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Antidepressants for chronic pain

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https://www.readbyqxmd.com/read/28097532/medication-overuse-in-chronic-pain
#1
REVIEW
Eric S Hsu
PURPOSE OF REVIEW: Chronic pain is usually managed by various pharmacotherapies after exhausting the conservative modalities such as over-the-counter choices. The goal of this review is to investigate current state of opioids and non-opioid medication overuse that includes NSAIDs, skeletal muscle relaxants, antidepressants, membrane stabilization agents, and benzodiazepine. How to minimize medication overuse and achieve better outcome in chronic pain management? RECENT FINDINGS: Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief...
January 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28075519/an-update-of-management-of-insomnia-in-patients-with-chronic-orofacial-pain
#2
REVIEW
Galit Almoznino, Yaron Haviv, Yair Sharav, Rafael Benoliel
In this review we discuss the management of chronic orofacial pain (COFP) patients with insomnia. Diagnostic work-up and follow-up routines of COFP patients should include assessment of sleep problems. Management is based on a multidisciplinary approach, addressing the factors that modulate the pain experience as well as insomnia and including both non-pharmacological and pharmacological modalities. Parallel to treatment, patients should receive therapy for co-morbid medical and psychiatric disorders, and possible substance abuse that may be that may trigger or worsen the COFP and/or their insomnia...
January 11, 2017: Oral Diseases
https://www.readbyqxmd.com/read/28074359/pharmacological-management-of-chronic-pelvic-pain-in-women
#3
REVIEW
Erin T Carey, Sara R Till, Sawsan As-Sanie
Chronic pelvic pain (CPP) is a multifaceted condition that often has both peripheral and central generators of pain. An understanding of neurobiology and neuropsychology of CPP should guide management. Successful treatment of CPP is typically multimodal, and pharmacologic treatment strategies include analgesics, hormonal suppression, anesthetics, antidepressants, membrane stabilizers, and anxiolytics. Evidence for these and other emerging pharmacologic therapies is presented in this article.
January 10, 2017: Drugs
https://www.readbyqxmd.com/read/28068620/temporal-trends-in-antidepressant-prescribing-to-children-in-uk-primary-care-2000-2015
#4
Jane Sarginson, Roger T Webb, S Jill Stocks, Aneez Esmail, Shruti Garg, Darren M Ashcroft
BACKGROUND: The prevalence of antidepressant prescribing in children and adolescents increased steadily in the United States and parts of Europe between 2005 and 2012 despite regulatory safety warnings. Little is known about the characteristics of those being prescribed antidepressants for the first time. METHODS: A longitudinal study of antidepressant prescribing in 3-17 year olds was carried out using data from the UK Clinical Practice Research Datalink (CPRD) between 2000 and 2015...
January 2, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28065184/long-term-outcomes-in-the-management-of-painful-diabetic-neuropathy
#5
Lauren M Mai, A John Clark, Allan S Gordon, Mary E Lynch, Pat K Morley-Forster, Howard Nathan, Catherine Smyth, Larry W Stitt, Cory Toth, Mark A Ware, Dwight E Moulin
BACKGROUND: Painful diabetic neuropathy (PDN) is a frequent complication of diabetes mellitus. Current treatment recommendations are based on short-term trials, generally of ≤3 months' duration. Limited data are available on the long-term outcomes of this chronic disease. The objective of this study was to determine the long-term clinical effectiveness of the management of chronic PDN at tertiary pain centres. METHODS: From a prospective observational cohort study of patients with chronic neuropathic non-cancer pain recruited from seven Canadian tertiary pain centres, 60 patients diagnosed with PDN were identified for analysis...
January 9, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28033519/characteristics-of-new-depression-diagnoses-in-patients-with-and-without-prior-chronic-opioid-use
#6
Jeffrey F Scherrer, Joanne Salas, F David Schneider, Kathleen K Bucholz, Mark D Sullivan, Laurel A Copeland, Brian K Ahmedani, Thomas Burroughs, Patrick J Lustman
: Chronic use (>90 Days) of opioid analgesics significantly increases the risk of development of new depression episodes (NDE). It is unclear whether depression that develops in this manner is similar to or different from NDE in persons not exposed to opioid analgesic use (OAU). METHODS: VA patients were classified into two groups, those who did not receive an opioid and developed depression (non-OAU+NDE, n=4314) and those that had >90 days OAU and developed NDE (OAU+NDE, n=444)...
December 21, 2016: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28024826/predictors-of-discordance-between-symptoms-and-signs-in-dry-eye-disease
#7
Jelle Vehof, Nicole Sillevis Smitt-Kamminga, Simone A Nibourg, Christopher J Hammond
PURPOSE: To investigate predictors of discordance between symptoms and signs in dry eye disease (DED). DESIGN: Cross-sectional association study. PARTICIPANTS: A total of 648 patients with dry eye from the Groningen LOngitudinal Sicca StudY (GLOSSY), a tertiary dry eye clinic patient cohort from the Netherlands. METHODS: Patient symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Dry eye signs were assessed by tear osmolarity, Schirmer test, tear breakup time, corneal and conjunctival staining, and meibomian gland dysfunction, all in both eyes, and a composite dry eye signs severity score was calculated from these 6 tests for each patient...
