Combined epidural morphine and bupivacaine in the treatment of lumbosacral radicular neuropathic pain: a noncontrolled prospective study

Vigneri, Simone; Sindaco, Gianfranco; Grua, Marco La; Zanella, Matteo; Ravaioli, Laura; Paci, Valentina; Pari, Gilberto

doi:10.2147/jpr.s113996

Cited by 6 publications

(8 citation statements)

References 31 publications

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“…Indeed, some severe neuropathic pain conditions are still treated by systemic MOR agonists, despite the important side effects. Thus, intrathecal opioids have been shown to be effective in some intractable clinical cases of non-cancer neuropathic pain, alone or in combination with other drugs (Martin Paiz et al, 2015;Sadiq & Poopatana, 2007;Vigneri et al, 2016;Warner, Watson, Bendel, & Moeschler, 2018;Wu, Huang, Chen, Huang, & Chou, 2013). Several studies have also addressed the issue of whether peripheral opioid mechanisms are of significance in some clinical settings.…”

Section: Of Opioids In Neuropathic Painmentioning

confidence: 99%

Why mu‐opioid agonists have less analgesic efficacy in neuropathic pain?

Martínez-Navarro

Maldonado

Baños

2018

European Journal of Pain

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Injury to peripheral nerves often leads to abnormal pain states (hyperalgesia, allodynia and spontaneous pain), which can remain long after the injury heals. Although opioid agonists remain the gold standard for the treatment of moderate to severe pain, they show reduced efficacy against neuropathic pain. In addition to analgesia, opioid use is also associated with hyperalgesia and analgesia tolerance, whose underlying mechanisms share some commonalities with nerve injury‐induced hypersensitivity. Here, we reviewed up‐to‐day research exploring the contribution of mu‐opioid receptor (MOR) on the pathophysiology of neuropathic pain and on analgesic opioid actions under these conditions. We focused on the specific contributions of MOR populations at peripheral, spinal and supraspinal level. Moreover, evidences of neuroplastic changes that may underlie the low efficacy of MOR agonists under neuropathic pain conditions are reviewed and discussed. Sensitization processes leading to pain hypersensitivity, molecular changes in signalling pathways triggered by MOR and glial activation are some of these mechanisms elicited by both nerve injury and opioid exposure. Nerve injury‐induced pain hypersensitivity might be masking the initial analgesic effects of opioid agonists, and alternatively, sustained opioid treatment to individuals already suffering from neuropathic pain could aggravate their pathophysiological state. Finally, some combined therapies that can increase opioid analgesic effectiveness in neuropathic pain treatment are highlighted. Significance This review provides evidence of the low benefit of opioid monotherapy in neuropathic pain and analyses the reasons of this reduced effectiveness. Opioid agonists along with drugs targeted to block the sensitization processes induced by MOR stimulation might result in a better management of neuropathic pain.

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Section: Of Opioids In Neuropathic Painmentioning

confidence: 99%

Why mu‐opioid agonists have less analgesic efficacy in neuropathic pain?

Martínez-Navarro

Maldonado

Baños

2018

European Journal of Pain

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“…13 This method showed at least a 30% reduction in a self-reported 1-10 numerical rating scale (1 = no pain, 10 = unbearable pain) in 73% of the patients involved. 13 Similarly, other epidural injections could substitute the opiate with a corticosteroid, thereby focusing on the inflammatory pathway. 14 One non-invasive treatment worth noting is the application of magnetic resonance imaging guided high-intensity focused ultrasound (MR-HIFU) to target the nerve by creating heating a small volume of tissue to a desired temperature.…”

Section: Minimally Invasive Proceduresmentioning

confidence: 92%

“…In one study, morphine (opiate) and bupivacaine (anesthetic) proved to be an effective combination for epidural injections to treat lumbosacral radicular CP. 13 Guided with fluoroscopy, an epidural catheter was inserted into the T12-L1 intervertebral space and the patient was injected three times per day for 30 days before the catheter was removed. 13 This method showed at least a 30% reduction in a self-reported 1-10 numerical rating scale (1 = no pain, 10 = unbearable pain) in 73% of the patients involved.…”

