Management of Neuropathic Pain with Methylprednisolone at the Site of Nerve Injury

Eker, H. Evren; Çok, Oya Yalçın; Aribogan, Anıs; Arslan, G.

doi:10.1111/j.1526-4637.2011.01323.x

Cited by 78 publications

(63 citation statements)

References 21 publications

(36 reference statements)

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“…1). [25][26][27][28][29] Trial, participants, and intervention characteristics (Table 1) All of the studies in the steroid groups involved a single injection of steroid. The median (range) target sample size was 88 (30-131) patients.…”

Section: Search Resultsmentioning

confidence: 99%

“…The median (range) target sample size was 88 (30-131) patients. The studies investigated patients receiving perineural steroids for NP secondary to compression or trauma of various peripheral nerves (common peroneal, suprascapular, popliteal, sciatic, thoracic paravertebral, and femoral nerves), 25 median nerve at the carpal tunnel, 26,29 the ninth (glossopharyngeal) cranial nerve, 28 and interdigital nerves in the foot (Morton's neuroma). 27 A validated scale for diagnosing NP was used in only one study (i.e., the Leeds Assessment of Neuropathic Symptoms and Signs -LANSS), 25 and all other studies enrolled participants only on the basis of neuropathic signs and symptoms.…”

Section: Search Resultsmentioning

confidence: 99%

“…26,29 Three studies had two groups for direct comparison of steroids with LA or CMM. 25,27,28 The other two studies (both on median nerve compression) had three groups. 26,29 In one of these two studies, steroids with and without LA were compared with LA 29 ; whereas, in the other study, steroids were compared with LA in one group and with placebo in another group.…”

Section: Search Resultsmentioning

confidence: 99%

“…26,29 In one of these two studies, steroids with and without LA were compared with LA 29 ; whereas, in the other study, steroids were compared with LA in one group and with placebo in another group. 26 The perineural steroids used in the studies were methylprednisolone (40 mg 27 or 80 mg) 25,28 and triamcinolone (40 mg). 26,29 Local anesthetics used in the comparator groups were lidocaine (0.5% or 2%) 25,27 or procaine (1%).…”

Section: Search Resultsmentioning

confidence: 99%

“…26 The perineural steroids used in the studies were methylprednisolone (40 mg 27 or 80 mg) 25,28 and triamcinolone (40 mg). 26,29 Local anesthetics used in the comparator groups were lidocaine (0.5% or 2%) 25,27 or procaine (1%). 26,29 Prior to perineural injection, the nerves were located using stimulation, 25 ultrasound, 27 or anatomic landmarks.…”

Section: Search Resultsmentioning

confidence: 99%

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Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis

Bhatia

Flamer

Shah

2015

Can J Anesth/J Can Anesth

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Purpose Perineural steroids are often used to treat chronic peripheral neuropathic pain (NP) secondary to trauma or compression. Nevertheless, when compared with local anesthetics (LA) or conventional medical management (CMM), their efficacy and safety in patients with trauma or compression-related neuropathic pain syndromes is unclear. The purpose of this systematic review and meta-analysis was to determine the efficacy and safety of perineural steroids in compression or traumarelated NP after one to three months of injection. Source We reviewed randomized controlled trials from MEDLINE Ò , EMBASE TM , Cochrane central register of controlled trials, Cochrane database of systematic reviews, and Google Scholar (first 200 hits) up to April 2014 that compared perineural injections of steroids with LA or CMM in adult patients with trauma or compression-related chronic peripheral NP. A meta-analysis was performed on the data on pain scores measured at one to three months after the interventions. Quality of evidence was classified using the GRADE system. Two authors independently reviewed all identified titles and abstracts for eligibility. Principal findings Five trials comprising 353 patients (177 in the steroid group and 176 in the comparator groups) were included. At one to three months after the interventions, patients who received perineural steroids reported lower pain scores than those who received LA or CMM (mean difference: -1.31 points on a 0-10 numerical rating scale for pain; 95% confidence interval: -2.50 to -0.13; quality of evidence: low; I 2 = 89%). None of the studies reported any significant adverse effects.This manuscript was screened for plagiarism using http:// smallseotools.com/plagiarism-checker/.Author contributions Anuj Bhatia wrote the manuscript. Anuj Bhatia and David Flamer participated in the acquisition of data. Anuj Bhatia, David Flamer, and Prakesh S. Shah helped design and conduct the study, and they participated in the conception of the review, the analysis and interpretation of data, and drafting the article. Conclusions Perineural steroids may provide analgesic efficacy for one to three months in patients with chronic peripheral NP of traumatic or compressive origin; however, the strength of this recommendation is weak. Well-designed large randomized studies are required. RésuméObjectif Les infiltrations périnerveuses de stéroïdes sont souvent utilisées pour le traitement de la douleur neuropathique périphérique chronique secondaire à un traumatisme ou une compression. Néanmoins, quand on les compare aux anesthésiques locaux (AL) ou à la prise en charge médicale conventionnelle (PCM), leur efficacité et sécurité chez les patients souffrant de syndromes neuropathiques douloureux secondaires à un traumatisme ou à une compression ne sont pas claires. Les objectifs de cette étude systématique et méta-analyse étaient de déterminer l'efficacité et l'innocuité des infiltrations périnerveuses de stéroïdes dans les neuropathies périphériques liées à une compression ou à un traumatis...

