury, hind paw skin was harvested and processed by using a monoclonal antibody against dopamine‐β‐hydroxylase to detect sympathetic fibers and a polyclonal antibody against calcitonin gene‐related peptide to identify peptidergic sensory fibers. We observed migration and branching of sympathetic fibers into the upper dermis of the hind paw skin, where they were normally absent. This migration was first detected at 2 weeks, peaked at 4–6 weeks, and lasted for at least 20 weeks postlesion. At 8 weeks postlesion, there was a dramatic increase in the density of peptidergic fibers in the upper dermis. Quantification revealed that densities of peptidergic fibers 8 weeks postlesion were significantly above levels in sham animals. The ectopic sympathetic fibers did not innervate blood vessels but formed a novel association and wrapped around sprouted peptidergic nociceptive fibers. Our data show a long‐term sympathetic and sensory innervation change in the rat hind paw skin after the chronic constriction injury. This novel fiber arrangement after nerve lesion may play an important role in the development and persistence of sympathetically maintained neuropathic pain after partial nerve lesions. J. Comp. Neurol. 495:679–690, 2006. © 2006 Wiley‐Liss, Inc.

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Section: Role Of Adrenergic Sensitivity In Neuropathic Pain After CCImentioning

confidence: 99%

Sympathetic sprouting and changes in nociceptive sensory innervation in the glabrous skin of the rat hind paw following partial peripheral nerve injury

Yen

Bennett

Ribeiro‐da‐Silva

2006

J of Comparative Neurology

103

102

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“…50 A previous case cross-over trial found no evidence of effectiveness with propranolol in patients with neuropathic pain 51 , whereas a trial in patients with a myogenous pain disorder suggested a benefit with propranolol in our study population. 52 Thus it is conceivable that β-adrenoreceptor antagonists in general (or propranolol in particular) are more effective in nociceptive than neuropathic pain.…”

Section: Discussionmentioning

confidence: 65%

Results of a Pilot Multicenter Genotype-based Randomized Placebo-controlled Trial of Propranolol to Reduce Pain After Major Thermal Burn Injury

Orrey

Halawa

Bortsov

et al. 2015

The Clinical Journal of Pain

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Background Results of previous studies suggest that β-adrenoreceptor activation may augment pain, and that β-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high activity haplotype. Methods Consenting patients admitted for thermal burn injury at participating burn centers were genotyped; those who were not high activity COMT homozygotes were randomized to propranolol 240mg/day or placebo. Primary outcomes were study feasibility (consent rate, protocol completion rate) and pain scores on study days 5-19. Secondary outcomes assessed pain and posttraumatic stress disorder (PTSD) symptoms 6 weeks post-injury. Results Seventy-seven (61/79) percent of eligible patients were consented and genotyped, and 77% (47/61) were genotype-eligible and randomized. Ninety-one percent (43/47) tolerated study drug and completed primary outcome assessments. In intention to treat and per protocol analyses, patients randomized to propranolol had worse pain scores on study days 5-19. Conclusions Genotype-specific pain medication interventions are feasible in hospitalized burn patients. Propranolol is unlikely to be a useful analgesic during the first few weeks after burn injury.

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“…50 Interestingly, blockade of ␤-adrenoceptors does not relieve symptoms in RSD patients. 51 Overall, these data suggest that the ␣-, but not the ␤-adrenoceptor is involved in mediation of pain.…”

Section: Treatmentmentioning

confidence: 85%

Reflex sympathetic dystrophy: facts and hypotheses

Kurvers

1998

Vasc Med

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Reflex sympathetic dystrophy (RSD) syndrome has been recognized clinically for many years. It is most often initiated by trauma to a nerve, neural plexus, or soft tissue. Diagnostic criteria are the presence of regional pain and other sensory changes following a noxious event. The pain is associated with changes in skin colour, skin temperature, abnormal sweating, oedema, and sometimes motor abnormalities. The clinical course is commonly divided into three stages: first (acute or hyperaemic), second (dystrophic or ischaemic), and third (atrophic) stage. The diagnosis is primarily clinical, but roentgenography, scintigraphy, thermography, electromyography and assessment of nerve conduction velocity can help to confirm the diagnosis. Although a wide variety of treatments have been recommended, the only therapies found to be effective in large studies aim at interfering with the activity of the sympathetic nervous system. To this end, efferent sympathetic nerve activity can be interrupted surgically or chemically. Alternatively, adrenoceptor blockers may be used to relieve pain. Numerous theories have been proposed to explain the pathophysiology. Sympathetic dysfunction, which often has been purported to play a pivotal role in RSD, has been suggested to consist of an increased rate of efferent sympathetic nerve impulses towards the involved extremity induced by increased afferent activity. However, the results of several experimental studies suggest that sympathetic dysfunction consists of supersensitivity to catecholamines induced by (partial) autonomic denervation. Besides, it has been suggested that excitation of sensory nerve fibres at axonal level causes release of neuropeptides at the peripheral endings of these fibres. These neuropeptides may induce vasodilation, increase vascular permeability, and excite surrounding sensory nerve fibres -- a phenomenon referred to as neurogenic inflammation. At the level of the central nervous system, it has been suggested that the increased input from peripheral nociceptors alters the central processing mechanisms.

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Clinical trial of propranolol in post-traumatic neuralgia

Cited by 52 publications

References 20 publications

Sympathetic sprouting and changes in nociceptive sensory innervation in the glabrous skin of the rat hind paw following partial peripheral nerve injury

Sympathetic sprouting and changes in nociceptive sensory innervation in the glabrous skin of the rat hind paw following partial peripheral nerve injury

Results of a Pilot Multicenter Genotype-based Randomized Placebo-controlled Trial of Propranolol to Reduce Pain After Major Thermal Burn Injury

Reflex sympathetic dystrophy: facts and hypotheses

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