Neuropathic Pain Component Research Articles

The influence of intensity and neuropathic component of pain syndrome on the quality of life in patients with multiple sclerosis

The aim of the work. To analyze the influence of intensity and neuropathic component of pain syndrome on the quality of life structure characteristics in patients with multiple sclerosis (MS). Materials and methods. 104 MS patients with different types of MS course and complaints of pain during the last month were examined in the Lviv Regional Multiple Sclerosis Center. The patients were interviewed using standardized questionnaires (Pain Detect, VAS, SF-36) followed by an analysis of the pain characteristics influence on the quality of life. Results. When assessing the influence of the main characteristics of MS course, the relationship between the physical component of quality of life and levels of disability (EDSS) and the total number of relapses was found (r = -0.60, P < 0.01; r = -0.34, P < 0.01, respectively). However, the mental component of quality of life had no significant relationship with the level of disability and the number of relapses. The average pain intensity within a month on the VAS scale was 5.0 [4.0; 7.0]. 24.0 % of patients had low-intensity pain, 54.8 % – moderate, 21.2 % – high. In MS patients with low-intensity pain within a month, 5 of the 11 quality of life indicators were significantly higher, in particular, the overall physical component of quality of life – 38.1 [33.8; 48.5] % in low-intensity pain against 31.8 [28.1; 38.7] %, P = 0.02 – in moderate. In MS patients, the level of both physical (r = -0.25; P = 0.01) and mental (r = -0.21; P = 0.03) component of quality of life decreased with increasing pain intensity. The most notable correlation was observed between intensity of pain and such characteristics of quality of life as energy/fatigue (r = -0.37; P ˂ 0.01) and emotional well-being (r = -0.28; P ˂ 0.01). In 30.8 % of patients, pain was neuropathic, in 47.1 % – nociceptive, in 22.1 % – undetermined. MS patients with the neuropathic type of pain had significantly lower scores, 7 out of 11 indicators of quality of life, largely the mental component, than scores in MS patients with nociceptive type (Р < 0.05). Correlation analysis showed the association between an increase in the manifestation of neuropathic pain component and a decrease in all quality of life characteristics, except in health change. In MS patients with a neuropathic component, in increasing level of its manifestation, the mental component of health decreased clearly (r = -0.36; P ˂ 0.01), namely its social functioning characteristic (r = -0.35; P < 0.01). Conclusions. In MS patients, increasing intensity of pain decreases both physical and mental components of quality of life with the most significant decrease in energy/fatigue and emotional well-being as parts of the mental component of quality of life. The neuropathic component of pain and the level of its manifestation are largely associated with a decrease in the mental component of quality of life as the overall indicator and social functioning as its structural element.

Neuropathic component of postoperative pain for predicting post-cesarean chronic pain at three months: a prospective observational study.

Recent investigations have showed that cesarean section (CS) might be a cause of chronic pain, with a consequent decrease in quality of life. Prospective observational study in a Spanish tertiary hospital. Main outcome measure was to assess early neuropathic characteristics of pain (DN2 score ≥3) one week after CS as a potential risk factor for post-cesarean section chronic pain (PCSCP) at three months. Secondary outcome was to identify other risk factors. Six hundred ten consecutive consenting patients undergoing CS were interviewed preoperatively, at discharge from recovery room and 24 hours postoperatively. Telephone follow-up interviews were conducted one week, three months and twelve months following surgery. We analyzed 597 consecutive patients. The incidence of PCSCP at three and twelve postoperative months were 6.2% and 1% respectively. Subjects with NRS score superior to five on movement one week after CS presented higher incidence of PCSCP (NRS superior to five: 19 [52.2%]; NRS equal or lower to five: 172 [30.9%]; P=0.009). On multivariate analysis neuropathic pain one week after CS was associated with a higher risk of PCSCP (AOR=1.63 [95% CI: 1.26-2.11; P<0.001]). Other identified risk factors for PCSCP were: uterine exteriorization during CS (AOR=3.89 [95% CI: 1.25-12.10; P=0.019]) and a lower gestational age (AOR=0.87 [95% CI: 0.78-0.96; P=0.008]). Incidence of PCSCP at three and twelve postoperative months was low, 6.2% and 1% respectively. Early neuropathic characteristics of pain after one week measured by neuropathic pain questionnaire, consisting of two questions (DN2)≥3/7 could be used to identify patients at risk for chronic post-surgical pain and develop preventive strategies.

