Management Of Painful Neuropathy Research Articles

Effects of Oxymatrine on the Neuropathic Pain Induced by Chronic Constriction Injury in Mice

Neuropathic pain associated with peripheral nerve injury is characterized by the sensory abnormalities such as spontaneous pain, hyperalgesia, allodynia, and radiation of pain [1]. Pain after injury to the nervous system is a major chronic pain condition. The traditional analgesics like opioids or nonsteroidal antiinflammatory drugs (NSAIDs) are not very satisfactory because of their significant side effects and ineffectiveness [2]. Therefore, the treatment of neuropathic pain remains a challenge. Chronic constriction injury (CCI) of sciatic nerve induced neuropathy is a widely employed model for the induction of neuropathic pain in experimental animals [3]. CCI-induced neuropathy in experimental animals mimics complex regional pain syndrome in humans [4]. More recently, various studies have reported herbal medicine to produce the beneficial effect in the management of painful neuropathy. Sophora alopecuroides L. is a predominant herbal plant resource in Northwest China. Among various alkaloids from Sophora alopecuroids L., oxymatrine (OMT) has been identified as the major bioactive component contributing to a variety of pharmacological effects. In the recent years, a large number of pharmacological and clinical studies have found that oxymatrine itself has a wide spectrum of effect in antivirus, liver fibrosis, immunoinhibition [5]. Studies have shown that oxymatrine has analgesic effect [6], while there has been no published support that oxymatrine is beneficial for the treatment on neuropathic pain. In the present study, we tested the hypothesis that the analgesic effect of oxymatrine on neuropathic pain induced by CCI of sciatic nerve in mice. Male Institute of Cancer Research (ICR) mice (21–25 g) were injured using the CCI model, as previously described [3]. Shamoperated mice were subjected to all surgical procedures except

Efficacy and tolerability of a fixed dose combination of methylcobalamin and pregabalin in the management of painful neuropathy

Pregabalin and Methylcobalamine are both capable reliving the symptoms of peripheral neuropathy but their effectiveness when used in a fixed dose combination still remains a subject of evaluation, especially in the orthopaedic setting. This post marketing surveillance study evaluates efficacy and tolerability of a fixed dose combination of Methylcobalamin 750 μg and Pregabalin 75 mg in the management of the same. The fixed dose combination of was prescribed for 4 weeks to the selected patients at 300 orthopaedic clinics all over India involving 1327 patients. Pain was assessed on a 10 point Numerical Pain Intensity Scale while physicians and patients overall assessment of efficacy and tolerability was done on a four-point scale. Results demonstrated a reduction in the pain which was evidenced by a visual analogue score of 38.87 and 73.99% at second and fourth week respectively. Eighty seven per-cent doctors and 88.11% patients expressed response to therapy as good to excellent. Tolerability was expressed as good to excellent by 81.48% of patients. Adverse events were of mild severity. Thus the fixed dose combination was efficacious and well tolerated in neuropathic pain with minimal adverse effects.

International Neuropathy Workshop of 2009: Introduction to the final reports

Neuropathies are amongst the most common of the long-term complications of diabetes, affecting up to 50% of patients. Their clinical features vary immensely and patients may present with a wide spectrum of specialties, from neurology to urology, for example, or from cardiology to podiatry. Neuropathies are typically characterized by a progressive loss of nerve fibres which may affect both of the principal divisions of the peripheral nervous system. The epidemiology and natural history of the diabetic neuropathies remain poorly defined. The International Consensus Workshop in Toronto in 2009 arose from the fact that at the moment there are no clear, universally accepted guidelines regarding the definition of diabetic neuropathies. This has resulted in a massive variation in how neuropathy is diagnosed in different centres and countries. A preliminary summary report of the Toronto meeting was published in 2010. The series of papers published in this issue of Diabetes/Metabolism Research and Reviews are the detailed reports that came from each sub-group of this Consensus panel. These reviews cover the problems with definitions and classification of neuropathy, the management of painful neuropathy and then the sub-group of small fibre neuropathies. There are also 3 papers on the autonomic neuropathies, covering cardiovascular autonomic neuropathies, as well as other areas of the autonomic neuropathies including gastrointestinal, urogenital and pseudomotor neuropathies. This series of papers will give the reader detailed information on the diverse aspects of diabetic neuropathies, their measurement and management, and will also assist in the selection of appropriate measures of both autonomic and somatic nerve function in clinical trials. This is clearly work in progress as diagnostic criteria for diabetic neuropathies are likely to evolve with developments in the field.

Management of painful neuropathies

Inadequately assessed and poorly managed pain contributes both to high general medical cost and to increasing numbers of societal problems. A large determining factor of inadequate pain care is the lack of understanding about the complex nature of pain and of a rational approach to its assessment and treatment. The less than adequate assessment of neuropathic pain and its relatively poor response to typical analgesic medications are major determinants to the undertreatment of pain. Other than the important management concept of treating the underlying cause, current approaches to the treatment of pain in general, and neuropathic pain in particular, have shifted away from treatment of individual syndromes toward the identification and management of common symptoms and the mechanisms upon which such symptoms are presumed to be based. This article summarizes the features of neuropathic pain that commonly appear in most peripheral neuropathies, regardless of the mechanism of injury, and provides an approach for the selection of treatment.

Sodium Valproate in the Management of Painful Neuropathy in Type 2 Diabetes – a Randomized Placebo Controlled Study

OBJECTIVE: To study the effectiveness and safety aspects of sodium valproate in the management of painful neuropathy in patients of type 2 diabetes mellitus. MATERIAL AND METHODS: A randomized double‐blind placebo controlled trial of sodium valproate was done in type 2 diabetic patients to assess its efficacy and safety in the management of painful neuropathy. We screened 60 patients but eight patients could not complete the study; hence, the present study was done on 52 patients. Each patient was assessed by clinical examination, pain score by short form of the McGill pain questionnaire (SF‐MPQ) and electrophysiological examination, which included motor and sensory nerve conduction velocity, amplitude and H‐reflex initially and at the end of 1 month of treatment. RESULTS: Significant improvement was noticed in the pain score of patients receiving sodium valproate in comparison to patients receiving placebo at the end of 1 month (P < 0.05). The changes in electrophysiological data were not significant. The drug was well tolerated by all patients except one who developed a raised aspartate transaminase (AST)/alanine transaminase (ALT) level after 15 days of treatment. CONCLUSION: Sodium valproate is a well‐tolerated drug and provides significant subjective improvement in painful diabetic neuropathy. These data provide a basis for future trials of longer duration in a larger group of patients.