Neuropathic pain: evidence matters

McQuay, Henry J

doi:10.1053/eujp.2001.0316

Cited by 61 publications

(29 citation statements)

References 34 publications

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“…Although opioids are considered to be less effective for relief of neuropathic pain than for nociceptive pain, 48,49 the frequent use of opioids and the perceived usefulness of this drug reported by some participants deserve further investigation. For example, several investigators 24,50 have suggested that specific neurological subgroups of neuropathic pains may respond to opioids.…”

Section: Discussionmentioning

confidence: 99%

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

2003

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Study design: Postal survey. Objectives: Because of the high prevalence and inadequate control of pain following spinal cord injury (SCI), it is important to have information about the factors associated with the use of specific pain therapies. We conducted this study to evaluate the ability of pain characteristics and psychosocial factors to predict the use of treatments. Setting: The Miami Project to Cure Paralysis (Miami, FL, USA). Methods: People with SCI (n ¼ 120) were mailed a packet containing a questionnaire with questions regarding demographic factors, pain characteristics, and pain treatments along with a copy of the Multidimensional Pain Inventory. Results: A total of 59% of the respondents had been prescribed treatment or self-initiated efforts to treat pain over the previous 18-month period. The most common treatments used by this sample were massage (26.6%), opioids (22.5%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (20%). The most effective treatments overall were 'physical therapies' with 50% receiving these treatments indicating that their pain was 'considerably reduced' or that they were 'pain free.' Opioids and anticonvulsants were perceived to be the most effective pharmacological agents prescribed (33.3 and 23.8% reporting their pain was considerably better or eliminated, respectively). People using prescription medication reported significantly greater pain severity, more widespread pain, more descriptive adjectives, more evoked pain, greater difficulty in dealing with pain, and more interference and decreased activity levels due to pain, compared to people not using prescription medication. A combination of greater difficulty in dealing with pain, intense pain, presence of evoked pain, and higher level of perceived support from significant others was predictive of taking prescription medication. Conclusion: People taking prescription medication reported significantly more intense pain with neuropathic characteristics that significantly affected daily life and routine activities. A substantial percentage of individuals with pain related to SCI did not obtain significant pain relief from prescription medications. None of the factors assessed predicted the use of nonprescription treatments. The results of this study confirm the inadequacy of available modalities to manage chronic pain related to SCI.

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Section: Discussionmentioning

confidence: 99%

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

2003

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“…Antidepressants have been used for more than 30 years in the clinical management of neuropathic pain (McQuay, 2002) and have been shown to provide analgesia for a variety of neuropathic pain syndromes regardless of the presence of depression (Richeimer et al, 1997;Mico et al, 2006). Many studies have demonstrated the efficacy of antidepressants for the management of diabetic neuropathy (Kvinesdal et al, 1984;Sindrup et al, 1989;Max et al, 1992), postherpetic neuralgia (Watson et al, 1982), poststroke pain (Leijon and Boivie, 1989), post-thoracotomy pain (Keller et al, 1994), and almost all types of neuropathic pain (Saarto and Wiffen, 2005;Sindrup et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Antidepressants for Improving the Neuropathic Pain-Like State and Pain-Induced Anxiety through Actions at Different Brain Sites

Matsuzawa-Yanagida

Narita

Nakajima

et al. 2007

Neuropsychopharmacol

121

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Clinically, it is well known that chronic pain induces depression, anxiety, and a reduced quality of life. There have been many reports on the relationship between pain and emotion. We previously reported that chronic pain induced anxiety with changes in opioidergic function in the central nervous system. In this study, we evaluated the anxiolytic-like effects of several types of antidepressants under a chronic neuropathic pain-like state and searched for the brain site of action where antidepressants show anxiolytic or antinociceptive effects. Sciatic nerve-ligated mice exhibited thermal hyperalgesia and tactile allodynia from days 7 to 28 after nerve ligation. At 4 weeks after ligation, these mice showed a significant anxiety-related behavior in the light-dark test and the elevated plus-maze test. Under these conditions, repeated administration of antidepressants, including the tricyclic antidepressant (TCA) imipramine, the serotonin noradrenaline reuptake inhibitor (SNRI) milnacipran, and the selective serotonin reuptake inhibitor (SSRI) paroxetine, significantly prevented the anxiety-related behaviors induced by chronic neuropathic pain. These antidepressants also produced a significant reduction in thermal hyperalgesia and tactile allodynia. Moreover, the microinjection of paroxetine into the basolateral amygdala or cingulate cortex reduced anxiety-related behavior, and microinjection into the primary somatosensory cortex significantly attenuated thermal hyperalgesia. These findings suggest that serotonergic antidepressants are effective for treating anxiety associated with chronic neuropathic pain and may be useful for treating neuropathic pain with emotional dysfunction such as anxiety. Furthermore, SSRIs show anxiolytic and antinociceptive effects by acting on different brain regions.

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“…DPN is mainly a progressive distal axonopathy, with loss of feeling and numbness in feet, hands and legs, which may be accompanied by painful tingling or burning sensations [7]. Diabetic neuropathies are painful in more than 15% of patients, a substantial proportion of whom complain of chronic pain [6] and poor response to conventional analgesics [8].…”

Section: Introductionmentioning

confidence: 99%

Regression of diabetic complications by islet transplantation in the rat

et al. 2009

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Aims/hypothesis Type 1 diabetes is a chronic disease leading to complications such as peripheral neuropathies, nephropathy and cardiovascular disease. Pancreatic islet transplantation is being extensively investigated for blood glucose control in animals and in human type 1 diabetic patients, but the question of whether it can reverse long-term diabetic complications has not been fully explored. We investigated the effects of islet transplantation on diabetic complications in a rat model of streptozotocin-induced diabetes.Methods Three groups of rats were used: healthy controls, diabetic and diabetic rats transplanted with microencapsulated islets at 2 months after diabetes induction, when neuropathy was detectable by a decrease in tail nerve conduction velocity (NCV) and impaired nociceptive thresholds. Blood glucose levels and body weight were measured weekly. The variables considered were: thermal (hot plate test) and mechanical sensitivity (Randal-Selitto paw withdrawal test), NCV and Na+, K+-ATPase activity in the sciatic nerve. At the end of the experiments hearts were removed for morphometric determination and myocyte number, and kidneys removed for histological examination. Results Islet transplantation in diabetic rats induced normoglycaemia in a few days, accompanied by a rapid rise in body weight and amelioration of impaired nociceptive thresholds, as well as normalisation of NCV and Na + , K + -ATPase, which were both about 25% below normal in diabetic rats. Myocyte loss was reduced (−34%) by islet transplantation and the observed mild kidney damage of diabetic rats was prevented. Conclusions/interpretation Besides controlling glycaemia, transplantation of microencapsulated pancreatic islets induced almost complete regression of neuropathy and prevented cardiovascular alterations.

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Neuropathic pain: evidence matters

Cited by 61 publications

References 34 publications

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

Usefulness of Antidepressants for Improving the Neuropathic Pain-Like State and Pain-Induced Anxiety through Actions at Different Brain Sites

Regression of diabetic complications by islet transplantation in the rat

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