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Neuropathic medications for Chronic Lower Back Pain

Bernard Bannwarth, Marie Kostine
Although there is an unmet need for pain medications that are both effective and safe, virtually no novel analgesics have been approved over the past two decades. In view of both experimental and clinical evidence of a major role for nerve growth factor (NGF) in the generation and maintenance of a wide range of pain states, the clinical development of humanised anti-nerve growth factor monoclonal antibodies (anti-NGF mAbs) aroused particular interest. However, the US Food and Drug Administration (FDA) placed a clinical hold on anti-NGF mAb clinical studies in late 2010, first because of reports of serious joint-related adverse events, and afterwards because of sympathetic nervous system safety concerns...
June 28, 2017: Drugs
Valérie Decrouy-Duruz, Thierry Christen, Wassim Raffoul
OBJECTIVE Chronic neuropathic pain after peripheral nerve injury is a major clinical problem. Its management is difficult, and therapeutic approaches vary and include oral medication, neurostimulation, and surgery. The aim of this study was to assess the adequacy of surgical nerve revision in a large series of patients with long-term follow-up. METHODS The authors reviewed the charts of 231 patients (335 nerve injuries) who experienced neuropathic pain after peripheral nerve injury and underwent surgery for nerve revision at the authors' institution between 1997 and 2012...
June 16, 2017: Journal of Neurosurgery
Xavier Moisset, Anne-Priscille Trouvin, Viet-Thi Tran, Nicolas Authier, Pascale Vergne-Salle, Virginie Piano, Valeria Martinez
OBJECTIVES: An urgent need is to improve the efficacy and safety of use of strong opioids in chronic non-cancer pain (CNCP) through responsible prescription rules supported by scientific evidence. METHODS: Clinical questions addressing the indication, the benefice, the risk and the precautions were formulated. A task force composed of physicians from several medical specialties involved in managing CNCP was charged to elaborate evidence-based recommendations. A systematic literature search was performed using CENTRAL, MEDLINE and EMBASE databases...
April 2016: La Presse Médicale
Siro Luvisetto, Parisa Gazerani, Carlo Cianchetti, Flaminia Pavone
Botulinum neurotoxin A (BoNT/A) is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a "glamour" drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles...
September 23, 2015: Toxins
Toshihiko Taguchi, Ataru Igarashi, Stephen Watt, Bruce Parsons, Alesia Sadosky, Kazutaka Nozawa, Kazuhiro Hayakawa, Tamotsu Yoshiyama, Nozomi Ebata, Koichi Fujii
OBJECTIVE: To evaluate the impact of pregabalin on sleep, pain, function, and health status in patients with chronic low back pain with accompanying neuropathic pain (CLBP-NeP) under routine clinical practice. METHODS: This prospective, non-interventional, observational study enrolled Japanese adults (≥18 years) with CLBP-NeP of duration ≥3 months and severity ≥5 on a numerical rating scale (0= no pain, 10= worst possible pain). Treatment was 8 weeks with pregabalin (n=157) or usual care alone (n=174); choice of treatment was determined by the physician...
2015: Journal of Pain Research
Ilkka K Martikainen, Emily B Nuechterlein, Marta Peciña, Tiffany M Love, Chelsea M Cummiford, Carmen R Green, Christian S Stohler, Jon-Kar Zubieta
UNLABELLED: Back pain is common in the general population, but only a subgroup of back pain patients develops a disabling chronic pain state. The reasons for this are incompletely understood, but recent evidence implies that both preexisting and pain-related variations in the structure and function of the nervous system may contribute significantly to the development of chronic pain. Here, we addressed the role of striatal dopamine (DA) D2/D3 receptor (D2/D3R) function in chronic non-neuropathic back pain (CNBP) by comparing CNBP patients and healthy controls using PET and the D2/D3R-selective radioligand [(11)C]raclopride...
July 8, 2015: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Yoshihito Sakai, Kenyu Ito, Tetsuro Hida, Sadayuki Ito, Atsushi Harada
PURPOSE: Pregabalin and opioids are used to treat chronic low back pain (LBP). No previous investigations have compared the efficacy of pregabalin and that of opioids for chronic LBP. METHODS: We performed a randomized controlled trial of pregabalin and opioids in 65 consecutive patients aged 65 years or older who had chronic LBP. Each agent was administered randomly in different phases. Pain and activities of daily living (ADL) were evaluated after 4 weeks of treatment using the visual analog scale, Japanese Orthopaedic Association score, Roland Morris Disability Questionnaire, short-form McGill Pain Questionnaire, EuroQol quality-of-life scale, and geriatric depression scale...
