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Pain Management Strategies and Alternative Therapies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Several locally applied treatments might be used, especially for the symptoms of somatic hyperalgesia. Lidocaine 5% medicated plaster (14 cm × 10 cm), applied on the area of maximum pain for 12 hours per day, has been used with variable outcomes; we find it particularly beneficial with symptoms of significant hyperalgesia and allodynia and also during pain flare-ups. Capsicum cream 0.025%, which is applied sparingly four times per day, has also been used with some success particularly for pain with a nerve injury component. Capsaicinoids are agonists of capsaicin receptor (TRPV1) and have some effect on the pain neuropeptide substance P.
The Opioid Epidemic
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Worsening pain routinely occurs during the treatment of chronic pain states with opioid analgesics. Tolerance describes a pharmacologic experience where the same dose of medication results in a diminished physiologic response—this can be in regard to analgesia or in the experience of side effects. Tolerance commonly occurs and, while frustrating, can be overcome by dose escalation. On the other hand, hyperalgesia describes decreased pain thresholds and increased pain intensity. Hyperalgesia is a form of central or secondary sensitization (which includes a necessary initial component of tolerance). When the hyperalgesia results from opioid administration, this worsened pain situation cannot be overcome with dose escalation—rather, this exacerbates the phenomenon.
Is Fibromyalgia a Central Pain State?
Published in Robert M. Bennett, The Clinical Neurobiology of Fibromyalgia and Myofascial Pain, 2020
symptom-chronic multifocal pain-and one sign-generalized allodynia/ hyperalgesia (1). The patient who is diagnosed with FMS, however, is polysymptomatic. Besides pain there is fatigue, sleep disturbance, psychological distress, impaired muscle function, and symptoms that are usually regarded as stress-related. Fibromyalgia is an illness, a syndrome, that effects three systems that regulate our well being: the nociceptive system, the stress-regulating system, and the immune system. These systems interact with each other, making it difficult to determine which of them is primarily affected in an individual patient. Psychological factors, personality traits, and social circumstances play a role for the total clinical picture. Fibromyalgia is indeed a biopsychosocial syndrome. The biological part concerns mainly pain and allodynia/hyper-algesia as well as biological changes related to continuous physical and emotional stress. This article will deal only with pain and allodynia. Allodynia is pain elicited by normally nonpainful stimuli. Hyperalgesia is increased pain intensity and prolonged pain duration evoked by stimuli that normally are painful.
Opioid MOP receptor agonists in late-stage development for the treatment of postoperative pain
Published in Expert Opinion on Pharmacotherapy, 2022
Qiu Qiu, Joshua CJ Chew, Michael G Irwin
Cebranopadol is first-in-class agent with both MOP and NOP receptor agonism. NOP receptor agonism gives cebranopadol broad pharmacodynamic advantages and these appear applicable to postoperative analgesia. It has many pharmacological properties that are useful in the management of chronic pain. These include its oral formulation, efficacy in neuropathic pain, once-a-day administration, and reduced hyperalgesia and allodynia. These properties could also be beneficial in acute postoperative pain, with oral dosing compatible with premedication prior to surgery. Moreover, a reduction in respiratory depression and abuse potential may serve to increase the safety of this agent both in hospital, and the community – if patients are planned for discharge whilst still requiring opioid analgesia. Given its efficacy in neuropathic pain, the investigation of a potential role in surgically induced neuropathic pain is important. This should include evaluating its use in surgeries such as amputations, mastectomy, and thoracotomy. Lastly, cebranopadol’s reduction in hyperalgesia and allodynia would lend biological plausibility for an influence on chronic postsurgical pain. Longitudinal evaluation should assess the incidence of this entity in high-risk groups.
Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?
Published in Behavioral Medicine, 2021
A. López-López, B. Matías-Pompa, J. Fernández-Carnero, A. Gil-Martínez, M. Alonso-Fernández, J. L. Alonso Pérez, J. L. González Gutierrez
In a basal situation, poor regulation of endogenous analgesia systems has been verified, alongside signs of hyperaglesia and allodynia.19,20 Although there is very little research on pain modulation under induced stress on FM patients, some studies suggest that a deficit in it does exist. One study showed a decrement in pain thresholds after a stress task,21 although the methodology of the study did not allow comparison with healthy people. Two other studies have shown signs of stress-induced hyperalgesia, with an increase in spontaneous pain following an acute stress task.15,22 Moreover, hyperalgesia appeared to be associated with lower cardiovascular reactivity.15 Other studies have found positive correlations between pain sensitivity and cardiovascular reactivity in healthy people, suggesting that it is in fact systolic blood pressure which mediates the effects of stress on pain rating.23,24 Regarding PTSD, to the best of our knowledge, there are no studies which analyze its role in stress-induced changes in pain sensitivity in FM.
A comparison of the efficacy of nonweight-bearing and weight-bearing exercise programmes on function and pain pressure thresholds in knee osteoarthritis: a randomised study
Published in European Journal of Physiotherapy, 2021
Vanessa Martins Pereira Silva Moreira, Fabiana da Silva Soares, Wallisen Tadashi Hattori, Valdeci Carlos Dionisio
Pain is the main symptom of KOA, and is directly related to decreased functional capacity [6]. The pain increased (hyperalgesia) can be classified as peripheral and central sensitisation. The peripheral sensitisation has been defined as an increase in the pain in deep tissue by increased excitability of primary afferent nociceptors. The central sensitisation, in its turn, is defined as an increase in the pain by the response from dorsal horn neurons [7]. The peripheral and central sensitisation has been observed in persons with KOA in areas close and distant from knee [8–11]. Assuming that the central sensitisation could affect the dermatomes, myotomes and sclerotomes, Imamura et al. [12] observed areas of hyperalgesia corresponding to the injury site (segmental distribution) in persons with severe KOA, meaning pain in close and distant points from the knee, but for mild and moderate KOA the areas of hyperalgesia remain unclear.