Contribution of AMPA Receptor-Mediated LTD in LA/BLA-CeA Pathway to Comorbid Aversive and Depressive Symptoms in Neuropathic Pain.

Comorbid anxiety and depressive symptoms in chronic pain are a common health problem, but the underlying mechanisms remain unclear. Previously, we have demonstrated that sensitization of the CeA neurons via decreased GABAergic inhibition contributes to anxiety-like behaviors in neuropathic pain rats. In this study, by using male Sprague Dawley rats, we reported that the CeA plays a key role in processing both sensory and negative emotional-affective components of neuropathic pain. Bilateral electrolytic lesions of CeA, but not lateral/basolateral nucleus of the amygdala (LA/BLA), abrogated both pain hypersensitivity and aversive and depressive symptoms of neuropathic rats induced by spinal nerve ligation (SNL). Moreover, SNL rats showed structural and functional neuroplasticity manifested as reduced dendritic spines on the CeA neurons and enhanced LTD at the LA/BLA-CeA synapse. Disruption of GluA2-containing AMPAR trafficking and endocytosis from synapses using synthetic peptides, either pep2-EVKI or Tat-GluA2(3Y), restored the enhanced LTD at the LA/BLA-CeA synapse, and alleviated the mechanical allodynia and comorbid aversive and depressive symptoms in neuropathic rats, indicating that the endocytosis of GluA2-containing AMPARs from synapses is probably involved in the LTD at the LA/BLA-CeA synapse and the comorbid aversive and depressive symptoms in neuropathic pain in SNL-operated rats. These data provide a novel mechanism for elucidating comorbid aversive and depressive symptoms in neuropathic pain and highlight that structural and functional neuroplasticity in the amygdala may be important as a promising therapeutic target for comorbid negative emotional-affective disorders in chronic pain.SIGNIFICANCE STATEMENT Several studies have demonstrated the high comorbidity of negative affective disorders in patients with chronic pain. Understanding the affective aspects related to chronic pain may facilitate the development of novel therapies for more effective management. Here, we unravel that the CeA plays a key role in processing both sensory and negative emotional-affective components of neuropathic pain, and LTD at the amygdaloid LA/BLA-CeA synapse mediated by GluA2-containing AMPAR endocytosis underlies the comorbid aversive and depressive symptoms in neuropathic pain. This study provides a novel mechanism for elucidating comorbid aversive and depressive symptoms in neuropathic pain and highlights that structural and functional neuroplasticity in the amygdala may be important as a promising therapeutic target for comorbid negative emotional-affective disorders in chronic pain.

Neuropathic Pain and its Relationship With Fibromyalgia, Vitamin D Status and Medication Use in Patients With Ankylosing Spondylitis.

To determine the frequency of neuropathic pain (NeP) and potentially related new factors including fibromyalgia, vitamin D and medication use in ankylosing spondylitis (AS) patients. In total, 102 patients with AS were prospectively enrolled in this study and evaluated for pain severity (visual analog scale, VAS), disease activity (the Bath Ankylosing Spondylitis Disease Activity Index, BASDAI), fibromyalgia and current medication use The presence of NeP was also assessed using the painDETECT questionnaire Blood samples were taken from all patients to analyze serum 25-hydroxyvitamin D and inflammatory marker levels. NeP component 32 (21 [20.6%]; clearly NeP and 11 [10.8%]; mixed NeP) was present in patients with AS Compared to those without NeP, they had significantly higher VAS and BASDAI scores (p=0.022 and 0.003, respectively) In addition, there was a highly significant difference of frequency of fibromyalgia between patients with and without NeP (50.0% vs 5.7%, p<0.001) Vitamin D status and medication use were comparable for patients with and without NeP Logistic regression analysis revealed that only fibromyalgia was a significant predictor of NeP. This study confirmed that about one-third of AS patients have the NeP component In addition, NeP was found to be associated with the frequency of fibromyalgia However, no relation was found between NeP and vitamin D status and medication use in AS.

PROMIS Neuropathic and Nociceptive Pain Quality in Musculoskeletal Pain Presentations.