June 2015: European Spine Journal
T Adoukonou, D Gnonlonfoun, A Kpozehouen, C Adjien, B Tchaou, F Tognon-Tchegnonsi, H Adechina, R Covi, D Houinato
The burden of chronic and neuropathic pain is high making it an important public health problem. The epidemiology is not well known in the general population in sub-Saharan Africa. We aimed to determine the prevalence of chronic pain with a neuropathic component at Tititou in Parakou in northeastern Benin. A cross-sectional study was conducted from 1st April to 31 May 2012 and included 2314 people in a door-to-door survey. Chronic pain was defined as pain occurring for more than three months. Neuropathic pain was assessed with the DN4 score...
November 2014: Revue Neurologique
Hans G Kress, E Dietlind Koch, Hristiyan Kosturski, Achim Steup, Keith Karcher, Bernd Lange, Can Dogan, Mila S Etropolski, Marëille Eerdekens
BACKGROUND: Tapentadol prolonged release (PR) is effective and well tolerated for chronic osteoarthritis, low back, and diabetic peripheral neuropathic pain. OBJECTIVES: To evaluate the efficacy and tolerability of tapentadol PR compared with placebo and morphine controlled release (CR) for managing moderate to severe chronic malignant tumor-related pain. STUDY DESIGN: Randomized-withdrawal, parallel group, active- and placebo-controlled, double-blind phase 3 study (NCT00472303)...
July 2014: Pain Physician
Craig P Hensley, Carol A Courtney
STUDY DESIGN: Case report. BACKGROUND: Pain can lead to a significant reduction in quality of life. A pain mechanisms-based classification scheme has been outlined to improve management of patients with pain, but studies describing its use are limited. Evidence for physical therapy interventions in those with chronic pain and multiple health conditions is also lacking. This case report describes management of a patient with chronic pain and multiple health conditions...
June 2014: Journal of Orthopaedic and Sports Physical Therapy
Shivanand P Lad, Ranjith Babu, Jacob H Bagley, Jonathan Choi, Carlos A Bagley, Billy K Huh, Beatrice Ugiliweneza, Chirag G Patil, Maxwell Boakye
STUDY DESIGN: Retrospective analysis of a population-based insurance claims data set. OBJECTIVE: To evaluate the use of spinal cord stimulation (SCS) and lumbar reoperation for the treatment of failed back surgery syndrome (FBSS), and examine their associated complications and health care costs. SUMMARY OF BACKGROUND DATA: FBSS is a major source of chronic neuropathic pain and affects up to 40% of patients who undergo lumbosacral spine surgery for back pain...
May 20, 2014: Spine
Bernard Bannwarth, Marie Kostine
It is unanimously accepted that there is an unmet need for pain medications that are both effective and safe. Unfortunately, no really novel analgesics have been approved over the past three decades. In view of both experimental and clinical evidence of a major role for nerve growth factor (NGF) in the generation and maintenance of a wide range of pain states, drug discovery efforts focusing on the development of anti-NGF agents have aroused particular interest. Several humanized anti-NGF monoclonal antibodies (mAbs) have entered clinical trials as potential analgesics...
April 2014: Drugs
Stephen L Able, Zhanglin Cui, Wei Shen
PURPOSE: This study applied a uniform methodology for measuring and comparing duloxetine adherence in the treatment of multiple chronic medical conditions. MATERIALS AND METHODS: Study patients 18-64 years of age initiating duloxetine therapy during 2008 were identified from a large managed care database. The study was restricted to patients with continuous health plan eligibility for 12 months pre- and post-duloxetine initiation. Study patients had ≥1 medical claim with an inpatient or outpatient diagnosis of one (and only one) of the following conditions: major depressive disorder (MDD); generalized anxiety disorder (GAD); fibromyalgia, diabetic peripheral neuropathic pain; or chronic musculoskeletal pain, as established in studies in patients with osteoarthritis and chronic lower back pain (CLBP)...
