Articles: neuralgia.
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Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic pain in general, the evidence base has been substantially enhanced by the recent publication of several major trials. Therefore, we have conducted a systematic review and meta-analysis for both efficacy and adverse events of analgesic therapy for PHN. ⋯ The evidence base supports the oral use of tricyclic antidepressants, certain opioids, and gabapentinoids in PHN. Topical therapy with lidocaine patches and capsaicin is similarly supported. Intrathecal administration of methylprednisolone appears to be associated with high efficacy, but its safety requires further evaluation.
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Preclinical studies have increased our understanding of the pathophysiology of neuropathic pain at the anatomic, cellular, and molecular levels. These lines of investigation have enabled more logical uses of older therapies for neuropathic pain and have contributed to our understanding of the potential mechanisms underlying the efficacy of newer remedies. ⋯ This review focuses on the central and peripheral nervous system changes believed to be important in the initiation and perpetuation of neuropathic pain. Currently used medications, as well as medications that are on the horizon, are highlighted.
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Neuropathic pain, caused or initiated by a primary lesion in the peripheral or central nervous system, can result in a dramatic reduction in the patient's quality of life. The expression neuropathic pain covers a heterogeneous group of conditions, including peripheral neuropathy, complex regional pain syndrome, trigeminal neuralgia and central pain. ⋯ We present here an evidence-based review of the options for the treatment of neuropathic pain syndromes. Consideration is given to the mechanisms of action, numbers needed to treat (NNT), the recommended doses and the most frequent side-effects of the drugs for which consistent support has been found for treatment of these pain conditions.
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Postherpetic neuralgia (PHN) remains one of the most troublesome common chronic neuropathic pain conditions. Many controlled trials have been published showing good efficacy and reasonable tolerability. ⋯ Combination therapies are possible, but have not been proven, and long-term follow-up is limited. Only few case series exist for surgical and other invasive therapies and their role remains uncertain.
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Basic Clin. Pharmacol. Toxicol. · Jun 2005
ReviewAntidepressants in the treatment of neuropathic pain.
Neuropathic pain is due to lesion or dysfunction of the peripheral or central nervous system. Tricyclic antidepressants and anticonvulsants have long been the mainstay of treatment of this type of pain. Tricyclic antidepressants may relieve neuropathic pain by their unique ability to inhibit presynaptic reuptake of the biogenic amines serotonin and noradrenaline, but other mechanisms such as N-methyl-D-aspartate receptor and ion channel blockade probably also play a role in their pain-relieving effect. ⋯ A recent study on bupropion, which is a noradrenaline and dopamine uptake inhibitor, indicated a surprisingly high efficacy of this drug in peripheral neuropathic pain. In conclusion, antidepressants represent useful tools in neuropathic pain treatment and must still be considered as first line treatments of neuropathic pain. However, without head-to-head comparisons between antidepressants and other analgesics, it is not possible to provide real evidence-based treatment algorithms for neuropathic pain.