Musculoskeletal pain is a significant contributor to the global disease burden. Management of musculoskeletal pain where a neuropathic component is present can be challenging. This study evaluated the internal structure of the Patient-Reported Outcome Measures Information System (PROMIS) pain quality scales, explored the prevalence of neuropathic and nociceptive pain, and identified health demographics and behaviors related to musculoskeletal pain presentations. Patients presenting to the Victoria University Osteopathy Clinic (Melbourne, Vic., Australia) were invited to complete a health demographics and behaviors questionnaire, and the PROMIS Neuropathic (NeuroPQ) and Nociceptive (NociPQ) pain quality scales, before their initial consultation. Descriptive, inferential, and correlation statistics were used to evaluate the PROMIS scales, health demographics, and behaviors. Mokken scale analysis was used to evaluate the internal structure and dimensionality of the NeuroPQ and NociPQ scales. Three hundred eighty-three (N=383) patients completed the measures. Mokken scaling suggested the PROMIS scales demonstrated acceptable internal structure and were unidimensional. Over 22% of patients demonstrated cutoff scores above 50, suggesting a substantive neuropathic pain component to their musculoskeletal presentation. Patients who reported cigarette smoking, not being born in Australia or not speaking English at home, demonstrated higher NeuroPQ scores. Females demonstrated significantly higher NociPQ scores than males. Pain intensity demonstrated small to medium correlations with NeuroPQ and NociPQ scores. This study provides support for the use of the NeuroPQ and NociPQ scales in musculoskeletal pain patients. Associations with health demographics and behaviors were identified, and patients typically experienced a combination of neuropathic and nociceptive pain.

AB0135 A VERY EARLY CLINICAL RESPONSE TO TOFACITINIB IS ASSOCIATED WITH LOW RHEUMATOID ARTHRITIS ACTIVITY AFTER 3 AND 6 MONTHS

Background:JAK inhibitors block intracellular signaling pathways responsible for the synthesis of cytokines and mediators involved in the development of chronic pain and central sensitization (CS). This determines a very rapid clinical response to JAK inhibitors. However, it is not clear how the significant pain reduction in the first weeks of therapy is associated with the achievement of low rheumatoid arthritis (RA) activity.Objectives:to assess the relationship between the early clinical response to tofacitinib and the decrease in RA activity after 3 and 6 months.Methods:Study group included 88 patients with RA, their age was 53±11,5, 79.3% of women, 89.8% of RF “+”, DAS28 5.2±1.2, receiving DMARDs (methotrexate 59.5% and leflunomide 19.8%), who were administered with tofacitinib 5 mg 2 times a day due to inefficacy or intolerance of biological DMARDs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration, RA activity using DAS28 after 3 and 6 months.Results:The mean pain severity at baseline was 5.3±2.0 according to the visual analogue scale (VAS 0-10), 51.1% of patients had signs of central sensitization (CSI ≥ 40), 15.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.1±1.8 (р&lt;0.05) and CS – CSI from 40.4±13.5 to 36.5±12.5 (р=0.01). After 28 days, the effect was higher: the pain level (VAS) was 2.8±1.6 (p=0.000), PainDETECT decreased from 11.8±5.6 to 6.8±3.1 (p=0.000), CSI – to 31.6±13.9 (p=0.000). DAS28 after 3 and 6 months was 3.7±1.3 and 3.6±1.2. The number of patients with pain decrease of ≥50% after 28 days of therapy was 59.9%. Low RA activity after 3 months. (DAS28 ≤3.2) was achieved in 64.4% of patients. There was a clear correlation between the number of patients with significant pain reduction at 28 days and the number of patients with low RA activity after 3 and 6 months (rS=0.548, p=0.000; rS=0.790, p=0.000). Six patients withdrew from the study due to inefficacy or social reasons. There were no serious adverse reactions.Conclusion:The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect and reduce CS signs. An early clinical response to tofacitinib (pain relief) predicts a decrease in RA activity after 3 and 6 months of the therapy.Limitation: Open-label observatory study.Disclosure of Interests:None declared

Total Knee Arthroplasty Postsurgical Chronic Pain, Neuropathic Pain, and the Prevalence of Neuropathic Symptoms: A Prospective Observational Study in Turkey.

