Successful Pain Relief of Cutaneous Leiomyomata Due to Reed Syndrome with the Combination Treatment of Pregabalin and Duloxetine

Two sisters with Reed’s syndrome: treatment with pregabalin

“…For patients with multiple lesions, therapeutic modalities to manage the pain should be provided. The pathogenesis of pain is explained by the compression of nerve fibers, contraction of tumoral muscles, or excitation of alpha-adrenergic receptors on the arrector pili muscle [10,15,16]. To reduce the pain, pharmacological agents including calcium channel blockers (e.g., nifedipine), gabapentin, pregabalin, hydrobromide, nitroglycerin, phenoxybenzamine, and alpha-adrenergic receptor blockers have been tried.…”

Treatment of a Patient with Multiple Cutaneous Piloleiomyoma-Related Pain with a Local Injection of Triamcinolone Acetonide

“…One theory is that leiomyoma may cause pain by compressing the cutaneous nerves, damaging neuronal fibres and distorting the myelin sheath, as determined by electron microscopy. The contraction of smooth muscle in the leiomyoma or the presence of increased numbers of nerve elements within the tumours are other proposed mechanisms for leiomyoma-associated pain [1,2,9]. Additionally, immunohistochemical staining for the S-100 protein and neurofilaments has revealed more myelinated nerves and nerve axons in the lesions than in the normal skin of the same patient [10].…”

“…However, in the presence of numerous scattered lesions or large confluent areas of involvement, as in our clinical case, surgery and CO 2 laser treatment should not be considered. Rather, various pharmacological options have been reported [6,7,8,9,10]. Nifedipine, phenoxybenzamine, nitroglycerine, phenoxybenzamine, doxazosin, gabapentin, tramadol, pregabalin, duloxetine, analgesic-antipyretic, and botulinum toxin type A treatment, alone or in combination, have been administered with low and variable success.…”

“…These treatments included the administration of nifedipine along with hyoscine butylbromide, nitroglycerine, phenoxybenzamine, doxazosin, gabapentin alone or in combination with tramadol, an analgesic-antipyretic, a combination of pregabalin and duloxetine, and botulinum toxin type A, as reported in the literature [6,7,8,9,10]. A visual analogue scale was used to measure changes in the patient's level of pain.…”

Surgical Strategy and Treatment for the Prevalence of the Post- Thoracotomy Pain Syndrome

“…Pregabalin, which binds to the α2δ subunit of the voltage-gated calcium channel, was reported to reduce the excessive release of excitatory neurotransmitters by hyper-excited neurons involved in the development of anxiety symptoms, and suggested to have early-onset effects on both somatic and psychological symptoms of anxiety about pain [11]. The antidepressant medcine, duloxetine (serotonin-nonepinephrin reuptake inhibitor) which facilitates the descending analgesic circuits by increasing the concentration of serotonin and noradrenalin was also reported to be effective to the patients with neuropathic pain combination treatment of pregabalin [12,13]. Additionally, cathepsin S, cysteine protease of the papain family is likely to play an important role in the maintenance and chronicity of neuropathic pain [14] and is expected as a promising therapeutic agent.…”