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Topic: Neuropathic pain

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	Understanding Neuropathic Pain
		Neuropathic pain, in contrast to nociceptive pain, is described as "burning", "electric", "tingling", and "shooting" in nature.
		The hallmarks of neuropathic pain are chronic allodynia and hyperalgesia.
		Benedetti et al suggest that postop neuropathic pair responds to opioid, opioid responsiveness of neuropathic pain is partly a matter of dosage and higher doses of opioids that are necessary to relieve neuropathic pain may be not a characteristic of neuropathic pain per se but a general feature related to the individual.
	www.spineuniverse.com /displayarticle.php/article1614.html (4965 words)

	Postgraduate Medicine: Patient Notes: Neuropathic pain
		The most dramatic and mysterious example of neuropathic pain is called "phantom limb syndrome." This occurs when an arm or a leg has been removed because of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb.
		Acute pain is related to the physical sensations caused by an injury.
		With neuropathic pain, the nerve fibers themselves may be damaged or injured.
	www.postgradmed.com /issues/1999/11_99/pn_neuropathy.htm (676 words)

	Brain Briefings: Neuropathic Pain
		While the exact number is unknown, many Americans— perhaps over 3 million— experience neuropathic pain, which results from a nervous system malfunction set off by nerve damage from diseases such as diabetes, trauma or toxic doses of drugs.
		The animal models of neuropathic pain also are helping to determine whether medications used to treat other ailments might work for the treatment of pain.
		Caicium (1) is thought to play a role in the pain process by regulating the release of chemicals that nerve cells use to communicate.
	www.sfn.org /content/Publications/BrainBriefings/neuropathic.html (775 words)

	Neurontin Significantly Reduces Chronic Neuropathic Pain (Site not responding. Last check: 2007-10-26)
		Results of the national, multi-centre DPN study demonstrated that patients suffering from diabetic peripheral neuropathy experienced a significant reduction in pain after treatment with the drug and that 26 percent of those patients treated with Neurontin were pain-free at the end of the trial compared to 15 percent of patients treated with placebo.
		While the pain tends to fade over a period of time, as many as 15 percent suffer from chronic neuropathic pain that persists beyond the resolution of the herpes zoster rash.
		The pain associated with DPN in diabetic patients is, at times, constant, severe and deep, and is frequently associated with mood and sleep disturbances as well as a decline in function.
	www.pslgroup.com /dg/D6AC6.htm (880 words)

	Hospital Practice: Neuropathic Pain (Site not responding. Last check: 2007-10-26)
		The latency for paw withdrawal (a marker for pain threshold) was measured with a precision of tenths of a second.
		Against neuropathic pain, as against epilepsy, the drug is thought to have dual modes of action: blockade of sodium channels (in the manner of lidocaine) along with potentiation of GABAergic neurotransmission (in the manner of a barbiturate).
		We hypothesize that in neuropathic pain, the normal effect becomes pathologic because the pain input that activates and maintains a central hyperexcitable state is being generated in an abnormal way.
	www.hosppract.com /issues/1998/10/bennett.htm (5599 words)

	Hospital Practice: Chronic Pain (Site not responding. Last check: 2007-10-26)
		Pain signals arriving from peripheral tissues stimulate the release of endorphins in the periaqueductal gray matter of the brain and enkephalins in the nucleus raphe magnus of the brainstem.
		The endorphins inhibit propagation of the pain signal by binding to µ-opioid receptors on the presynaptic terminals of nociceptors and the postsynaptic surfaces of dorsal horn neurons.
		Pain signals from peripheral nerves are thus heightened, and the cycle of chronic pain is continued (Figure 4).
	www.hosppract.com /issues/2000/07/brook.htm (2829 words)

	Understanding Nociceptive and Neuropathic Pain
		Visceral pain is the subtype of nociceptive pain that involves the internal organs.
		Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system.
		Neuropathic pain is frequently chronic, and tends to have a less robust response to treatment with opioids, but may respond well to other drugs such as anti-seizure and antidepressant medications.
	www.helpforpain.com /arch2000dec.htm (800 words)

	Neuropathic Pain: Pain: Merck Manual Professional
		Pain can develop after injury to any level of the nervous system, peripheral or central; the sympathetic nervous system may be involved (causing sympathetically maintained pain).
		Central neuropathic pain syndromes appear to involve reorganization of central somatosensory processing; the main categories are deafferentation pain and sympathetically maintained pain.
		Neuropathic pain is suggested by its typical symptoms when nerve injury is known or suspected.
	www.merck.com /mmpe/sec16/ch209/ch209c.html (1337 words)

