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Neuropathic Pain

Neuropathic Pain

The Neuropathic Pain Knowledge Centre is a unique resource containing a wealth of current information in this field of medicine.

The nervous system (central and peripheral) constantly receives and interprets information about the body's surroundings and the body's own functioning, responding by sending out messages to tissues and organs.

The Knowledge Centre addresses the two types of pain: nociceptive and clinical. Nocicpetive pain aims to protect individuals from harm. Clinical pain results from damage or inflammation of a part of the body and consists of both spontaneous pain that may arise with no apparent peripheral stimulus, and from hypersensitivity to peripheral stimuli1 due to peripheral and central sensitisations.

Neuropathic pain is often described as a shooting, stabbing or burning sensation. Estimates suggest that neuropathic pain may affect as much as 3% of the population.

Different types of neuropathic pain exist depending on their origin, details of which can be found in the Knowledge Centre: Painful Diabetic Neuropathy, Herpes Zoster and Post-Herpetic Neuralgia (PHN), HIV Associated-Neuropathy (HIV-AN), Cancer-related Neuropathic Pain, Post-surgical/Post-traumatic Neuropathic Pain.

In the clinic, the diagnosis of neuropathic pain relies on an accurate history and examination and some pain evaluation tools are used.

As Neuropathic pain doesn't respond to conventional therapy with analgesics, the different treatment regimens are antidepressants, anticonvulsants, opioids, topical agents and combination treatment.

To help physicians in the pharmacological management of this condition, recent guidelines are available.

Enter the Neuropathic Pain Knowledge Centre


References:

1. Ji R-R, et al. Central sensitization and LTP: Do pain and memory share similar mechanisms? Trends in Neuroscience 2003;26(12):696–705

Date of preparation: August 2012 PAIN/12/0003/EUd

Recent Drug Updates

Clinical Guidelines

Management of chronic pain

Dec 2013

This guideline provides recommendations based on current evidence for best practice in the..

... assessment and management of adults with chronic non-malignant pain in non-specialist settings. It does not cover: - interventions which are only delivered in secondary care. - treatment of patients with headache - children. While chronic pain occurs in children, some of their treatment options are different to those of adults, and evidence on the paediatric population has not been included in this remit. - underlying conditions. Chronic pain is caused by many underlying conditions. The treatment of these conditions is not the focus of this guideline so the search strategies were restricted to the treatment of chronic pain, not specific conditions.

Neuropathic pain – pharmacological management: The pharmacological management of neuropathic pain in adults in non-specialist settings

Nov 2013

This short clinical guideline aims to improve the care of adults with neuropathic pain by making..

... evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

Clinical Trials

A RCT of Supportive Finger Tape for PIPJ Osteoarthritis

16-08-2014

Oesteoarthritis of the joints of the finger(s) is a common problem. The first-line treatment involves pain killers taken either as tablets, gels, or patches. Secondly, some joints are amenable to injections of steroids and anaesthetic agents. Finally,..

... as a last resort, some joints may be fused or replaced with prosthetic joints by Hand Surgeons. We are investigating whether supportive taping of the painful finger joint reduces pain and improves function, and whether this treatment could be used to substitute pain killers, injections or surgery. We hypothesise that supportive finger tape may improve pain, improve the stability of the joint and thereby improve day-to-day hand function too. We will investigate this through a two-group parallel randomised controlled trial whereby one group will receive the treatment taping and the other group will receive a theoretically placebo taping configuration. We will measure pain daily, hand function and adverse events.

Imaging Pain Relief in Osteoarthritis

04-08-2014

Osteoarthritis (OA) is a degenerative joint disease and is the most common form of arthritis. Pain reduction and functional recovery are the key elements of the clinical management of OA. Current treatment guidelines recommend a combination of..

... pharmacological and non-pharmacological treatments. However, these are not always effective, with nearly 20% of patients not responding to any standard therapy, including joint replacement.

The mechanisms of pain relief are not well understood and are complicated by the remarkably large placebo effect, and inter-individual variation. There is no objective criteria for predicting whether a patient will respond to a given treatment

Duloxetine, an antidepressant drug, has proven effectiveness in various chronic pain syndromes including knee OA. The effect is however limited and only clinically relevant in around half of the trial patients. Importantly, it is currently unclear how and in whom duloxetine alleviates chronic pain.

Advanced MRI techniques use strong magnetic fields and radio frequency signals to generate metabolic, anatomical and functional brain images (fMRI).

Remifentanil is a potent analgesic agent whose analgesic effect has been well characterised in healthy volunteers, including fMRI studies showing modulation of activation of regions in the brain related to pain processing. Nevertheless, the neural correlates of remifentanil effects have not yet been investigated in chronic pain patients.

The aim of this research is to use a combination of multimodal MRI, genetic and psychometric assessments to identify the mechanisms of pain relief in knee OA patients, following treatments with duloxetine and remifentanil, in a placebo control condition. With this we also aim to identify genetic and brain activity predictors of treatment outcomes.

We hypothesise that:

- The antinociceptive effect of both duloxetine and remifentanil is mediated by improving endogenous pain inhibition through normalisation of functional connectivity and acute pain processing;

- The extent of defunct cortical control of pain processing networks at baseline predicts treatment response at 6 weeks;

- The antinociceptive effects of duloxetine is partially mediated by ts anxiolytic effect as indexed by reduction of amygdala activation.

This study is expected to last for two years. It is funded by Arthritis Research UK and forms part of a wider scientific investigation, using translational methodologies, to enhance the understanding of arthritis pain and to improve its treatment.

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