PurposeChronic post-surgical pain (CPSP) is a detrimental condition that persists at least two months after surgical procedures and seriously affects patients’ quality of life. Although its incidence varies according to operation types and definitions, its prevalence is between 3% and 85%. The purpose of this study is to evaluate the prevalence of CPSP and neuropathic pain in patients undergoing TKA for osteoarthritis.Patients and MethodsIn this study, patients who had undergone total knee arthroplasty (TKA) were examined prospectively and observationally. 42 patients were included in the study. Numeric rate scale (NRS) for developing chronic pain, Douleur Neuropathique 4 (DN-4) questionnaire to evaluate neuropathic pain and symptoms, and von Frey filaments to evaluate mechanical hyperesthesia and alladony.ResultsNRS scores were 1 or higher for all patients. Twenty-seven patients constituted the mild pain group (NRS: 1–4), and 15 patients constituted the moderate pain group (NRS: 4–7). The number of patients defined as having “neuropathic pain,” according to DN-4 scores, was 17 (40.4%; DN-4 ≥ 4). The moderate pain group reported greater severity of neuropathic symptoms on average than the mild pain group (p = 0.039). When patients knees affected by TKA were divided into suprapatellar, patellar, and infrapatellar regions and evaluated with von Frey filaments, a significant difference was found between the three regions (p < 0.05).ConclusionIn this study, we showed—unlike other studies—that the rate of neuropathic pain was higher among CPSP patients, and all patients had neuropathic symptoms. In evaluating patients knees with von Frey filaments, we showed that the neuropathic component of patients’ pain occurred mostly in the knee’s infrapatellar region. Although the incidence of CPSP and neuropathic pain in these patients was higher than expected, we think CPSP, its diagnosis, and its treatment present an important issue that requires further examination.

Chronic Pain in People Impaired by Thalidomide Embryopathy: An Explorative Analysis of Prevalence, Pain Parameters and Biopsychosocial Factors

The aim of the study was to show the frequency, localisation, intensity, quality and degree of chronic pain in people with thalidomide-induced congenital defects (thalidomide embryopathy) and to investigate the association with biopsychosocial factors more closely. A group of 202 people from North Rhine-Westphalia with thalidomide embryopathy were studied for the first time both physically for the pattern of the original damage and also psychiatrically in a structured diagnostic interview (SCID I & SCID II). The results were combined with a standardized pain interview (MPSS) and questionnaires on further pain-related (SF-36, painDETECT) and sociodemographic variables and analysed. In the analysis 167 completed datasets were included. The prevalence of pain in the sample population was 94%. The majority (107, 54.0%) already showed an advanced stage of chronicity in the MPSS: 63 subjects with Stage II (37.7%) and 44 with Stage III (26.3%). In 74 subjects (44.3%) the PainDetect score showed a possible or neuropathic pain component. The factors that most reliably influenced the chronicity of pain proved to be hip pain (p<0.001) and also mental health disorders (p=0.001), above major depression (p<0.001) and also somatic symptom disorders and substance-related disorders (p=0.001 in each case). Social variables proved non-significant here (p=0.094 for living alone, p=0.122 for unemployment, p=0.167 for lack of college education), as did the care situation (p=0.191 for care dependency) and the underlying pattern of organ damage (p=0.229 for damage to hearing, p=0.764 for dysmelia). People with thalidomide defects frequently suffer from a separate pain disorder which can be seen as secondary thalidomide-induced damage and which requires specialized and personalized multimodal pain management.

Contribution of neurogenic mechanisms to the pathogenesis of chronic joint pain

Objective: to study the contribution of neurogenic mechanisms to the pathogenesis of chronic pain in patients with rheumatoid arthritis (RA), knee osteoarthritis (OAk) and ankylosing spondylitis (AS). To evaluate the effectiveness of an anticonvulsants in complex therapy of RA and OAk.Patients and methods. The study included 518 patients, 208 (40.2%) had definite RA, 160 (30.9%) had OAk and 150 (28.9%) had AS. All patients were rheumatologically and neurologically examined to determine the state of the somatosensory system; DN4 and Pain DETECT questionnaires were used to diagnose pain descriptors characteristic of neuropathic and nocyplastic pain; visual analogue scale (VAS) was used for pain intensity at rest assessment; algometry – for detecting secondary hyperalgesia. Functional, affective disorders and quality of life were assessed as well. Moreover, efficacy of the anticonvulsant in the complex therapy of RA and OAk was evaluated.Results and discussion. 49.5% of RA patients had neuropathic pain. It has been statistically significantly shown that older patients with a long history of the disease, advanced X-ray stage and high level of anxiety and depression experience neuropathic pain more frequently. Disease activity and ESR level did not affect the severity of the neuropathic component of pain. In 37.5% of OAk cases, signs of nociplastic pain were observed. Patients in this group were in pain according to VAS, worse functional state and quality of life, as well as a higher level of anxiety, the differences were statistically significant. 12.7% of AS patients had nociplastic pain. There was no association with the age and duration of the disease. Higher levels of disease activity, pain and depression and worse functional abilities were observed when nociplastic pain was present. The effectiveness of anticonvulsant is demonstrated in the complex therapy of chronic articular pain in RA and OAk, which confirms the role of central sensitization in the pathogenesis of pain in these diseases.Conclusion. Chronic pain in RA, OAk and AS patients in some cases has mixed nature, both inflammatory and neurogenic mechanisms (neuropathic and nociplastic) are involved. It is necessary to examine patients to identify the neuropathic component of pain, which will improve pain control and ensure a holistic approach to therapy. In patients with RA and OAk, having a mixed nature of pain, complex treatment, containing a central action drug from a group of anticonvulsants, is more effective compared with standard anti-inflammatory therapy.

