Articles: neuropathic-pain.
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A number of case reports and nonplacebo controlled studies have documented the efficacy of clonazepam (Klonopin) in the treatment of a number of chronic pain syndromes including lancinating and neuropathic/deafferentation pain. There are, however, no data on the efficacy of clonazepam for chronic pain (CP) associated with myofascial pain syndrome (MFPS). Therefore, we wish to report the results of an open clinical treatment trial of clonazepam for CP associated with MFPS. ⋯ Clonazepam may have an antinociceptive effect for pain associated with myofascial pain syndrome.
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It has been hypothesized that serotonin reuptake inhibitor antidepressants (ADs) are only weakly antinociceptive but augment noradrenergic (NA) antinociception. Thus, ADs with combined serotonergic (SN) and NA activity, (i.e., the serotonergic/noradrenergic (SN/NA) ADs) should have greater antinociceptive activity versus the NA ADs, which in turn should have more antinociceptive activity than the SN ADs. The objective of this structured review was to test this hypothesis by reviewing relevant basic science literature on the treatment of experimental pain with the above different types of ADs. DESIGN, SETTING, PARTICIPANTS, OUTCOME, MEASURES: Animal or human experimental AD pain treatment studies were located by the usual search methods. For animal studies only placebo-controlled studies were included for review. For human studies only double blind placebo-controlled studies were selected for review. The animal and human studies were then sorted according to the pain model represented, e.g., neuropathic pain model. Studies were then characterized according to the type of AD utilized, and the antinociceptive outcome of the AD trial. ⋯ Overall, the results of this structured review support the above hypothesis.
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The present study sought to derive an algorithm using factor analysis and structural equation modeling (SEM) to describe headache and orofacial pain patients using measures of behavioral and psychological functioning. This investigation further examined whether the underlying factor structure differed in 3 presumed distinct diagnostic categories: myofascial, neuropathic, and neurovascular pain. ⋯ Analysis derived a 3-factor solution. The factors were Pain Impact, Illness Conviction, and Depression. SEM revealed the critical causal pathway showing that Depression determined Illness Conviction and Pain Impact. We conclude that the main target for pain treatment is depression. No differences in factor structure were found for the 3 diagnostic categories of myofascial, neuropathic, or neurovascular pain. This suggests that psychological processes are similar in chronic headache and orofacial pain patients despite their presumed distinct underlying pathophysiological mechanisms. SME is a powerful methodology to construct causal models that has been underutilized in the pain literature.
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Objective. Post-herniorrhaphy pain syndrome can be difficult to treat. The exact mechanism of pain is not always apparent. ⋯ Conclusion. Post-herniorrhaphy pain can have the same features of both nociceptive and neuropathic pain syndromes. In cases which have failed conservative therapy we believe that a trial of spinal cord stimulation is warranted as in other cases of neuropathic pain syndromes.
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Background. Spinal cord stimulation (SCS) is being used with increasing frequency in the treatment of various chronic pain conditions. There is a paucity of reliable outcome data regarding changes in pain tolerance and peripheral sensory nerve function. ⋯ The results of this study appear to substantiate the postulates that both segmental and suprasegmental effects are involved in SCS-mediated analgesia. SCS modulates segmental large afferent fiber input as reflected by a statistically significant increase in large fiber CPTs (2000 Hz) at the symptomatic site post-SCS. A statistically significant increase in small fiber (5 Hz) CPTs at the control site suggests a central sensory (suprasegmental) modulating effect on nociceptive fiber activity. sNCT testing provided reliable outcome data for evaluating response to SCS.