December 23, 2016: Ophthalmology
https://www.readbyqxmd.com/read/27995604/exercise-therapy-for-chronic-fatigue-syndrome
#8
REVIEW
Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard-Jensen, Jonathan R Price
BACKGROUND: Chronic fatigue syndrome (CFS) is characterised by persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches and impaired concentration and short-term memory. CFS presents as a common, debilitating and serious health problem. Treatment may include physical interventions, such as exercise therapy, which was last reviewed in 2004. OBJECTIVES: The objective of this review was to determine the effects of exercise therapy (ET) for patients with CFS as compared with any other intervention or control...
December 20, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27989328/pharmacologic-treatment-of-pain
#9
REVIEW
Eapen Mathew, Eugene Kim, William Zempsky
Adolescents and children are frequently affected by chronic pain conditions that can lead to disability and distress. The best approach to evaluation and treatment of these conditions involves use of the biopsychosocial model, which includes use of medication management. Chronic pain conditions are treated pharmacologically with a number of different medication classes via several routes of administration as drug delivery systems have progressed. These include anti-inflammatory drugs, muscle relaxants, antiepileptic medicines, antidepressants, opioids, and local anesthetics...
August 2016: Seminars in Pediatric Neurology
https://www.readbyqxmd.com/read/27984527/agomelatine-a-new-opportunity-to-reduce-neuropathic-pain-preclinical-evidence
#10
Chouki Chenaf, Eric Chapuy, Frédéric Libert, Fabien Marchand, Christine Courteix, Marianne Bertrand, Cecilia Gabriel, Elisabeth Mocaër, Alain Eschalier, Nicolas Authier
Antidepressants are first-line treatments of neuropathic pain but not all these drugs are really effective. Agomelatine is an antidepressant with a novel mode of action, acting as an MT1/MT2 melatonergic receptor agonist and a 5-HT2C receptor antagonist that involves indirect norepinephrine release. Melatonin, serotonin, and norepinephrine have been involved in the pathophysiology of neuropathic pain. Yet, no study has been conducted to determine agomelatine effects on neuropathic pain in animal models. Using 3 rat models of neuropathic pain of toxic (oxaliplatin/OXA), metabolic (streptozocin/STZ), and traumatic (sciatic nerve ligation/CCI [chronic constriction nerve injury]) etiologies, we investigated the antihypersensitivity effect of acute and repeated agomelatine administration...
January 2017: Pain
https://www.readbyqxmd.com/read/27894923/therapeutic-implications-of-toll-like-receptors-in-peripheral-neuropathic-pain
#11
REVIEW
Krishan K Thakur, Jyoti Saini, Kanika Mahajan, Dhyanendra Singh, Dinkar P Jayswal, Srishti Mishra, Anupam Bishyaee, Gautam Sethi, Ajaikumar B Kunnumakkara
Neuropathic pain is a state of chronic pain arising after peripheral or central nerve injury. These injuries can be mediated through the activation of various cells (astrocytes, microglia and Schwann cells), as well as the dissolution of distal axons. Recent studies have suggested that after nerve injury, Toll-like receptors (TLRs) involved in Wallerian degeneration and generation of neuropathic pain. Furthermore, these TLRs are responsible for the stimulation of astrocytes and microglia that can cause induction of the proinflammatory mediators and cytokines in the spinal cord, thereby leading to the generation and maintenance of neuropathic pain...
January 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27888525/breaking-sad-unleashing-the-breakthrough-potential-of-ketamine-s-rapid-antidepressant-effects
#12
David Feifel
Preclinical Research The surprising results of a small clinical trial on the effects of low dose ketamine, a 65-year old anesthetic drug that is also used off-label for chronic pain and recreationally as a club drug, in eight depressed subjects unleashed the most significant advance in antidepressant drug development in decades. That study and subsequent ones have demonstrated that low dose, infused ketamine is able to induce a remission of depression in patients who have failed conventional medications, within 24 h...
December 2016: Drug Development Research
https://www.readbyqxmd.com/read/27880651/durations-of-opioid-nonopioid-drug-and-behavioral-clinical-trials-for-chronic-pain-adequate-or-inadequate
#13
Baraa O Tayeb, Ana E Barreiro, Ylisabyth S Bradshaw, Kenneth K H Chui, Daniel B Carr
OBJECTIVES:  A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had "inadequate duration." To explore the evidence, we examined durations of studies on opioid, nonopioid drug, and behavioral therapies for chronic pain. METHODS:  We retrieved Cochrane reviews of anticonvulsants, antidepressants, NSAIDs, opioids, or behavioral interventions for chronic pain...
November 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27807736/-analgesic-drugs-during-pregnancy
#14
S Hultzsch, C Schaefer
Some important limitations must be taken into consideration for analgesic therapy during pregnancy. Paracetamol is the agent of choice for mild to moderate pain in any stage of pregnancy. Ibuprofen is the non-steroidal anti-inflammatory drug (NSAID) of choice; however, these substances are contraindicated after 28 weeks of gestation due to the increasing risk of premature closure of the ductus arteriosus and impairment of fetal kidney function. Even opioids can be used for severe pain but peripartum administration can lead to neonatal respiratory depression and adaptation disorders and long-term therapy up to the end of pregnancy can lead to neonatal withdrawal symptoms...