Are pain coping strategies and neuropathic pain associated with a worse outcome after conservative treatment for Achilles tendinopathy? A prospective cohort study

ObjectivesTo analyse whether (1) passive or active pain coping strategies and (2) presence of neuropathic pain component influences the change of Achilles tendinopathy (AT) symptoms over a course of 24 weeks in conservatively-treated patients. DesignProspective cohort study. MethodsPatients with clinically-diagnosed chronic midportion AT were conservatively treated. At baseline, the Pain Coping Inventory (PCI) was used to determine scores of coping, which consisted of two domains, active and passive (score ranging from 0 to 1; the higher, the more active or passive). Presence of neuropathic pain (PainDETECT questionnaire, −1 to 38 points) was categorized as (a) unlikely (≤12 points), (b) unclear (13–18 points) and (c) likely (≥19 points). The symptom severity was determined with the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (0–100) at baseline, 6, 12 and 24 weeks. We analysed the correlation between (1) PCI and (2) PainDETECT baseline scores with change in VISA-A score using an adjusted Generalized Estimating Equations model. ResultsOf 80 included patients, 76 (95%) completed the 24-weeks follow-up. The mean VISA-A score (standard deviation) increased from 43 (16) points at baseline to 63 (23) points at 24 weeks. Patients had a mean (standard deviation) active coping score of 0.53 (0.13) and a passive score of 0.43 (0.10). Twelve patients (15%) had a likely neuropathic pain component. Active and passive coping mechanisms and presence of neuropathic pain did not influence the change in AT symptoms (p=0.459, p=0.478 and p=0.420, respectively). ConclusionsContrary to widespread belief, coping strategy and presence of neuropathic pain are not associated with a worse clinical outcome in this homogeneous group of patients with clinically diagnosed AT.

Preoperative use of the modified radiofrequency neuroablation of the genicular and cutaneous nerves of the knee joint for alleviating postoperative pain after arthroplasty

The aim of the study. To improve the effectiveness of pain syndrome management in the postoperative period in patients after knee arthroplasty with radiofrequency neuroablation (RFNA). Materials and methods. A prospective, open, randomized study on the treatment result analysis of 93 patients with knee joint osteoarthritis of the III–IV stage was conducted. Patients were divided into two groups: the study group (n = 44) and the comparison group (n = 49). The study group patients underwent arthroplasty of one knee and RFNA of the genicular and cutaneous nerves in the preoperative period. The comparison group patients underwent only knee arthroplasty. Assessment of pain intensity, functional status and quality of life of patients was performed using the VAS, WOMAC, KOOS questionnaires before treatment, 1.5, 3 and 6 months after surgery, taking into account the overall quality of life according to the SF-36 questionnaire and the possibility of developing neuropathic pain component according to the PainDetect questionnaire. Results. The result analysis obtained with the VAS showed pain reduction in both groups in 6 months after total knee arthroplasty (TKA), in the study group – 2 (2; 2) points, in the comparison group – 3 (2; 3) points. The results assessed with the WOMAC questionnaire showed greater improvement in treatment outcomes among patients who underwent knee arthroplasty in combination with RFNA – 32 (28; 34) points after 6 months. In the comparison group, there was also an improvement in functional status on examination in 1.5 months after surgery, but with less effective reduction of pain and physical recovery, which was seen on the examination in 6 months – 33.0 (28.5; 37.0) points. The analysis using the KOOS questionnaire showed a positive increase in postoperative indicators in both groups of patients, and it was 41.88 (37.20; 44.79) points in the comparison group and 47.67 (40.63; 50.51) points in the study group during a 6-month follow-up after arthroplasty. The SF-36 result analysis in 6 months after surgical treatment showed nearly identical restore of the psychological component of health in both patient groups – 56.63 (55.83; 59.03) points in the comparison group and 58.96 (54.24, 60.35) points – in the study group. The study group demonstrated better restoration of the physical component of health. The neuropathic component of pain was not detected among the examined groups of patients using the PainDetect questionnaire. Conclusions. RFNA of the genicular nerves and additional ablation of cutaneous nerves reduces the intensity of pain in the postoperative period after knee replacement and allows patients more quickly and easier restore functional activity and improve quality of life.

