Nonsurgical acute pain
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2014
Neuropathic pain associated with spinal cord injury is classified as “at-level” and “below-level” (Finnerup and Baastrup, 2012) and may be reported early after the injury, or later in the recovery and rehabilitation stages. At-level pain arises from injury to the spinal cord or nerve roots and therefore may have both central and peripheral components. It usually presents early after the injury as a band of pain in the dermatomes at the level of the injury. Below-level pain is a central pain resulting from spinal cord damage. It is often more diffuse and its onset may be delayed for up to 12 months. As with other patients with neuropathic pain, patients with a spinal cord injury may report burning, tingling, shooting, stabbing pain, “pins and needles,” or dysesthesia (unpleasant and abnormal sensations). Allodynia and hyperalgesia are commonly associated with at-level pain, but will also be present below the level of the injury if spinal cord damage is incomplete.
Nonsurgical Acute Pain
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2021
Neuropathic pain associated with spinal cord injury is classified as “at-level” and “below-level” (Siddall & Middleton, 2015) and may be reported early after the injury or later in the recovery and rehabilitation stages. At-level pain arises from injury to the spinal cord or nerve roots. It usually presents early after the injury as a band of pain within the dermatomes at the level of the injury and/or within three dermatomes below this level. Below-level pain is pain resulting from spinal cord damage that can extend from the level of the injury to within or more than three dermatomes below. It is often more severe, and its onset may be delayed for months or years. As with other patients with neuropathic pain, patients with a spinal cord injury may report burning, tingling, shooting, stabbing pain, “pins and needles,” or dysesthesia (unpleasant and abnormal sensations). Allodynia and hyperalgesia may also be present.
Quantitative Clinical, Sensory, and Autonomic Testing of Chronic Neuropathic Pain
Gary W. Jay in Practical Guide to Chronic Pain Syndromes, 2016
When any irritative pathophysiological process (5) occurs within one or more portions of the central or peripheral nervous system, the resulting unpleasant symptoms may be classified as neuropathic in origin (6-9). Of all the known chronic pain syndromes, neuropathic pain is often perceived to be the most likely to be intractable and least likely to be caused by a single etiologic mechanism. This suggests that successful management of any aspect of chronic neuropathic pain can only be attained when established treatments are applied to all components of the specific syndrome. The primary purpose of this chapter is to review specific quantitative methods that have been used to assess individual physical or physiological changes that occur in patients with chronic neuropathic pain. The secondary purpose is to differentiate the mechanisms and goals of subjective (clinical, sensory) techniques from those that form the basis of objective (autonomic, sympathetic sudomotor) quantitative testing.
Overcoming clinical challenges of refractory neuropathic pain
Published in Expert Review of Neurotherapeutics, 2022
Iulia Pirvulescu, Alexandras Biskis, Kenneth D Candido, Nebojsa Nick Knezevic
Neuropathic pain is a broad clinical term describing a variety of symptoms and conditions affecting the nervous system. Unfortunately, these conditions are frequently unresponsive to conventional treatment. Diverse treatment modalities, with a range of invasiveness, have been studied in patients with demonstrated refractory neuropathic pain. Several pharmacological approaches have involved drug infusions as opposed to oral administration of compounds such as ketamine. Testing of adjuvants has proven useful in improving safety and effectiveness of other, more conventional treatments. Some drugs such as botulinum toxin type A are being administered through subcutaneous injections. Nerve blocks and intrathecal injection have shown efficiency by providing a more targeted administration. Interventional therapies, through the neuromodulation of different parts of the central and peripheral nervous systems, are currently among the most promising treatments with several large clinical trials published and currently ongoing. Although there is a dire need for high-quality evidence throughout the treatment modalities, the wealth and diversity of clinical trials initiated in the past 5 years shows promise.
An update on the pharmacological management of pain in patients with multiple sclerosis
Published in Expert Opinion on Pharmacotherapy, 2020
Clara G. Chisari, Eleonora Sgarlata, Sebastiano Arena, Emanuele D’Amico, Simona Toscano, Francesco Patti
In general, according to the Kyoto protocol of the International Association for the Study of Pain (IASP) Basic Pain Terminology, the pain has been defined as an ‘unpleasant sensory experience associated with actual or potential tissue damage or described in terms of such damage’ [5]. Based on physiological mechanisms, pain syndromes have been classified into two categories: nociceptive and neuropathic [6]. Nociceptive pain typically occurs as a result of an appropriate encoding of noxious stimuli, representing a physiological response transmitted to a conscious level with the aim of warning the organism of tissue damage. On the other hand, neuropathic pain is probably due to primary lesions or dysfunctions in the peripheral or central nervous system. It is described as burning, dysesthetic, piercing pain, allodynia, or hyperalgesia, commonly not preceded by any warning, causing suffering and distress [6].
Spinal cord stimulation for the treatment of neuropathic pain: expert opinion and 5-year outlook
Published in Expert Review of Medical Devices, 2020
Mark N. Malinowski, Sameer Jain, Navdeep Jassal, Timothy Deer
The management of neuropathic pain remains a multifaceted approach to include medication management and removal of the offending cause where possible. Neuropathic pain arises from a myriad of causes of metabolic, infectious, malignant, toxicological, traumatic, hereditary, idiopathic, central nervous systems disorders, and complex regional pain syndrome (I and II). The goal of medical intervention is to improve symptoms and restore function. First line therapies include tricyclic antidepressants, atypical antidepressants (i.e., venlafaxine), α-2δ anticonvulsants (i.e., gabapentin, pregabalin) [7]. Second- and third-line therapies include topiramate, carbamazepine, lamotrigine, valproate, opiates, opioids, cannabinoids and topical capsaicin [7]. When medication management is contraindicated or fails to achieve appropriate goals, then advanced techniques in neuromodulation such as SCS are an effective choice. This paper will review the history regarding SCS, discuss mechanisms of action and provide an overview of newer waveforms such as burst and high frequency. There will be a review of safety and a discussion to the future outlook, specifically to SCS.
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