Articles: neuralgia.
-
Ivabradine, a hyperpolarization-activated cyclic nucleotide-gated cation (HCN) channel blocker and clinically approved bradycardic agent, has analgesic effects against neuropathic pain. Although the expression of HCN channels in the spinal dorsal horn (SDH) is augmented under inflammatory pain, spinal responses to centrally and peripherally applied ivabradine remain poorly understood. We investigated the spinal action and cellular mechanisms underlying the drug's analgesic effects against inflammatory pain using inflammatory pain model rats. ⋯ These phenomena were inhibited by forskolin, an activator of HCN channels. In conclusion, spinal responses mediated by HCN channels on primary afferent terminals are suppressed by central and peripheral administration of ivabradine; the drug also exhibits analgesic effects against inflammatory pain. In addition, ivabradine preferentially acts on C-fiber terminals of SDH neurons and induces a stronger inhibition of neuronal excitability in inflammatory pain.
-
Thermic rhizolysis is a reliable therapy for pharmaco-resistant trigeminal neuralgia (TN). Temperature, duration of electrocautery and needle location can influence the efficacy and complications of the therapy. ⋯ We have adapted the technique of radiofrequency rhizolysis for TN. Our procedure allows individual peroperative adaptation of the parameters of thermocoagulation, according to the specific position of the electrode during rhizolysis. Preliminary results on a series of 22 patients have shown promising results.
-
Randomized Controlled Trial
The Therapeutic Efficacy of Pulsed Radiofrequency Alone Versus a Dexamethasone and Pulsed Radiofrequency Combination in Patients With Trigeminal Postherpetic Neuralgia: A Double-blind, Randomized Controlled Trial.
Pulsed radiofrequency (PRF) of the Gasserian ganglion is a common surgical intervention used to treat trigeminal postherpetic neuralgia (PHN). Dexamethasone has been reported to possess anti-inflammatory effects and potential analgesic benefits. ⋯ The therapeutic efficacy of PRF combined with a dexamethasone injection into the Gasserian ganglion was superior to that of PRF{and saline injection} alone of the Gasserian ganglion for trigeminal PHN.
-
Neuropathic pain is a common condition experienced by older adults. Prevalence estimates of neuropathic pain and descriptive data of pharmacologic management among nursing home residents are unavailable. We estimated the prevalence of neuropathic pain diagnoses and described the use of pain medications among nursing home residents with possible neuropathic pain. ⋯ Resident characteristics associated with lack of medications included advanced age, dependency in activities of daily living, cognitive impairment, and diagnoses of comorbid conditions. A diagnosis of neuropathic pain is common among nursing home residents, yet many lack pharmacologic treatment for their pain. Future epidemiologic studies can help develop a more standard approach to identifying and managing neuropathic pain among nursing home residents.
-
P2X7 receptor antagonists have potential for treating various central nervous system (CNS) diseases, including neuropathic pain, although none have been approved for clinical use. Reasons may include insufficient understanding of P2X7 receptor signalling in pain, and the lack of a corresponding preclinical mechanistic biomarker. ⋯ Sub-optimal translation of preclinical molecules has hindered the clinical development of novel mechanism of action analgesics. We have undertaken a comprehensive in vitro analysis of migroglial signalling mechanisms recruited upon P2X7 receptor activation, a number of which were shown to be modulated by a selective P2X7 receptor antagonist in a well characterized animal model of neuropathic pain. Subject to further confirmation in other neuropathic models, this opens up the possibility to investigate their clinical utility as potential pain biomarkers in patients.