Central Neuropathic Mechanisms in Pain Signaling Pathways: Current Evidence and Recommendations
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REVIEW
Central Neuropathic Mechanisms in Pain Signaling Pathways: Current Evidence and Recommendations Omar Viswanath . Ivan Urits . James Burns . Karina Charipova . Kyle Gress . Alexandra McNally . Richard D. Urman . Ali Welschmeyer . Amnon A. Berger . Hisham Kassem . Manuel G. Sanchez . Alan D. Kaye . Treniece N. Eubanks . Elyse M. Cornett . Anh L. Ngo
Received: February 12, 2020 Ó The Author(s) 2020
ABSTRACT Purpose: This is a comprehensive review of the current literature on central neuropathic pain mechanisms that is secondary to spinal cord injury. It reviews recent and seminal findings on the pathophysiology, diagnosis, and treatment and compares treatment options and recommendations. Recent Findings: Neuropathic pain (NP) is a common complication of spinal cord injury (SCI). Chronicity of NP is attributed to increased Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.12058299. O. Viswanath Valley Anesthesiology and Pain Consultants–Envision Physician Services, Phoenix, AZ, USA O. Viswanath Department of Anesthesiology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA O. Viswanath Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA I. Urits (&) A. A. Berger Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA e-mail: [email protected]
abundance of inflammatory mediators and ion channel dysfunction leading to afferent nerve sensitization; nerve damage and nerve–glia cross talk have also been implicated. Conventional treatment is medical and has had limited success. Recent studies have made headway in identifying novel biomarkers, including microRNA and psychosocial attributes that can predict progress from SCI to chronic NP (CNP). Recent advances have provided evidence of efficacy for two promising drugs. Baclofen was able to provide good, long-lasting pain relief. Ziconotide, a voltage-gated calcium channel blocker, was studied in a small trial and was able to provide good analgesia in most participants. However, several participants had to be J. Burns K. Charipova K. Gress A. McNally A. Welschmeyer Georgetown University School of Medicine, Washington, DC, USA R. D. Urman Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA H. Kassem Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA M. G. Sanchez A. L. Ngo Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
Adv Ther
withdrawn because of worrisome creatine phosphokinase (CPK) elevations, and further studies are required to define its safety profile. Non-medical interventions include brain sensitization and biofeedback techniques. These methods have recently had encouraging results, albeit preliminary. Case reports of non-conventional techniques, such as hypnosis, were also reported. Summary: CNP is a common complication of SCI an
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