	Health: Living with pain: new relief for neuropathic pain - US News and World Report
		So is pain felt in the limbs of diabetics, pain in people with multiple sclerosis, some kinds of back pain, and pain persisting for months after an outbreak of shingles.
		Earlier this month, at an international pain conference held in Istanbul, doctors announced that two drugs combined to deal with this kind of pain are better than either one alone.
		The same week as the pain meeting, another drug that slows down nerve activity, called pregabalin, got the green light from the European Commission to be used for neuropathic pain.
	www.usnews.com /usnews/health/articles/060926/26pain.htm (611 words)

	Neuropathic Pain or Neuralgia
		In nature, pain is supposed to be a response to a noxious stimulus to teach us to not do whatever we did that caused the pain in the first place.
		The approach to a patient with neuropathic pain when seen by a neurologist will be very different when seen by physicians who consider themselves pain specialists.
		Some of the most frequent causes of neuropathic pain are reviewed in separate articles but any shooting, stabbing, or burning type pain in the distribution of a particular nerve can benefit from this approach.
	www.loftusmd.com /Articles/Pain/overview.html (541 words)

	Researchers identify key protein involved in neuropathic pain
		Neuropathic pain is a common and severely disabling state that affects millions of people worldwide.
		Many people suffering from neuropathic pain appear normal, but are in agony experiencing lightning-like pain known as allodynia.
		This type of pain can alter perception to a point where previously innocuous or even pleasurable stimuli applied to the skin or tissues become extremely painful.
	www.eurekalert.org /pub_releases/2005-12/uot-rik121205.php (841 words)

	ScienceDaily: Local Anesthetics Are Effective For Neuropathic Pain
		Neuropathic pain, which can occur with chronic diseases or conditions, is frequently unresponsive to treatment and worsens over time.
		The patients studied had pain from cerebrovascular lesions or tumors, spinal cord injuries, multiple sclerosis, amputation and a variety of other causes, including pain for which there was no apparent cause.
		Neuropathic pain is a complex, chronic pain state often with no obvious cause; often, nerve fibers themselves may be damaged, dysfunctional or injured and send incorrect signals to other pain centers.
	www.sciencedaily.com /releases/2005/10/051023122217.htm (758 words)

	Neuropathic pain causes, symptoms, diagnosis, and treatments on MedicineNet.com (Site not responding. Last check: 2007-10-26)
		Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury.
		With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured.
		In cases that are difficult to treat, a pain specialist may use invasive or implantable device therapies to effectively manage the pain.
	www.medicinenet.com /Neuropathic_Pain/article.htm (431 words)

	Treatment options for neuropathic pain
		Instead, the primary goals of treatment are to reduce the pain as much as possible, balance the negative side effects of the treatment, and help patients manage any unresolved pain.
		Once neuropathic pain is well established, however, it tends to become more difficult to successfully manage and more aggressive treatments may be required.
		Because of the complex nature of neuropathic pain, a multi-disciplinary, integrated approach to managing the pain is often useful.
	www.spine-health.com /topics/conserv/neuropaintr/neuropaintr01.html (304 words)

	Pain News & Information - Pain Treatment Updates
		Interestingly, suggestions of analgesia can induce alterations of pain perception even in poorly susceptible subjects; however these effects did not occur in the area of the body where the patient was instructed to feel pain relief.
		The pain of lateral epicondylitis, "tennis elbow," is relieved with steroid injection, but long-term outcomes are better with physical therapy or waiting.
		This study, presented at the Society for Neuroscience, showed that phantom pain could be reduced by training amputees to discriminate the location and frequencies of electrical stimuli applied to their stumps.
	www.helpforpain.com /mednews.htm (4883 words)

	Systemic administration of local anesthetic agents to relieve neuropathic pain
		In early reports, intravenous lidocaine and its oral analogs mexiletine and tocainide relieved neuropathic pain, a type of pain caused by disease in the nervous system.
		With the recent publication of clinical trials with high quality standards, we have reviewed the use of systemic lidocaine and its oral analogs in neuropathic pain to update our knowledge, to measure their benefit and harm, and to better define their role in therapy.
		Lidocaine and oral analogs were safe drugs in controlled clinical trials for neuropathic pain, were better than placebo, and were as effective as other analgesics.
	www.cochrane.org /reviews/en/ab003345.html (576 words)

