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Neuropathic pain arises from a lesion or dysfunction within the nervous system; the specific mechanisms that elicit neuropathic pain symptoms are the subject of ongoing research. It is generally acknowledged that neuropathic pain is extremely difficult to treat, and a major factor impacting outcomes is the presence of comorbidities such as poor sleep, depressed mood, and anxiety. Patients who suffer from chronic pain experience difficulties in initiating and maintaining sleep. Sleep deprivation has been associated with a decreased pain threshold, muscle aches, and stiffness in normal volunteers. The interrelationship of these factors is complex: Many chronic pain patients are depressed and anxious; sleep deprivation can lead to anxiety; and depression can be both the cause and the result of sleep disturbances. Thus, physicians must evaluate all aspects of pain, sleep, and mood in chronic pain patients. Several instruments have been developed to aid physicians in gathering qualitative and quantitative information from chronic pain patients. This triad of chronic pain, sleep disturbances, and depression/anxiety must be fully addressed if the patient is to be restored to optimal functionality. A multidisciplinary team approach allows for treatment of the whole patient. Nonpharmacologic interventions include relaxation therapy, sleep restriction therapy, and cognitive therapy. Strategies for pharmacologic interventions should attempt to maximize outcomes by employing, where possible, agents that address both the pain and the comorbidities. In this way, functionality may be restored and the patient's quality of life improved.
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PMID:Comorbidities in chronic neuropathic pain. 1499 27

Certainly it is important for good nursing practice to know what medications are being prescribed, the desired therapeutic effects, and the anticipated undesirable side effects. Understanding the physiologic rationale for pain medications is, therefore, basic to good nursing care of persons with pain. Understanding the physiology of pain and rationale for use of medications also underscores the importance of a good pain assessment. Neuropathic pain often does not respond to traditional analgesics and the nurse's assessment will assist in identifying the type of pain a person is experiencing. A knowledge of how and why medications work to manage pain is also essential in order to provide good patient and family education. Misunderstandings can arise if individuals do not understand the rationale for their medications. For example, a patient who receives a prescription for desipramine may learn from his pharmacist that his new medication treats depression, leading to questions about the perception of his emotional status. Misinformation and confusion causes anxiety and can undermine trust in healthcare providers. Therefore, the rationale for all medications should be explained to patients. This is especially important when using medications that are not traditionally viewed as analgesics, such as tricyclic antidepressants and anticonvulsants. In most circumstances, pain can be very effectively treated. This requires a thorough initial assessment to determine the type and cause of pain, the careful selection of interventions, systematic evaluation of the effectiveness of interventions, and appropriate changes in the plan if optimal pain management is not achieved. The focus of this paper is on the rationale for use of various medications to manage pain. However, it is essential to remember that non-pharmacological interventions are very important in managing pain and must be included in a comprehensive plan of care for pain management.
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PMID:The physiologic basis of pain medications. 1513 49

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent reported current passive suicidal ideation (PSI), 13% had active thoughts of committing suicide (ASI), 5% had a current suicide plan, and 5% reported a previous suicide attempt. Drug overdose was the most commonly reported plan and method of attempt (75%). Thirteen-percent reported a family history of suicide attempt/completion. Pain-specific and traditional suicide risk factors were evaluated as predictors of current PSI and ASI. Logistic regression analyses revealed that a family history of suicide attempts/completions was associated with a 7.5 fold increase in risk of PSI (P=0.001) and a 6.6 fold increase in ASI (P=0.003), after adjusting for significant covariates. Having abdominal pain was associated with an adjusted 5.5 fold increase in PSI (P=0.05) and a 4.2 fold increase in ASI (P=0.10). Neuropathic pain significantly reduced risk for both PSI (P=0.002) and ASI (P=0.01). Demographics, pain severity, and depression severity were not associated with suicidal ideation in multivariate analyses. These findings highlight the need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain.
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PMID:Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk. 1532 24

Neuropathic pain is defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system. It is a devastating and difficult to manage consequence of peripheral nerve injury and has a variety of clinical symptoms. Neuropathic pain is a major health problem. It has been estimated that 70% of patients with advanced cancer and inflammatory pathologies are afflicted by chronic pain. About 95% of patients with spinal cord injuries have neuropathic pain problems. Chronic pain is debilitating and cause of depression and decreasing quality of life. Pharmacological treatment for the symptoms of painful neuropathy is difficult, because there has been limited understanding of the underlying causes and systemic levels that an effective dose can have on multiple side effects. The use of molecular methods, such as gene therapy, stem cell therapy and viral vector for delivery of biologic antinociceptive molecules, has led to a better understanding of the underlying mechanisms of the induction of intractable neuropathic pain.
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PMID:Neuropathic pain: is the end of suffering starting in the gene therapy? 1572 Feb 15

Pain is the primary reason for patients seeking healthcare, and it has been estimated to result in more than dollar 100 billion per year in direct medical costs. Neuropathic pain (NP) alone has been associated with an approximately 3-fold increase in use of healthcare resources. The indirect costs associated with chronic pain result from increased absenteeism and decreased productivity at work, and they also have been estimated to total dollar 100 billion each year in the United States. NP contributes substantially to these costs. Results from one study indicated that employment was affected in 43% of patients with NP. Quality of life is also significantly reduced in such patients. Patients with chronic pain also have difficulty in initiating and maintaining sleep, and sleep deprivation has the potential to exacerbate pain. Sleep deprivation is also associated with both anxiety and depression, and both of these conditions can exacerbate sleep disturbances. Effective management of the patient with chronic pain, including NP, requires assessment and, if necessary, treatment of all comorbidities associated with this condition.
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PMID:Consequences of neuropathic pain: quality-of-life issues and associated costs. 1677 58