Correlation between the Neuropathic PainDETECT Screening Questionnaire and Pain Intensity in Chronic Pain Patients.

Background and Objectives: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. Materials and Methods: A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. Results: One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. Conclusions: The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP.

La gestion de la douleur chez les patients atteints du cancer dans un hôpital tunisien

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30% of cases but under treatment. Relief opioids were prescribed in 43% of cases to relieve pain. Paracetamol was prescribed in 26% of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62% consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

Effectiveness of Pregabalin Treatment for Neuropathic Pain in Patients with Spine Diseases: A Pooled Analysis of Two Multicenter Observational Studies in Japan.

PurposeNeuropathic pain (NeP) is common among patients with chronic pain associated with spine diseases. Practical effectiveness of pregabalin, one of the first-line treatments for NeP, has not been evaluated in an entire population of patients with spine diseases, including various pathophysiological conditions. This pooled analysis aimed to evaluate the therapeutic value of pregabalin for chronic pain with NeP component in patients with spine diseases in routine primary care settings.Patients and MethodsWe pooled data from two 8-week prospective observational cohort studies for patients with chronic low back pain with accompanying lower limb pain (NeP component), and patients with chronic cervical pain and accompanying upper limb radiating pain (NeP component) in routine primary care settings in Japan. For both studies, patients were treated for 8 weeks with pregabalin (alone/with other analgesics) or usual care with conventional analgesics (eg, non-steroidal anti-inflammatory drugs). Changes in pain numerical rating scale (NRS), Pain-Related Sleep Interference Scale (PRSIS), and EuroQol 5-dimension 5-level (EQ-5D-5L) scores from baseline to week 8 were summarized and compared between the pregabalin and usual care groups, and also for subgroups of primary diagnosis. Safety was evaluated by adverse events (AEs) in the pregabalin group.ResultsThe pooled dataset comprised 700 patients (pregabalin group: 302; usual care group: 398). All patient-reported outcomes (PRO) scores significantly improved from baseline to week 8 in the pregabalin than in the usual care group (NRS: P<0.0001; PRSIS: P<0.0001, and EQ-5D-5L: P=0.0006). Overall, all three PRO measures showed greater improvement in the pregabalin than in the usual care group, irrespective of the primary diagnosis. AEs were reported in 36.1% of the pregabalin group.ConclusionThis analysis suggested multi-faceted effectiveness of treatment with pregabalin from the patient’s perspectives under a “real-world” practice in all patients with chronic NeP from various spine diseases.

Ankilozan Spondilitli Hastalarda Nöropatik Bel Ağrısı ve Hastalık Aktivitesi, Fonksiyonel kapasite ve Yaşam kalitesi ile İlişkisi

Amaç: Bu çalışmada Ankilozan spondilit (AS)’li hastalarda bel ağrısının nöropatik komponentinin değerlendirmesi ve nöropatik ağrının; hastalık aktivitesi, fonksiyonel kapasite ve yaşam kalitesi ile ilişkisini araştırması amaçlandı.&#x0D; Gereç ve yöntemler: Çalışmaya 15 AS tanılı hasta dahil edildi. Hastalık aktivitesini değerlendirmek için Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI), fonksiyonel durumu değerlendirmek için Bath Ankylosing Spondylitis Functional Index (BASFI), ve yaşam kalitesini değerlendirmek için Ankylosing Spondylitis Quality of Life (ASQoL), bel ağrısının şiddetinin değerlendirmek için visual analog scale (VAS), nöropatik ağrıyı değerlendirmek için ise painDETECT anketi kullanıldı. &#x0D; Bulgular: PainDETECT skoru hastaların % 13'ünde kesin nöropatik ağrı, % 33'ünde ise olası nöropatik ağrı saptandı. PainDETECT skorları ile bel ağrısı VAS değerleri, BASFI ve CRP düzeyleri arasında anlamlı düzeyde pozitif korelasyon saptandı (p

