Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study

Staudt, Michael D.; Clark, Alexander J.; Gordon, Allan; Lynch, Mary; Morley-Forster, Pat; Nathan, Howard J.; Smyth, Catherine; Stitt, Larry; Toth, Cory; Ware, Mark A.; Moulin, Dwight E.

doi:10.1017/cjn.2018.55

Cited by 18 publications

(7 citation statements)

References 53 publications

(112 reference statements)

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“…Indeed, conventional assessment scales such as VAS or NRS predominantly measure the sensory component of pain, whereas the cognitive and affective dimensions remain understudied. Recent research supports that improvement in functional metrics can be dissociated from pain scores; for example, a prospective study of medical management for central neuropathic pain identified a greater proportion of patients achieving a functional improvement as opposed to pain reduction (38.5% vs. 13.5% of patients, respectively) (27). Studies of deep brain stimulation for neuropathic pain have also reported improvements quality of life metrics (e.g., BDI, MPQ) despite inadequate reductions in pain intensity (28,29).…”

Section: Discussionmentioning

confidence: 99%

Craniofacial Peripheral Nerve Stimulation: Analysis of a Single Institution Series

Harland

Zbrzeski

DiMarzio

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Section: Discussionmentioning

confidence: 99%

Craniofacial Peripheral Nerve Stimulation: Analysis of a Single Institution Series

Harland

Zbrzeski

DiMarzio

et al. 2020

Neuromodulation: Technology at the Neural Interface

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“…However, these drugs have many side effects, such as neurocognition, falls, and weight gain [ 18 ]. In addition, the management of neuropathic pain lasts for long-term, and most patients have not enough to relieve pain [ 19 , 20 ]. Therefore, it is particularly urgent and important to investigate more effective and novel therapeutic options for neuropathic pain.…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture Modulates Spinal BDNF/TrκB Signaling Pathway and Ameliorates the Sensitization of Dorsal Horn WDR Neurons in Spared Nerve Injury Rats

Xue

Sun

Xia

et al. 2020

IJMS

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Neuropathic pain is more complex and severely affects the quality of patients’ life. However, the therapeutic strategy for neuropathic pain in the clinic is still limited. Previously we have reported that electroacupuncture (EA) has an attenuating effect on neuropathic pain induced by spared nerve injury (SNI), but its potential mechanisms remain to be further elucidated. In this study, we designed to determine whether BDNF/TrκB signaling cascade in the spinal cord is involved in the inhibitory effect of 2 Hz EA on neuropathic pain in SNI rats. The paw withdrawal threshold (PWT) of rats was used to detect SNI-induced mechanical hypersensitivity. The expression of BDNF/TrκB cascade in the spinal cord was evaluated by qRT-PCR and Western blot assay. The C-fiber-evoked discharges of wide dynamic range (WDR) neurons in spinal dorsal horn were applied to indicate the noxious response of WDR neurons. The results showed that 2 Hz EA significantly down-regulated the levels of BDNF and TrκB mRNA and protein expression in the spinal cord of SNI rats, along with ameliorating mechanical hypersensitivity. In addition, intrathecal injection of 100 ng BDNF, not only inhibited the analgesic effect of 2 Hz EA on pain hypersensitivity, but also reversed the decrease of BDNF and TrκB expression induced by 2 Hz EA. Moreover, 2 Hz EA obviously reduced the increase of C-fiber-evoked discharges of dorsal horn WDR neurons by SNI, but exogenous BDNF (100 ng) effectively reversed the inhibitory effect of 2 Hz EA on SNI rats, resulting in a remarkable improvement of excitability of dorsal horn WDR neurons in SNI rats. Taken together, these data suggested that 2 Hz EA alleviates mechanical hypersensitivity by blocking the spinal BDNF/TrκB signaling pathway-mediated central sensitization in SNI rats. Therefore, targeting BDNF/TrκB cascade in the spinal cord may be a potential mechanism of EA against neuropathic pain.

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Section: Epidemiologymentioning

confidence: 99%

“…Studies of long-term outcomes in the management of CNP show that patients with CNP are less likely to achieve clinically notable improvements in pain relief and function than those with peripheral neuropathic pain [16]. SCI-related neuropathic pain is associated with a lower response to placebo compared to other neuropathic pain conditions (e.g., HIV neuropathy) [17].…”

Section: Epidemiologymentioning

confidence: 99%

Central Neuropathic Mechanisms in Pain Signaling Pathways: Current Evidence and Recommendations

et al. 2020

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Purpose This is a comprehensive review of the current literature on central neuropathic pain mechanisms that is secondary to spinal cord injury. It reviews recent and seminal findings on the pathophysiology, diagnosis, and treatment and compares treatment options and recommendations. Recent Findings Neuropathic pain (NP) is a common complication of spinal cord injury (SCI). Chronicity of NP is attributed to increased abundance of inflammatory mediators and ion channel dysfunction leading to afferent nerve sensitization; nerve damage and nerve–glia cross talk have also been implicated. Conventional treatment is medical and has had limited success. Recent studies have made headway in identifying novel biomarkers, including microRNA and psychosocial attributes that can predict progress from SCI to chronic NP (CNP). Recent advances have provided evidence of efficacy for two promising drugs. Baclofen was able to provide good, long-lasting pain relief. Ziconotide, a voltage-gated calcium channel blocker, was studied in a small trial and was able to provide good analgesia in most participants. However, several participants had to be withdrawn because of worrisome creatine phosphokinase (CPK) elevations, and further studies are required to define its safety profile. Non-medical interventions include brain sensitization and biofeedback techniques. These methods have recently had encouraging results, albeit preliminary. Case reports of non-conventional techniques, such as hypnosis, were also reported. Summary CNP is a common complication of SCI and is a prevalent disorder with significant morbidity and disability. Conventional medical treatment is limited in efficacy. Recent studies identified baclofen and ziconotide as possible new therapies, alongside non-medical interventions. Further research into the pathophysiology is required to identify further therapy candidates. A multidisciplinary approach, including psychosocial support, medical and non-medical interventions, is likely needed to achieve therapeutic effects in this difficult to treat syndrome.

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Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study

Abstract: Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.

Cited by 18 publications

References 53 publications

Craniofacial Peripheral Nerve Stimulation: Analysis of a Single Institution Series

Craniofacial Peripheral Nerve Stimulation: Analysis of a Single Institution Series

Electroacupuncture Modulates Spinal BDNF/TrκB Signaling Pathway and Ameliorates the Sensitization of Dorsal Horn WDR Neurons in Spared Nerve Injury Rats

Central Neuropathic Mechanisms in Pain Signaling Pathways: Current Evidence and Recommendations

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