Articles: neuralgia.
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Curr Pain Headache Rep · Jun 2004
ReviewNew and emerging pharmacological targets for neuropathic pain.
Increasing knowledge of the molecular consequences of nerve injury and the availability of genome databases has greatly increased the range of potential targets for the pharmacological management of neuropathic pain. Controlling neuronal sensitization and the associated alterations in gene expression, protein modification, and neuronal excitability is the key to managing neuropathic pain. Control of neuronal sensitization can occur through inhibition of nerve injury-associated production of cytokines, activation of glial cells, modulation of potassium channel subtypes, mitogen-activated protein kinases, the ubiquitin-proteasome system, or the protection and amplification of spinal cord dorsal horn inhibitory systems. These new and already established targets promise unparalleled opportunities for the prevention, management, and resolution of persistent pain states following nerve injury.
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Curr Pain Headache Rep · Jun 2004
ReviewNeuromodulating drugs for the symptomatic treatment of neuropathic pain.
Significant improvement of neuropathic pain has been achieved with studies that have demonstrated efficacy of newer anticonvulsants in relieving this type of pain, by having a neuromodulatory effect on the hyperexcitable damaged nervous system. Two drugs from this class, gabapentin and lamotrigine, have been submitted to a number of clinical trials. ⋯ Pregabalin, the newest agent that has demonstrated efficacy in the treatment of post-herpetic neuralgia, is awaiting approval. A number of available anticonvulsants are undergoing clinical trials and many drugs with neuromodulatory properties are being considered for further development.
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Curr Pain Headache Rep · Jun 2004
ReviewStrategies for finding new pharmacological targets for neuropathic pain.
Chronic pain of neuropathic origin is an unmet therapeutic challenge that may require the development of novel drug entities. The resources involved in developing novel drugs and testing them in clinical trials are so large that few candidates can be fully tested in practice. ⋯ At the same time, the research community has identified large numbers of potential pharmacological targets for analgesia in recent years, with individual investigators promoting favorites with increasing zeal. Because of the uncertain predictive value of animal models of neuropathic pain, it is essential to consider rational strategic approaches to selecting the most likely candidate targets.
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Curr Pain Headache Rep · Jun 2004
ReviewTargeted peripheral analgesics therapy for neuropathic pain.
The term targeted peripheral analgesics has been suggested to describe analgesics with a mechanism of action that appears to be primarily through reducing pain transmission within the peripheral nervous system. Key differences between targeted peripheral (topical) and systemic analgesics and the difference between topical and transdermal analgesics are discussed in this article. A review of the clinical conditions, which have been reported to respond to targeted peripheral analgesics, also is described in detail.
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Peripheral nerve damage results in loss of sensation in the affected region of the body. Oaklander and Brown now report that, in the rat, transection of a peripheral nerve in only one side of the body also results in profound loss of the innervation of the same region on the opposite side of the body. Peripheral nerve damage may also produce persistent (neuropathic) pain conditions that are presumed to arise from maladaptive reorganization of the central nervous system. Thus, the possibility that comparable bilateral changes occur in patients and that such changes contribute to neuropathic pain conditions must be considered.