Relationship of neuropathic pain component and osteoarthritis stage in patients with knee osteoarthritis

Aim: The aim of this study was to determine the frequency of neuropathic pain (NP) in patients with knee osteoarthritis (OA) and the relationship between knee OA stage and NP degree.Materials and Methods: This study included 63 patients (11 male, 52 female; mean age 62.4 ± 11.9 years; range 40-89 years) who were diagnosed with knee OA according to the American College of Rheumatology between January and May 2019. For all the participants, the knee pain was evaluated with the Visual Analog Scale (VAS), the functional evaluation was performed through Western Ontario and McMaster University (WOMAC) Osteoarthritis Index, and the neuropathic pain (NP) component was evaluated through Pain-DETECT Questionnaire (PDQ). The Kellgren-Lawrence grading system was used to determine radiological severity.Results: Of the total, 18 patients (28.5%) were classified as possible NP and 15 patients (23.5 %) were classified as likely NP. The symptom durations of the patients with final NP diagnosis were longer (p<0.05). The PDQ score was determined to be moderate and positively correlated with the WOMAC subscale scores and total score (pain score: r=0.450, p<0.001; stiffness score: r=0.4011, p=0.001; physical function score: r=0.397, p=0.001; total score: r=0.424, p=0.001). A positive and weak correlation was detected between the knee OA stage and neuropathic pain scores (p<0.05; r: 0.265).Conclusion: This study showed that the underlying cause of knee pain in the significant part of knee-OA patients has the NP component. Knee-OA patients with neuropathic pain component had higher rates of OA-related disability. There was a poor correlation between NP scores and radiographically advanced osteoarthritis symptoms. However, we suggest that further studies should be conducted with larger sample groups, the NP component should be kept in mind and should be included in the treatment plan for the knee-OA patients.

Transforaminal Epidural Steroid Injection Improves Neuropathic Pain in Lumbar Radiculopathy: A Prospective, Clinical Study.

This study aims to evaluate the effects of transforaminal epidural steroid injection (TFESI) on neuropathic pain (NP) in patients with chronic unilateral radiculopathy due to lumbar disc herniation (LDH). Between September 2018 and April 2019, a total of 61 patients who were diagnosed with unilateral/unilevel radiculopathy due to LDH and were scheduled for single-level TFESI were included in this study. The Numeric Rating Scale (NRS), modified Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and NP-Douleur Neuropathique 4 Questionnaire (DN4) were used before the procedure and at 1 hour, 3 weeks, and 3 months after the procedure. There was a significant decrease in the NRS and significant improvement in the ODI, BDI, and DN4 scores in all patients at all postprocedural timepoints (P < 0.05). The number of patients with NP decreased from 35 (60.3%) at baseline to 23 (41.2%) at 3 months (P = 0.001). The NRS scores were similar at 3 weeks and 3 months between the patients with and without NP (P > 0.05). The ODI scores were significantly higher at 3 months in the patients with NP than those without NP (P = 0.013). The BDI scores at baseline, 3 weeks, and 3 months were significantly higher in the patients with NP than those without NP (P < 0.001, P = 0.016, and P = 0.016, respectively). Our study results suggest that TFESI is an effective and safe method to decrease not only nociceptive but also NP component in patients with chronic radiculopathy due to LDH. Clinicians should keep in mind that NP is a risk factor that adversely affects the TFESI success and patients should be evaluated before the procedure.

Management of pain in colorectal cancer patients.

In this review we focus on the pathophysiology of CRC-related pain and discuss currently applied pain management. Pain is a symptom reported by over 70 % of colorectal cancer (CRC) patients. It remains a feared and debilitating consequence of both cancer and cancer-related treatment. There are many options for pain management in CRC, consisting of intravenous, oral or topical medications. In order to address the full spectrum of pain, proper treatment should address the nociceptive, neuropathic and/or psychogenic pain component. Currently available methods do not bring pain relief to satisfying number of patients and, if used improperly, can cause a number of complications. Therefore, future treatments should focus primarily on alleviating pain, but also on reducing possible side effects. In this article we cover recent and promising pharmacological and non- pharmacological developments emerging in the field of CRC treatment.