Section: Minimally Invasive Proceduresmentioning

confidence: 99%

“…13 Guided with fluoroscopy, an epidural catheter was inserted into the T12-L1 intervertebral space and the patient was injected three times per day for 30 days before the catheter was removed. 13 This method showed at least a 30% reduction in a self-reported 1-10 numerical rating scale (1 = no pain, 10 = unbearable pain) in 73% of the patients involved. 13 Similarly, other epidural injections could substitute the opiate with a corticosteroid, thereby focusing on the inflammatory pathway.…”

Section: Minimally Invasive Proceduresmentioning

confidence: 99%

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Investigating The Effects Of Pulsed Radiofrequency Therapy In The Blocking Of Action Potentials In Nerves

Safakish¹

2021

Preprint

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<div>Radiofrequency (RF) currents (pulsed or continuous mode) are used as a treatment modality for chronic pain management. This is achieved by blocking sensory nerves’ ability to propagate pain signals. In this thesis, it was proposed that pulsed RF (PRF) therapy can block action potential propagation, and that when used in clinical settings, deliver thermal doses below the threshold for</div><div>thermal damage to nerves. A neurophysiology system with stimulating and reading electrodes was used to study earthworm nerves before and after PRF therapy. It was shown that 60% of earthworms in the high-voltage-group treated with bipolar PRF experienced a block in action</div><div>potential propagation. Computer simulations of the electrical field and heating patterns were created, experimentally validated, and after determining a threshold thermal dose for nerve damage, it was shown that for C6 medial branch nerve PRF therapy the temperature at the nerve was not high enough to cause thermal damage.</div>

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“…Two questionnaires were used to evaluate the QoL of our patients and took ~20 minutes to complete. These questionnaires included: McGill Pain Questionnaire Short Form (MPQSF) 37 , 38 and EuroQol Five Dimensions Questionnaire (EQ-5D). 15 …”

Section: Methodsmentioning

confidence: 99%

The analgesic effect of intravenous methylprednisolone on acute neuropathic pain with allodynia due to central cord syndrome: a retrospective study

Han

et al. 2018

JPR

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BackgroundCentral cord syndrome (CCS) may be associated with severe neuropathic pain that often resists to conventional pain therapy regimens and affects the patients’ quality of life (QoL) seriously. Current treatments for CCS-associated neuropathic pain have limited evidence of efficacy. This retrospective study was performed to present the effects of early treatment with methylprednisolone (MP) on acute neuropathic pain relief and the QoL in CCS patients.Patients and methodsData were collected from the medical records of CCS patients who suffered from acute neuropathic pain with allodynia. All the patients received intravenous MP treatment for up to 1 week. Patients were evaluated with standard measures of efficacy: neuropathic pain intensity, the area of allodynia, and the QoL at baseline, daily treatment, and at 1 and 3 months after the end of MP treatment.ResultsThirty-four eligible patients were enrolled in our study. By the end of MP treatment, the proportion of patients who gained total or major (visual analog scale [VAS] score decreased by 50% or more) allodynia relief from the treatment was 91.18%, and a decrease in spontaneous pain was also observed. Moreover, this study showed MP could significantly improve the QoL of patients based on McGill Pain Questionnaire Short Form and EuroQol Five Dimensions Questionnaire. Four patients (11.76%) during MP treatment experienced mild or moderate side effects. None of the patients manifested CCS-associated neuropathic pain recurrence and MP-associated side effects at follow-up.ConclusionThe current results suggested that MP offered an effective therapeutic alternative for relieving CCS-associated acute neuropathic pain with allodynia. Given the encouraging results of this study, it would be worthwhile to confirm these results in randomized placebo-controlled clinical trials.

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Combined epidural morphine and bupivacaine in the treatment of lumbosacral radicular neuropathic pain: a noncontrolled prospective study

Cited by 6 publications

References 31 publications

Why mu‐opioid agonists have less analgesic efficacy in neuropathic pain?

Why mu‐opioid agonists have less analgesic efficacy in neuropathic pain?

Investigating The Effects Of Pulsed Radiofrequency Therapy In The Blocking Of Action Potentials In Nerves

The analgesic effect of intravenous methylprednisolone on acute neuropathic pain with allodynia due to central cord syndrome: a retrospective study

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