Therapeutic Basis of Clinical Pain Modulation

Kirkpatrick, R B S Daniel; McEntire, M B S Dan; Hambsch, Jasmin; Kerfeld, J B S Mitchell; Smith, April; Reisbig, Mark D.; Youngblood, Charles F.; Agrawal, Devendra K.

doi:10.1111/cts.12282

Cited by 50 publications

(39 citation statements)

References 75 publications

(278 reference statements)

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“…Pharmacological treatments engaging descending noradrenergic and serotonergic control pathways have shown some efficacy in the treatment of pain, demonstrating the importance of serotonin and norepinephrine in pain modulation (Bannister & Dickenson, 2017; Kirkpatrick et al, 2015). Antidepressants such as tricyclic antidepressants, serotonin–norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors are used for pain management in chronic pain conditions such as neuropathic pain, migraines, and fibromyalgia (Dharmshaktu, Tayal, & Kalra, 2012).…”

Section: A Few Other Pharmacological and Therapeutic Applicationsmentioning

confidence: 99%

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Damien

Colloca

Belleï-Rodriguez

et al. 2018

International Review of Neurobiology

106

107

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Accumulating evidence reveal important applications of endogenous pain modulation assessment in healthy controls and in patients in clinical settings, as dysregulations in the balance of pain modulatory circuits may facilitate pain and promote chronification of pain. This article reviews data on pain modulation, focusing on the mechanisms and translational aspects of pain modulation from conditioned pain modulation (CPM) to placebo and nocebo effects in experimental and clinical pain. The specific roles of expectations, learning, neural and neurophysiological mechanisms of the central nervous system are briefly reviewed herein. The interaction between CPM and placebo systems in pain inhibitory pathways is highly relevant in the clinic and in randomized controlled trials yet remains to be clarified. Examples of clinical implications of CPM and its relationship to placebo and nocebo effects are provided. A greater understanding of the role of pain modulation in various pain states can help characterize the manifestation and development of chronic pain and assist in predicting the response to pain-relieving treatments. Placebo and nocebo effects, intrinsic to every treatment, can be used to develop personalized therapeutic approaches that improve clinical outcomes while limiting unwanted effects.

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Section: A Few Other Pharmacological and Therapeutic Applicationsmentioning

confidence: 99%

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Damien

Colloca

Belleï-Rodriguez

et al. 2018

International Review of Neurobiology

106

107

View full text Add to dashboard Cite

show abstract

“…(77) Further, descending pathways such as periaqueductal gray and rostral ventromedial medulla provide anti-nociceptive modulation of the pain signals. (78) Stress and its associated negative emotions have a significant effect on pain perception. (79) Thus people with higher stress have increased axonal connections and dendritic arborization in amygdala, and decreased axonal connections and dendritic arborization in hippocampus and prefrontal cortex.…”

Section: Possible Mechanism Of Actionmentioning

confidence: 99%

Complementary and alternative medicine therapies for chronic pain

Bauer

Tilburt

Sood

et al. 2016

Chin. J. Integr. Med.

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Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.

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“…Excessive pain inputs are endogenously suppressed at the spinal cord by the descending inhibitory pathway, in which c-amino butyric acid (GABA) participates as a predominant inhibitory neurotransmitter. 2 In our case, pregabalin and gabapentin, which inhibit the ascending pain pathway by binding to voltage-gated calcium channels, 3 are ineffective. However, etizolam and clonazepam markedly alleviated the pain.…”

mentioning

confidence: 65%