Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0423716 (Neuropathic pain)
 1,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Until now, there have not been any parameters to monitor opioid therapy in cancer patients with pain. In this study, 325 consecutive advanced cancer patients were scheduled for a prospective longitudinal survey. After exclusions, 67 patients were surveyed. All included patients were advanced cancer patients with pain that required opioid therapy for more than 6 weeks before death. Opioid escalation, symptoms associated with opioid therapy, pain mechanism, and pain intensity were recorded. Indices were calculated to categorize the response to opioids. The opioid escalation index (OEI) was used to index the mean increase of the starting opioid dosage, expressed as a percentage or in mg. The length of the period of stable dose (MLD) and the effective analgesic score (EAS), that is, the analgesic consumption/pain relief ratio calculated at fixed intervals, were also used. Patients with a mean visual analogue scale score (VAS) of less than 4 and regular OEI and EAS were considered responsive; patients with a mean VAS less than 4 but with an OEI more than 5 or increases of more than 100% of EAS when compared to that calculated the week before were considered mildly responsive; and patients with a mean VAS more than 4 were considered unresponsive. Advanced age, female gender, and previous chemotherapy were all factors reducing OEI. Head and neck cancer was associated with a higher OEI. Regarding the influence of the opioid-related symptoms, an increased OEI was associated with the presence of confusion. Moreover the presence of confusion was associated with neuropathic pain. Neuropathic pain taken alone, however, did not influence this score. Gender-specific cancer, such as breast cancer, influenced the gender differences reported for MLD (significantly longer than that reported for males and other primary tumor). Good responsiveness was observed in 28 patients, partial responsiveness in 33 patients, unresponsiveness in six patients. Psychological factors were associated with poor pain relief, probably reducing the patient's compliance. The tools used in this study may be useful in monitoring the effects of opioid therapy in cancer pain patients. Simple numbers are easy to compare and make it possible to profile opioid responsiveness and differences among patients.
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PMID:Monitoring of opioid therapy in advanced cancer pain patients. 913 31

The aim of this study was to investigate a possible distinction in three categories of opioid response and to identify possible factors associated with a poor response. A prospective survey was carried out in 105 consecutive patients requiring morphine for at least 4 weeks before death. Mean pain intensity, opioid doses and symptom intensity at weekly intervals, pain syndromes, and the presence of psychological distress were assessed. Opioid escalation index (OEI%) was calculated from the parameters recorded. Three categories were considered, including (1) patients with slow increments of opioid dose and a mean analgesic 10-cm visual analogue scale (VAS) less than 4 (responders), (2) patients with an OEI% more than 5 but a mean VAS less than 4 (partial responders), and (3) patients with a mean VAS more than 4 (poor responders). Treating physicians were asked to make a judgment on the pain treatment difficulties on a numerical scale (0-10). Significant differences in opioid starting dose (OSD), opioid dose at--4 weeks, nausea and vomiting at--1 week, opioid maximum doses, mean VAS, and OEI were found in the three categories of response. Significant correlations with the physician judgment were found for opioid maximum dose, mean VAS, VAS at the different time intervals, the doses used at the different intervals, OEI, and confusion. Neuropathic pain was significantly associated with a judgment of poor pain outcome. The correlation between the physician judgment and the categories of opioid response was highly significant. Seven of the 12 patients in the third category (poor response) were considered as having a relevant psychological distress. The categorization of the opioid response used in this study could be used in clinical research and as an audit tool, and could be tested in other settings to compare different treatments.
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PMID:Investigation of an opioid response categorization in advanced cancer patients. 1058 58

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

Neuropathic pain is a considerable burden that affects activities of daily living. The management of neuropathic pain can be challenging because of multiple etiologies and complex manifestations. Ziconotide is a nonopioid intrathecal (IT) analgesic option for patients with neuropathic pain refractory to conventional treatments. The objective of this article is to review the published literature on ziconotide for the treatment of neuropathic pain. Relevant publications were identified through searches of all years of 6 databases, which included PubMed, EMBASE, and CINAHL. Search terms used were ziconotide, SNX-111, MVIIA, Prialt, and neuropathic pain. Publications were included if ziconotide was intrathecally administered (either alone or in combination with other IT agents) to treat neuropathic pain of any etiology and if pain assessment was an outcome measure. Data extracted included study design, IT drug doses, pain outcome measures, and adverse events (AEs). Twenty-eight articles met the inclusion criteria: 5 were preclinical studies and 23 were clinical studies. In the preclinical studies, ziconotide demonstrated antiallodynic effects on neuropathic pain. Data from double-blind, placebo-controlled (DBPC) trials indicated that patients with neuropathic pain reported a mean percent improvement in pain score with ziconotide monotherapy that ranged from 15.7% to 31.6%. A low starting dose and slow titration of ziconotide resulted in an improved safety profile in the aforementioned trials. Common AEs associated with ziconotide include nausea and/or vomiting, dizziness, confusion, urinary retention, and somnolence. Evidence from DBPC trials, open-label studies, case series, and case studies suggests that ziconotide, as either monotherapy or in combination with other IT drugs, is a potential therapeutic option for patients with refractory neuropathic pain. Additional studies are needed to establish the long-term efficacy and safety of ziconotide for neuropathic pain.
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PMID:Intrathecal ziconotide for neuropathic pain: a review. 1968 21

Acute nociceptive pain is an undesirable feeling but has a physiological significance as a warning system for living organisms. Conversely, chronic pain is lacking physiological significance, but rather represents a confusion of nerve functions. The neuropathic pain that occurs after peripheral nerve injury (PNI) is perhaps the most important type of chronic pain because it is refractory to available medications and thus remains a heavy clinical burden. In recent decades, studies have shown that spinal microglia play a principal role in the alterations in synaptic functions evoking this pain. It is also clear that the P2X4 receptor (P2X4R), a subtype of ionotropic ATP receptors, is upregulated exclusively in spinal microglia after PNI and plays a key role in evoking neuropathic pain. Neuropathic pain is caused by several conditions associated with activated microglia without nerve damage. 'Microgliopathic pain' is a new concept indicating such abnormal pain related to activated microglia.
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PMID:A state-of-the-art perspective on microgliopathic pain. 3048