	NEJM -- Oral Opioid Therapy for Chronic Peripheral and Central Neuropathic Pain
		neuropathic pain, there are limited data to guide their use.
		From the Pain Clinical Research Center, Department of Neurology (M.C.R., L.T., P.S.D., L.R., K.T., D.M.), and the Department of Anesthesia (M.C.R.), University of California, San Francisco, School of Medicine; and the University of California, San Francisco, School of Pharmacy (L.R.) — all in San Francisco.
		Somers, D. L, Clemente, F R. Transcutaneous Electrical Nerve Stimulation for the Management of Neuropathic Pain: The Effects of Frequency and Electrode Position on Prevention of Allodynia in a Rat Model of Complex Regional Pain Syndrome Type II.
	content.nejm.org /cgi/content/abstract/348/13/1223?ck=nck (748 words)

	Adjuvant Analgesics in Cancer Pain Management -- Lussier et al. 9 (5): 571 -- The Oncologist
		is analgesic in neuropathic pain [24, 25] and often is activating.
		Pain in ambulatory patients with lung or colon cancer: prevalence, characteristics, and effect.
		Oral ketamine as an adjuvant to oral morphine for neuropathic pain in cancer patients.
	theoncologist.alphamedpress.org /cgi/content/full/9/5/571 (7400 words)

	National Pain Foundation - Chronic Pain, Arthritis Pain, Back and Neck Pain, Headache Pain, Cancer Pain, CRPS Pain
		This condition is called diabetic peripheral neuropathic pain, or diabetic nerve pain.
		Results from a phase 3 clinical trial indicate that Fentora (fentanyl buccal tablet) is beneficial for the treatment of breakthrough pain in patients with neuropathic pain who are already taking opioids around-the-clock to manage their persistent pain.
		Chronic neuropathic pain is associated with conditions such as diabetic peripheral neuropathy, traumatic injury, postherpetic neuralgia and complex regional pain syndrome (CRPS).
	www.nationalpainfoundation.org (756 words)

	The pharmacological management of neuropathic pain
		Typical features of neuropathic pain, regardless of the causal injury, include shooting / lancinating pain, burning pain, paraesthesia / dysaesthesia, numbness and allodynia (pain produced by a normally non-painful stimulus).
		It may therefore be that opiates can be used to treat chronic neuropathic pain when co-administered with a CCK antagonist, although the debate will continue as to whether a dose limit be put on the sustained release morphine preparation.
		While many other agents may be used in treating neuropathic pain, their use is not verified by appropriate studies.
	www.priory.com /anaes/neuropathic.htm (4389 words)

	Neuropathic pain causes, symptoms, diagnosis, and treatments on MedicineNet.com (Site not responding. Last check: 2007-10-26)
		Epidural Steroid Injection - Read about epidural steroid injection, a common procedure to treat spinal nerve irritation and back pain.
		Cryotherapy - Read about cryotherapy pain management treatment for pinched nerves, neuralgia, neuromas, and more on MedicineNet.com
		MedicineNet does not provide medical advice, diagnosis or treatment.
	www.medicinenet.com /neuropathic_pain/article.htm (431 words)

	AVANIR Initiates Phase III Clinical Trial of Neurodex for the Treatment of Diabetic Neuropathic Pain - Forbes.com (Site not responding. Last check: 2007-10-26)
		"The results of our previous open-label study of Neurodex in patients with diabetic neuropathic pain were encouraging, and we are eager to explore the potential of Neurodex as a treatment for diabetic neuropathic pain in a larger placebo-controlled study.
		The results of a four-week Phase II open-label dose escalation safety study of Neurodex in patients with diabetic neuropathic pain were reported in November at the 2004 annual meeting of the American Society of Regional Anesthesia and Pain Medicine.
		The degree of pain relief increased with the duration of the open label study.
	www.forbes.com /businesswire/feeds/businesswire/2005/06/23/businesswire20050623005322r1.html (955 words)

	[No title]
		In this module, you will review the comprehensive assessment of a patient with neuropathic pain and formulate an initial treatment strategy.
		First, you will assess the patient by reviewing the history prior to the present pain complaint and then the history of the present illness.
		Throughout this module, health care professionals can 'consult' members of the Department of Pain Medicine and Palliative Care, including physicians, a psychologist, and a social worker.You will need Windows Media Player to view these video clips.
	www.stoppain.org /for_professionals/interactive_module/elearn.html (478 words)

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