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Query: UMLS:C0423716 (Neuropathic pain)
 1,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain may be the most common reason patients seek treatment from physicians. When persistent and unrelieved, pain can frustrate both the person suffering with this condition and the physician trying to alleviate it. Relief from such discomfort may be particularly difficult to achieve and fraught with misconceptions. Treatment usually requires trials of physical, pharmacologic, and surgical interventions to achieve resolution. In cases that remain insoluble, patients must accept partial relief and seek adaptive strategies. Sources of persistent pain may be nociceptive or neuropathic. Both utilize the same nerve pathways for transmission, but significant physiologic differences exist in mechanisms through which these painful stimuli are biologically processed and resolved. Nociceptive pain resulting from a known or obvious source (eg, trauma, cancer metastasis, ischemia, arthritis) is often easy to identify. Neuropathic pain, however, may occur in the absence of an identifiable precipitating cause. Physicians must remain alert to differences in presentation and course of neuropathic pain syndromes, some of which may be subtle or unusual.
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PMID:Managing neuropathic pain. 1798 77

Neuropathic pain affects 26 million patients worldwide resulting in a worldwide healthcare cost over $ 3 billion per year. Despite the availability of an impressive arsenal of powerful drugs for the effective management of pain, there remains a great medical need for new medicines to treat pain. While little is known about the proteins that detect noxious stimuli (especially those of a physical nature), vanilloid receptor, an excitatory ion channel expressed by nociceptors, has been identified as molecular target for the development of recent therapies to treat pain. Initially, the focus was on the development of TRPV1 agonists e.g. capsaicin and resiniferatoxin (RTX) as analgesic agents through the desensitization/denervation approach. While various formulations of capsaicin are either marketed or are currently under development, this approach is often hindered by the pain and discomfort experienced on initial treatment. Thus, TRPV1 antagonists are being evaluated as promising drug candidates to inhibit the transmission of nociceptive signals from the periphery to the CNS and to block other pathological states associated with this receptor. Since the discovery of capsazepine as the first TRPV1 antagonist, multiple classes of antagonists has been reported that can be broadly classified as urea/amide-based and non-urea/non-amide-based agents. However, depending on their chemical structures all these agents can be grouped as benzenesulfonamides, cinnamides, ureas, thio-ureas, amides, benzimidazoles, and piperazine carboxamides, N-aryl-cinnamides etc. The present review will focus on all these antagonists as an emerging class of novel, analgesic, antiinflammatory agents that have been reported in the literature over the last several years and the status of the developmental candidates in various stages of clinical trials.
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PMID:Vanilloid receptor antagonists: emerging class of novel anti-inflammatory agents for pain management. 1927 64

Neuropathic pain is thought to affect up to 8% of the adult population in the UK. The condition can severely impact on patients' quality of life and can be difficult to treat. The capsaicin 8% patch has been developed to directly target the source of peripheral neuropathic pain and has been shown to provide pain relief for up to 3 months from a single 30- or 60-minute application. Adherence to the capsaicin 8% patch application procedure is important to achieve effective treatment. The authors are a group of health professionals experienced in using the capsaicin 8% patch. In this article the authors describe the optimal patch application procedure from their real-world clinical experience and provide recommendations on how to optimize the therapeutic benefit of the patch. Other key aspects of the application procedure are also addressed, including the importance of patient management, the ideal treatment setting, the best way to manage application-associated discomfort and post-treatment care. The observations and learning that the authors have gained from their clinical experience with the capsaicin 8% patch will help others to maximize the benefit gained with this novel treatment option.
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PMID:The capsaicin 8% patch for peripheral neuropathic pain. 2184 57

The cornea is supplied principally by the ophthalmic branch of the trigeminal nerve and is the most densely innervated organ in the human body. Under normal conditions, the corneal nerve terminals incorporate sensors that monitor the thickness and integrity of the tear film, which are essential for meaningful vision. A disrupted tear film or direct noxious stimulation of these corneal nerves can produce discomfort or pain limited to the affected surface. Damage to these nerves can sometimes lead to a chronic neuropathic condition, where pain persists months following the initial insult, long after the nerves appear to have healed in the cornea itself following treatment. Neuropathic pain appears to persist indefinitely in a few patients.
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PMID:Oculofacial Pain: Corneal Nerve Damage Leading to Pain Beyond the Eye. 2772 96

A 66-year-old female patient was diagnosed with hepatocellular carcinoma accompanied by neuropathic pain induced by a metastatic tumor that compromised root and spinal canal. Although her pain was relieved following medical treatment, breakthrough pain occurring 1-2 times a day was still distressing. Neuropathic pain in her right lower limb caused discomfort and irritability and decreased her quality of life. We had limited options to adjust her prescription drug regime, due to the side effect of these drugs. Although acupuncture therapy was only performed at her home once a week, the efficacy was outstanding. The patient did not report any further instances of breakthrough pain, and she did not require additional bolus morphine. She could comfortably live in her familiar surroundings with her family and did not require any emergency room visits or admission into the hospital during the last month of her life. She had excellent quality of life in the terminal period of her life, and could even participate in a family function during this time. The present case report suggests that acupuncture may have a role in treating neuropathic pain induced by bone metastasis in patients with advanced cancer across clinical and in-home settings.
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PMID:Home care with acupuncture increased the quality of life in a patient with advanced cancer with neuropathic pain induced by bone metastasis: a case report. 2969 Nov 87

