Psychiatric Treatment Approaches for Pediatric Pain
Andrea Kohn Maikovich-Fong in Handbook of Psychosocial Interventions for Chronic Pain, 2019
Treatment usually is initiated in youth at low doses spread across the day and then is gradually titrated upwards for clinical effect. Patients often are observed within two weeks, yet an adequate trial can require two months or more. Its pharmacokinetic effects are thought to diminish at higher doses with more limited bioavailability. In children younger than 5, higher relative doses may be required due to enhanced metabolism. Although generally well-tolerated, sedation and ataxia are somewhat common and dose dependent. Nighttime doses are thought to facilitate sleep onset and improve slow-wave sleep. In children under 12, gabapentin use has been associated with increased emotional reactivity and hyperactivity, warranting monitoring for these activating side effects in young patients. Drug–drug interactions are not thought to be problematic, and gabapentin often is used as adjunctive treatment for patients not optimally responding to other agents. Unlike other anticonvulsants, gabapentin is not thought to be an effective treatment for acute mania.
Preventive analgesia and beyond: current status, evidence, and future directions
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
Table 9.5 shows the six studies that were found to have examined designs assessing preemptive and preventive analgesic effects of perioperative gabapentin. The Jadad et al.72 quality index scores of the six articles ranged from four to five with a mean ± S.D. of 4.3 ± 0.52. Of the six studies identified, only one fits the classification of a preemptive design.122 The other five studies113, 114, 117, 127, 129 provided data to assess the preventive effects of gabapentin beyond the 5.5 half-lives (40 hours) after the final administration of the drug. Four of the five studies (80 percent) demonstrated impressive preventive effects in favor of the gabapentin treated versus placebo control group. Perioperative gabapentin administration was associated with a significant decrease in postoperative opioid consumption,117, 127[II] a reduction in the incidence of pain at the surgical incision site one month after surgery,114[II] and a reduction in neuropathic pain three months after surgery.113[II]
Neuropathic Pain †
Gary W. Jay in Chronic Pain, 2007
In general, for neuropathic pain either gabapentin or amitriptyline (or a similar tricyclic antidepressant) should be first-line therapy. When considering issues such as time to effective analgesic action and toxicity, gabapentin is more attractive. Gabapentin often is our first choice, followed by a tricyclic antidepressant, such as nortriptyline. Both drugs must be started slowly and titrated to effect, perhaps to rather high levels, for full benefit. However, tricyclics have many potential side effects that must be considered, particularly anticholinergic and cardiac interactions and organ toxicity. Clearly, gabapentin is a safer drug, but may cause sedation or dysphoria in some patients. Occasionally patients complain of weight gain and nonpitting edema. Until recently another disadvantages of gabapentin included its cost (approximately 10 times the cost of a generic tricyclic antidepressant at usual starting doses) and the need to take the drug three or four times a day. Keep in mind that the dosage of gabapentin must be reduced appropriately for patients with renal insufficiency. Newer marketed medications such as duloxetine and pregabalin may also, as time and treatment experience grows, become primary treatments.
Advances in molecular therapies for targeting pathophysiology in spinal cord injury
Published in Expert Opinion on Therapeutic Targets, 2023
Ha Neui Kim, Madeline R. McCrea, Shuxin Li
Some therapeutic strategies that target cellular and molecular pathophysiology have been moved to clinical trials for SCI patients, such as the use of the neuroprotective Na channel blocker riluzole, the cytokine G-CSF, and systemic hypothermia [5]. Other reagents aimed to promote axon regeneration are also under investigation in clinical trials for SCI, such as an anti-Nogo-A antibody (NG-101), a Nogo receptor antagonist [AXER-204 or NgR(310)ecto-Fc], and Elezanumab, a human anti-RGMa monoclonal antibody [5]. Early systemic treatments with gabapentinoid, an α2δ subunit Ca channel blocker, enhanced motor recovery in SCI patients [6]. Gabapentin is an FDA-approved drug used to treat regional seizures and neuropathic pain. Several clinical trials of SCI that target rewiring of spinal neuronal circuits are also ongoing, including transplants of adipose tissue-derived mesenchymal stem cells (MSCs) and neuro-spinal scaffolds, and implanting brain–spine interfaces. The recent clinical trials with transplanting human NSCs into patients with thoracic and cervical SCIs indicated a trend toward motor benefits [7]. This overall review is aimed to provide insight into preclinical therapeutic targets for SCI reported in recent years.
Observation on the effect of platelet-rich plasma combined with drugs in the treatment of herpes zoster neuralgia
Published in International Journal of Neuroscience, 2022
Zenghua Zhou, Xin Hu, Fangran Yan, Yanhua Zhou, Ruilin He, Xiaolong Ye, Zongbin Jiang
At present, studies on the drug treatment of ZRN have shown that it has a certain clinical efficacy [16]. The results of this study also showed that after gabapentin combined with other drugs, the pain degree and sleep status of patients were improved compared with before treatment. But the long-term use of oral drugs can bring inconvenience to the life of patients and cause some adverse reactions. Therefore, it is necessary to find new technologies for the treatment of ZRN. Research on the use of PRP in the treatment of HZN is relatively rare. In this study, on the basis of drug treatment, freshly prepared PRP was injected into the ganglion of the corresponding segment of the painful part of the ZRN patients. The results showed that after PRP treatment, the pain degree and sleep status of patients were significantly improved compared with the drug-alone treatment group. At the same time, the dosage of gabapentin used in the observation group was significantly reduced compared with that in the control group at the first week, one month, three months, and six months after treatment, which also avoided the adverse reactions caused by long-term large amounts use of oral drugs. It is speculated that the mechanism of PRP in the treatment of ZRN may be related to its anti-inflammatory effects and its role in promoting neural recovery.
Assessment of gabapentin misuse using prescription drug monitoring program data
Published in Substance Abuse, 2021
Yifan Zhang, Alexandria R. Castracane, Erin L. Winstanley
Gabapentin daily doses per prescription ranged from 25 mg to 7000 mg. The mean gabapentin daily dose (±SD) was 1103.8 (±865.9) mg. Forty-three percent of gabapentin prescriptions (N = 1,096,141) were low dose, 30.1% were moderate dose, and 27.1% were high dose. Few prescriptions (0.32%) were supratherapeutic. Overall, 0.39% of individuals (N = 379,372) were identified as having been dispensed two or more supratherapeutic gabapentin prescriptions, and 0.64% met the criterion for gabapentin misuse during the study period. The Lorenz-1 value of gabapentin was 5.5%, which does not exceed the threshold for misuse potential (15%), and the Lorenz-1 value for individuals with an OUD was lower compared to individuals without OUD (3.9% versus 5.5%). Individuals with an OUD were significantly more likely to have been dispensed prescriptions classified as supratherapeutic (p < 0.001), had more prescribers (median 3 versus 1, p < 0.001), and used more pharmacies (median 2 versus 1, p < 0.001) (see Table 1).
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