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Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis

Bhatia

Flamer

Shah

2015

Can J Anesth/J Can Anesth

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Combination pharmacotherapy for the treatment of neuropathic pain in adults

Chaparro

Wiffen

Moore³

et al. 2012

Cochrane Database of Systematic Reviews

250

213

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Background Pharmacotherapy remains an important modality for the treatment of neuropathic pain. However, as monotherapy current drugs are associated with limited e icacy and dose-related side e ects. Combining two or more di erent drugs may improve analgesic e icacy and, in some situations, reduce overall side e ects (e.g. if synergistic interactions allow for dose reductions of combined drugs). Objectives This review evaluated the e icacy, tolerability and safety of various drug combinations for the treatment of neuropathic pain. Search methods We identified randomised controlled trials (RCTs) of various drug combinations for neuropathic pain from CENTRAL, MEDLINE, EMBASE and handsearches of other reviews and trial registries. The most recent search was performed on 9 April 2012. Selection criteria Double-blind, randomised studies comparing combinations of two or more drugs (systemic or topical) to placebo and/or at least one other comparator for the treatment of neuropathic pain. Data collection and analysis Data extracted from each study included: proportion of participants a) reporting ≥ 30% pain reduction from baseline OR ≥ moderate pain relief OR ≥ moderate global improvement; b) dropping out of the trial due to treatment-emergent adverse e ects; c) reporting each specific adverse e ect (e.g. sedation, dizziness) of ≥ moderate severity. The primary comparison of interest was between study drug(s) and one or both single-agent comparators. We combined studies if they evaluated the same drug class combination at roughly similar doses and durations of treatment. We used RevMan 5 to analyse data for binary outcomes. Main results We identified 21 eligible studies: four (578 participants) evaluated the combination of an opioid with gabapentin or pregabalin; two (77 participants) evaluated an opioid with a tricyclic antidepressant; one (56 participants) of gabapentin and nortriptyline; one (120 participants) of gabapentin and alpha-lipoic acid, three (90 participants) of fluphenazine with a tricyclic antidepressant; three (90 participants) of an N-methyl-D-aspartate (NMDA) blocker with an agent from a di erent drug class; five (604 participants) of various topical medications; one (313 participants) of tramadol with acetaminophen; and another one (44 participants) of a cholecystokinin blocker (L-365,260) with morphine. The majority of combinations evaluated to date involve drugs, each of which share some element of central nervous system (CNS) depression (e.g. sedation, cognitive dysfunction). This aspect of side e ect overlap between the combined Combination pharmacotherapy for the treatment of neuropathic pain in adults (Review)

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Peripheral nerve injury and myelination: Potential therapeutic strategies

Modrak

Talukder

Gurgenashvili

et al. 2019

J of Neuroscience Research

141

118

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Traumatic peripheral nerve injury represents a major clinical and public health problem that often leads to significant functional impairment and permanent disability. Despite modern diagnostic procedures and advanced microsurgical techniques, functional recovery after peripheral nerve repair is often unsatisfactory. Therefore, there is an unmet need for new therapeutic or adjunctive strategies to promote the functional recovery in nerve injury patients. In contrast to the central nervous system, Schwann cells in the peripheral nervous system play a pivotal role in several aspects of nerve repair such as degeneration, remyelination, and axonal growth. Several non‐surgical approaches, including pharmacological, electrical, cell‐based, and laser therapies, have been employed to promote myelination and enhance functional recovery after peripheral nerve injury. This review will succinctly discuss the potential therapeutic strategies in the context of myelination following peripheral neurotrauma.

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Management of Neuropathic Pain with Methylprednisolone at the Site of Nerve Injury

Abstract: Our results suggest that peripheral nerve block with 80 mg depo-methylprednisolone plus 0.5% lidocaine provides effective management in the treatment of neuropathic pain due to peripheral nerve damage.

Cited by 78 publications

References 21 publications

Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis

Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis

Combination pharmacotherapy for the treatment of neuropathic pain in adults

Peripheral nerve injury and myelination: Potential therapeutic strategies

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