The Burden of Cancer-related Neuropathic Pain: A Multi-centric Cross-sectional Observational Study from North India.

Introduction:Neuropathic cancer pain is a common consequence of cancer itself and anti-cancer treatments. It is a complex phenomenon, often underdiagnosed by physicians or underreported by patients. Its diagnosis and management are usually more challenging than nociceptive pain. There is a dearth of epidemiological evidence for neuropathic pain in cancer patients in India. Screening questionnaires serve as a quick guide to identify potential cases of neuropathic pain. The aim of the present study was to identify the burden of cancer-related neuropathic pain using the Self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale.Methodology:This was a cross-sectional, observational, multi-centric study conducted at three hospitals in North India. From January 2017 to October 2017, patients attending pain clinic were screened for participation in the study. Adults aged ≥18 years and experiencing the pain of oncologic origin were eligible to participate in the study if they provided informed consent. S-LANSS questionnaire was used to screen patients with neuropathic pain.Results:From a total of 261 patients, who were enrolled in the study, 56.7% were male and their mean age was 50.87 (18–80) years. Fifty-four percent patients had pain with predominantly neuropathic component (S-LANSS score ≥10).Conclusion:High burden of neuropathic cancer pain has been observed in outpatient palliative care settings. Early diagnosis of neuropathic pain through screening questionnaires can serve as a quick guide for physicians in resource-constrained settings. This will allow identification of the neuropathic component of pain in patients suffering with mixed pain.

Long-Term Effectiveness and Tolerability of Pain Treatment with Tapentadol Prolonged Release

BACKGROUND: The central analgesic tapentadol prolonged release (PR) has proven effective and generally well tolerated in a broad range of chronic pain conditions. Long-term data of its use are still scarce. OBJECTIVES: To evaluate long-term effectiveness, tolerability, and safety of tapentadol PR in patients with severe chronic osteoarthritis (OA) knee pain or low back pain (LBP) who responded to tapentadol in 1 of 4 preceding 12-week phase 3b clinical trials. STUDY DESIGN: Open-label, uncontrolled, observational extension study of up to 72 weeks. SETTING: Fourteen centers in Spain. Protocol approval by the reference ethics committee for all the participating centers. METHODS: Eligible patients started the extension trial on the tapentadol PR dosage optimized for them in the preceding trial; dose adjustments were permitted throughout the extension. Treatment effectiveness outcomes included changes in pain intensity, sleep, state of health, quality of life, patient and clinician global impression of change, and patients’ satisfaction with treatment. Patients with OA knee pain also answered the Western Ontario and McMaster Universities OA index, and patients with LBP with a possible neuropathic pain component completed neuropathic pain-related questionnaires. RESULTS: Eighty-three patients were enrolled: 40 with OA knee pain, 43 with LBP. The full analysis set consisted of 81 patients. Mean pain intensity remained relatively stable over the 72-week extension period with mean increases from baseline of 0.44 (95% confidence interval [CI], -0.1,1.0; Numeric Rating Scale) for all patients, 0.2 (95% CI, -0.5, 0.9) for patients with OA, and 0.68 (95% CI, -0.2, 1.6) for patients with LBP. State of health and quality of life baseline ratings were maintained; overall impression of change was “improved.” Most patients (88.9%) reported at least good treatment satisfaction at the end of treatment. Mean daily tapentadol PR doses slightly increased from 313.3 ± 139.5 mg at baseline to 315.7 ± 140.1 mg at end of study. Uptitration was required for 8.4% of the patients, 4.8% had a dose reduction during the trial. Adverse events considered probably/likely or certainly related to tapentadol PR treatment by the investigator were documented for 18.1% of all patients, most commonly constipation (7.2%). Seven patients (8.4%) experienced adverse events leading to premature discontinuation. LIMITATIONS: An open-label design, stable concomitant analgesics (World Health Organization step I), and dose adjustments were allowed during the study. All patients had benefitted from tapentadol PR in preceding trials. CONCLUSIONS: Sustained pain relief and quality of life for up to 72 treatment weeks under relatively stable dosing, as well as the good safety profile, indicate the usefulness of tapentadol PR for patients who suffer from severe chronic OA knee pain and LBP with limited risk for tolerance development. KEY WORDS: Tapentadol prolonged release, extension study, long-term, chronic pain, osteoarthritis, low back pain, efficacy, safety