November 2, 2016: Der Schmerz
https://www.readbyqxmd.com/read/27770809/is-low-dose-amitriptyline-effective-in-the-management-of-chronic-low-back-pain-study-protocol-for-a-randomised-controlled-trial
#15
Donna M Urquhart, Anita E Wluka, Malcolm R Sim, Maurits van Tulder, Andrew Forbes, Stephen J Gibson, Carolyn Arnold, Chris Fong, Shane N Anthony, Flavia M Cicuttini
BACKGROUND: Low back pain is a major clinical and public health problem, with limited evidence-based treatments. Low-dose antidepressants are commonly used to treat pain in chronic low back pain. However, their efficacy is unproven. The aim of this pragmatic, double-blind, randomised, placebo-controlled trial is to determine whether low-dose amitriptyline (an antidepressant) is more effective than placebo in reducing pain in individuals with chronic low back pain. METHODS/DESIGN: One hundred and fifty individuals with chronic low back pain will be recruited through hospital and private medical and allied health clinics, advertising in local media and posting of flyers in community locations...
October 22, 2016: Trials
https://www.readbyqxmd.com/read/27752210/a-comparative-study-of-trigger-point-therapy-with-local-anaesthetic-0-5%C3%A2-bupivacaine-versus-combined-trigger-point-injection-therapy-and-levosulpiride-in-the-management-of-myofascial-pain-syndrome-in-the-orofacial-region
#16
Pranav Gupta, Virendra Singh, Sujata Sethi, Arun Kumar
AIM: To compare the efficacy of combined local anesthetic injection with 0.5 % bupivacaine and levosulpiride versus local anesthetic injection alone on outcome measures including levels of pain intensity and depression in the management of myofascial pain syndrome in orofacial region. PATIENTS AND METHODS: This was a prospective, randomized, controlled and open-label comparative clinical study. Seventy-four patients diagnosed to have myofascial pain syndrome and fulfilling the inclusion criteria were enrolled for the study...
September 2016: Journal of Maxillofacial and Oral Surgery
https://www.readbyqxmd.com/read/27751669/review-of-safety-and-efficacy-of-sleep-medicines-in-older-adults
#17
REVIEW
Jennifer L Schroeck, James Ford, Erin L Conway, Kari E Kurtzhalts, Megan E Gee, Krista A Vollmer, Kari A Mergenhagen
PURPOSE: Insomnia is problematic for older adults. After behavioral modifications fail to show adequate response, pharmacologic options are used. The pharmacokinetics of agents used to treat insomnia may be altered. This review focuses on the safety and efficacy of medications used to treat insomnia. METHODS: A literature search of Medline, PubMed, and Embase was conducted (January 1966-June 2016). It included systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on insomnia in an older population...
November 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27730494/intraepidermal-nerve-fiber-density-diagnostic-and-therapeutic-relevance-in-the-management-of-chronic-pruritus-a-review
#18
REVIEW
Manuel P Pereira, Sebastian Mühl, Esther M Pogatzki-Zahn, Konstantin Agelopoulos, Sonja Ständer
In recent years, measurement of the intraepidermal nerve fiber (IENF) density has gained relevance in the diagnostics of chronic pruritus. This method allows the objectification and quantification of a small-fiber neuropathy, which may manifest clinically with pruritus, pain or dysesthetic sensory symptoms, such as burning, stinging and tingling sensations or numbness. Upon suspicion of a small-fiber neuropathy as a cause for chronic pruritus, targeted diagnostic procedures are essential for the early detection of the neuroanatomical changes...
December 2016: Dermatology and Therapy
https://www.readbyqxmd.com/read/27704502/neuropathic-pain
#19
Janne Gierthmühlen, Ralf Baron
Diagnosing neuropathic pain and distinguishing it from nociceptive pain can be challenging, but is essential because both forms of pain require different treatment strategies. The diagnosis of neuropathic pain is primarily based on clinical findings. Therefore, a careful, focused history and an examination of the signs characteristic of neuropathic pain are crucial. Imaging techniques and electrophysiological examinations, as well as punch skin biopsy can support the clinical diagnosis. Ideally, treatment should be individualized using a mechanism-based approach...
October 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27697147/the-pharmacological-therapy-of-chronic-neuropathic-pain
#20
Andreas Binder, Ralf Baron
BACKGROUND: Chronic neuropathic pain, including painful peripheral polyneuropathy and post-herpetic neuralgia, affects 6.9-10% of the general population. METHODS: In this article, we present current treatment recommendations on the basis of a selective review of the literature. RESULTS: Neuropathic pain does not respond consistently to classic non-opioid analgesic drugs and is better treated with co-analgesic, antidepressant, and anticonvulsant drugs and topical agents...
September 16, 2016: Deutsches Ärzteblatt International
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