2014: ClinicoEconomics and Outcomes Research: CEOR
Joanna Mika, Magdalena Zychowska, Wioletta Makuch, Ewelina Rojewska, Barbara Przewlocka
The current knowledge of the pharmacological actions of the tricyclic antidepressants (TCAs) has slowly evolved through their over 40-year history. Chronic pain represents one of the most important public health problems, and antidepressants are an essential part of the therapeutic strategy in addition to classical analgesics. This article reviews the available evidence on the efficacy and safety of antidepressants in chronic pain conditions; namely, headaches, low back pain, fibromyalgia, cancer pain and especially neuropathic pain...
2013: Pharmacological Reports: PR
Toshihiko Yamashita, Kazuhisa Takahashi, Kazuo Yonenobu, Shin-ichi Kikuchi
BACKGROUND: The incidence and characteristics of neuropathic pain associated with spinal disorders have not yet been fully clarified. The purpose of this study was to investigate the prevalence of neuropathic pain and the degree of deterioration of quality of life (QOL) in patients with chronic pain associated with spinal disorders who visited orthopedic outpatient clinics. METHODS: This cross-sectional study was conducted in 1,857 patients recruited from 137 medical institutions nationwide...
January 2014: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
A Werber, M Schiltenwolf, A Barié
A 64-year-old man with chronic low back pain had been treated with tramadol, meloxicam and metamizole for several years. Due to additional neuropathic pain in the lower extremities, the medication was complemented with carbamazepine. After 5 weeks of treatment, the patient developed maculopapulose exanthema and fever, followed by hepatitis, leukocytosis and eosinophilia. The patient was diagnosed with so-called DRESS (drug rash with eosinophilia and systemic symptoms) syndrome, a severe anaphylactic reaction to carbamazepine treatment...
August 2013: Der Schmerz
(no author information available yet)
OBJECTIVE: The objective of this health technology policy assessment was to determine the effectiveness of spinal cord stimulation (SCS) to manage chronic intractable neuropathic pain and to evaluate the adverse events and Ontario-specific economic profile of this technology. CLINICAL NEED: SCS is a reversible pain therapy that uses low-voltage electrical pulses to manage chronic, intractable neuropathic pain of the trunk or limbs. Neuropathic pain begins or is caused by damage or dysfunction to the nervous system and can be difficult to manage...
2005: Ontario Health Technology Assessment Series
Sumihisa Aida, Norifumi Kuratani, Yukiko Ohara, Sumio Amagasa, Zen'ichiro Wajima
Three patients presented with severe spontaneous pain, allodynia and numbness on the lateral side of the left heal, foot and/or toe due to L5 and/or S1 root injury, as a result of repeated failed back surgeries including Love's surgery and laminaectomy (failed back surgery syndrome). The neuropathic pain in the lower extremities did not respond to somatic nerve block, lumbar-sympathetic ganglion block, spinal cord stimulation, and/or medications. At the spots in the foot showing the most severe allodynia, bones were drilled with fluoroscopic assistance...
2011: BMJ Case Reports
Ilona Steigerwald, Matthias Müller, Anthony Davies, Daniel Samper, Rainer Sabatowski, Ralf Baron, Sylvie Rozenberg, Anna Szczepanska-Szerej, Antonio Gatti, Hans G Kress
OBJECTIVE: This open-label, phase 3b study evaluated the effectiveness and tolerability of tapentadol prolonged release and tapentadol immediate release (for acute pain episodes) for severe, chronic low back pain with or without a neuropathic pain component that was inadequately managed in patients taking World Health Organization (WHO) Step I or II analgesics or who were not regularly treated with analgesics. RESEARCH DESIGN AND METHODS: Average baseline pain intensity was greater than 5 (11-point numerical rating scale-3 [NRS-3; 3-day average pain intensity]) with WHO Step I or II analgesics and greater than 6 with no regular analgesic regimen...
June 2012: Current Medical Research and Opinion
A Dario, A Marra, P Marra, A Dorizzi
Objective and Importance. The subarachnoid infusion of narcotics by programmable devices in patients with chronic non-malignant pain can be a useful therapeutic method. However, certain side-effects, opioid tolerance or changes in the nature of the pain can lead to failure of the therapy. Clinical Presentation. We present a case report of a woman with both chronic perineal pain and sciatic pain with radiation to her lower limbs caused by failed back surgery syndrome. The pain proved to be resistant to common medical therapy and to spinal cord stimulation...
July 1998: Neuromodulation: Journal of the International Neuromodulation Society
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