Introduction Animal disease models are predictive for signs seen in disease. They may rarely mimic all signs in a specific disease in humans with respect to etiology, cause or development. Several models have been developed for different pain states and the alteration of behavior has been interpreted as a response to external stimulus or expression of pain or discomfort. Considerable attention must be paid not to interpret other effects such as somnolence or motor impairment as a pain response and similarly not to misinterpret the response of analgesics. Neuropathic pain is caused by injury or disease of the somatosensory system. The clinical manifestations of neuropathic pain vary including both stimulus-evoked and non-stimulus evoked (spontaneous) symptoms. By pharmacological intervention, the threshold for allodynia and hyperalgesia in the various pain modalities can be modulated and measured in animals and humans. Animal models have been found most valuable in studies on neuropathic pain and its treatment. Aim of the study With these interpretation problems in mind, the present text aims to describe the most frequently used animal models of neuropathic pain induced by mechanical nerve injury. Methods The technical surgical performance of these models is described as well as pain behavior based on the authors own experience and from a literature survey. Results Nerve injury in the hind limb of rats and mice is frequently used in neuropathic pain models and the different types of lesion may afford difference in the spread and quality of the pain provoked. The most frequently used models are presented, with special focus on the spared nerve injury (SNI) and the spinal nerve ligation/transection (SNL/SNT) models, which are extensively used and validated in rats and mice. Measures of mechanical and thermal hypersensitivity with von Frey filaments and Hargreaves test, respectively, are described and shown in figures. Conclusions A number of animal models have been developed and described for neuropathic pain showing predictive value in parallel for both humans and animals. On the other hand, there are still large knowledge gaps in the pathophysiologic mechanisms for the development, maintenance and progression of the neuropathic pain syndrome Implications Better understanding of pathogenic mechanisms of neuropathic pain in animal models may support the search for new treatment paradigms in patients with complex neuropathic pain conditions.
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PMID:Neuropathic pain models in the development of analgesic drugs. 2991 50

Post-traumatic trigeminal neuropathy (PTTN) is a known complication of common oral and maxillofacial procedures. The burden on the patient and society is often underestimated. This retrospective study included 29 patients with PTTN who underwent surgical treatment. Symptoms were differentiated, pre- and postoperatively, into neuropathic discomfort and loss of perceptive function. Clinical and patient-reported outcomes were recorded. The Brief Pain Inventory questionnaire was completed at the last follow-up. The effect of different variables was evaluated through subgroup analysis. The mean time interval between injury and surgery was 19 weeks. Overall, 20 patients (69%) showed improvement during a mean follow-up of 49 months. Neuropathic pain decreased in most patients (13/18; 72%) and two patients became pain-free. However, 16 patients reported persistent pain on the Brief Pain Inventory questionnaire. Medication use decreased postoperatively. Subgroup analysis showed a positive association between improvement and male sex (Fisher's exact test, P=0.033), and between improvement and the buccal fat nerve wrapping procedure (Fisher's exact test, P=0.02). In conclusion, surgery showed substantial benefit in the treatment of PTTN, even when neuropathic pain was present. The effect of different variables and the potential of buccal fat nerve wrapping should be evaluated further in future research.
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PMID:The benefit of surgical management in post-traumatic trigeminal neuropathy: a retrospective analysis. 3250 39

There exists a subgroup of patients who undergo neck dissection (ND) who postoperatively complain of either neuropathic pain, dysaesthesia and/or discomfort that is located within the dermatomal distribution of the cervical plexus. The purpose of our study was to determine the prevalence, characteristic, and demographics of these symptoms in our patient cohort. We undertook a retrospective randomised observational cohort study of 105 patients who had undergone ND. The primary predictor variable was the undertaking of a ND. The secondary outcome variable was the complaint of either neuropathic pain or a noxious neuropathy, at a minimum of twelve months after surgery. A recognised symptom questionnaire and a visual analogue score was employed for the purpose of the study. A descriptive and statistical analysis was applied to the assembled data. Twenty patients (19%) complained of either spontaneous (n=9) or evoked (n=11) neuropathic pain that occurred within the surgical site. In addition, 71 patients (68%) described an altered sensation in the dermatomal distribution of the great auricular or tranverse cervical nerves while 70 patients (67%) described the feeling of 'neck tightness'. There were no characteristics of the study cohort that underpinned these results. Neuropathic pain can occur following ND. This can cause distress to a small but defined group of patients. Despite its importance, we found a paucity of studies in the literature that have investigated neuropathic pain following ND. We believe this condition requires more research attention and clinical awareness.
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PMID:Complaints of neuropathic pain, noxious cervical plexus neuropathy and neck tightness are reported by patients who undergo neck dissection: an institutional study and narrative review. 3294 36