European journal of pain : EJP
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Anticonvulsants are widely used for the treatment of neuropathic pain. Here we review the evidence for a number of peripheral and central changes after nerve injury that may provide a basis for the mechanisms of action of anticonvulsant therapies. ⋯ The focus of this article is on anticonvulsants; however, opioids and antidepressants can also be effective in increasing inhibitions to control of pain in a manner similar to that of the enhancement of gamma-aminobutyric acid (GABA) function by antiepileptic drugs. A brief account of these approaches to neuropathic pain is also given.
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Neuropathic pain represents a series of relatively uncommon chronic pain conditions, caused by lesions or dysfunctions of peripheral or central afferent pathways in the nervous system. The symptoms and signs of neuropathic pain can all be explained by a neuronal hyperexcitability at the site of the nerve lesion, which subsequently and in a dynamic fashion recruits more central sites. The manifestations of such neuronal hyperexcitability are therefore rather similar, irrespective of the causes or sites of the lesions. ⋯ Our understanding of the mechanisms underlying neuronal hyperexcitability has increased dramatically within the last decade, and accordingly, it has been suggested that pain be classified according to a mechanism-based approach. The challenge for an improved understanding of neuropathic pain--which is the key for better treatment--lies in elucidating the relationships between symptoms, signs, aetiology, anatomical lesions, and underlying mechanisms. At present, this is not a trivial task.
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While it may be convenient to categorize neuropathic pain syndromes on the basis of anatomical distribution or disease state (e.g., diabetic neuropathy, radiculopathy, postherpetic neuralgia), the treatment of neuropathic pain, alone, should also consider the signs and symptoms and the underlying putative mechanisms that may then be inferred from each individual's signs and symptoms. A diagnosis-based approach to treatment may not effectively relieve a patient's pain or improve his or her quality of life, the ultimate goal of treatment. Although research that supports a symptom- and mechanism-based approach to treating neuropathic pain is ongoing and dynamic, the preclinical and clinical data available thus far form an initial rational framework within which we may attempt to target putative pain mechanisms.
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Two-third of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. ⋯ Radiotherapy is used for preventing pathological fracture by treating osteolytic lesions especially in the weight-bearing bones such as the spinal column and long bones. Radiotherapy is the treatment of choice in spinal cord compression, which is the most serious complication caused by bone secondaries. Radiotherapy provides efficient, well-tolerated and cost-effective palliative care.