Neuropathic pain, caused by various central and peripheral nerve disorders, is especially problematic because of its severity, chronicity and resistance to simple analgesics. The condition affects 2%-3% of the population, is costly to the health care system and is personally devastating to the people who experience it. The diagnosis of neuropathic pain is based primarily on history (e.g., underlying disorder and distinct pain qualities) and the findings on physical examination (e.g., pattern of sensory disturbance); however, several tests may sometimes be helpful. Important pathophysiologic mechanisms include sodium-and calcium-channel upregulation, spinal hyperexcitability, descending facilitation and aberrant sympathetic-somatic nervous system interactions. Treatments are generally palliative and include conservative nonpharmacologic therapies, drugs and more invasive interventions (e.g., spinal cord stimulation). Individualizing treatment requires consideration of the functional impact of the neuropathic pain (e.g., depression, disability) as well as ongoing evaluation, patient education, reassurance and specialty referral. We propose a primary care algorithm for treatments with the most favourable risk-benefit profile, including topical lidocaine, gabapentin, pregabalin, tricyclic antidepressants, mixed serotonin-norepinephrine reuptake inhibitors, tramadol and opioids. The field of neuropathic pain research and treatment is in the early stages of development, with many unmet goals. In coming years, several advances are expected in the basic and clinical sciences of neuropathic pain, which will provide new and improved therapies for patients who continue to experience this disabling condition.
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PMID:Neuropathic pain: a practical guide for the clinician. 1688 Apr 48

Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. It is estimated that 75-150 million people in the United States have a chronic pain disorder. Neuropathic pain has a great impact on the quality of life. It is debilitating and often has an associated degree of depression that contributes to decreasing human wellbeing. Moreover, the management of chronic pain is costly to the health care system. The United States Congress has declared the present decade (2001-2010) as the "Decade of Pain Control and Research", making pain a national healthcare priority. In Europe, statistics provided by the International Association on the Study of Pain (IASP) and the European Federation of the IASP Chapters (EFIC) indicate that one in five people suffer from moderate to severe chronic pain, and that one in three are unable or less able to maintain an independent lifestyle due to their pain. Between one-half and two-thirds of people with chronic pain are less able or unable to exercise, enjoy normal sleep, perform household chores, attend social activities, drive a car, walk or have sexual relations. The effect of pain means that one in four reports that relationships with family and friends are strained or broken, according to the IASP/EFIC data. Neuropathic pain treatment is extremely difficult. Neuropathic pain is a very complex disease, involving several molecular pathways. Excitatory or inhibitory pathways controlling neuropathic pain development show altered gene expression, caused by peripheral nerve injury. Current available drugs are usually not acting on the several mechanisms underlying the generation and propagation of pain. Nowadays, pain research is directing on new molecular methods, such as gene therapy, stem cell therapy and viral vectors for delivery of biologic antinociceptive molecules. These methods could provide a new therapeutic approach to neuropathic pain relief.
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PMID:Molecular approaches for neuropathic pain treatment. 1762 16

Neuropathic pain is caused by functional abnormalities of structural lesions or dysfunction in the peripheral or central nervous system, and occurs without peripheral nociceptor stimulation. Neuropathic pain has a great impact on the quality of life. Majority of the patients are unable to maintain an independent lifestyle due to their moderate to severe chronic pain and often depression contributes to the illness. Many common diseases, such as stroke, multiple sclerosis and syringomyelia may produce neuropathic pain. Neuropathic pain is a complex disease, involving several molecular pathways. Neuropathic pain treatment is stil extremely difficult despite our knowledge about this difficult to diagnose and treat pain condition has improved a lot with the aid of recent experimental and clinical studies. This review summarizes the underlying mechanisms, diagnosis and treatment approaches based on different mechanisms of effect.
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PMID:[Neuropathic pain]. 1809 93

Neuropathic pain syndromes are characterized by intense and long lasting pain that is resistant to usual analgesics. Patients are therefore at high risk of decreased quality of life and impaired well-being. Using a case report, we will consider in this article the diagnosis and treatment of neuropathic pain as well as its impact on the quality of life including psychological consequences such as depression and anxiety. We will present simple and reliable scales that can help the general practitioner evaluate the neuropathic component of the pain syndrome and its related psychiatric co-morbidities. This comprehensive approach to pain management should facilitate communication with the patient and help the practitioner select the most appropriate therapeutic strategy, notably the prescription of antidepressants, the efficacy of which we will discuss at the end of the article.
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PMID:[Neuropathic pain: tips and tools for specific and comprehensive pain management]. 1864 94

Neuropathic pain is commonly associated with affective disorders such as anxiety and depression. We have previously characterised a rodent model of HIV, anti-retroviral-associated neuropathy in which rats develop hypersensitivity to a punctate mechanical stimulus and display anxiety-like behaviour in the open field paradigm. To assess the potential of this behavioural paradigm for the assessment of pain related co-morbidities in rodent models of pain, here we test the sensitivity of this anxiety-like behaviour to the analgesic agents gabapentin and morphine in comparison to the known anxiolytic drug diazepam. We found that gabapentin (30 mg/kg, i.p.) and morphine (2.5 mg/kg, i.p.), which reduce mechanical hypersensitivity in these rats, significantly reduces measures of thigmotaxis in the open field. The effect of gabapentin and morphine did not differ significantly from diazepam (1 mg/kg, i.p.). This study highlights the potential use of this rodent model and behavioural paradigm in the validation of the affective component of novel analgesic pharmacological targets and elucidation of underlying pathophysiological mechanisms.
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PMID:Anxiety-like behaviour is attenuated by gabapentin, morphine and diazepam in a rodent model of HIV anti-retroviral-associated neuropathic pain. 1892 76


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