Neuropathic Pain Scores Research Articles

The effects of cannabis, cannabinoids, and their administration routes on pain control efficacy and safety: A systematic review and network meta-analysis

ObjectivesTo determine the effects of cannabis, cannabinoids, and their administration routes on pain and adverse euphoria events. Data sourcesA systematic search was performed in PubMed, ScienceDirect, ClincalTrials.gov, Scopus, Cochrane Library, and Embase from inception until June 2017. Study selectionRandomized controlled trials investigating the effects of cannabis or cannabinoids on pain reduction. Data extractionTwo reviewers extracted and assessed the quality of studies by means of Cochrane risk of bias. Standardized mean difference (SMD) was calculated. Random-effects model was undertaken to pool the treatment effects. ResultsA total of 25 studies involving 2270 patients were included. We found that delta-9-tetrahydrocannabinol/cannabidiol (THC/CBD) (oromucosal route), THC (oromucosal route), and standardized dried cannabis (with THC; SCT; inhalation route) could reduce neuropathic pain score (SMD −0.41, 95% CI −0.7 to −0.1; −0.61, 95% CI −1.2 to −0.02; and −0.77, 95% CI −1.4 to −0.2; respectively). For nociceptive pain, only standardized cannabis extract (with THC; SCET) via oral route could reduce pain score (SMD −1.8, 95% C; −2.4 to −1.2). In cancer pain, THC/CBD via oromucosal route and THC via oral or oromucosal route could reduce pain score (SMD −0.7, 95% CI −1.2 to −0.2; and −2.1, 95% CI −2.8 to −1.4; respectively). No study was observed for THC/CBD via oral route or inhalation or THC via inhalation for cancer and nociceptive pain, SCET via oromucosal route or inhalation for neuropathic and cancer pain, THC via oromucosal route for nociceptive pain, and SCT via oromucosal or oral route for neuropathic, cancer, and nociceptive pain. Statistically significant increased risks of euphoria were observed in THC/CBD (oromucosal), THC (oromucosal), and SCT (inhalation). ConclusionThe use of cannabis and cannabinoids via certain administration routes could reduce different types of pain. Product developers could consider our findings as part of their product design so that the effective route of cannabis and cannabinoids for pain control can be achieved.

A Randomized Controlled Trial to Assess the Effectiveness of Muscle Strengthening and Balancing Exercises on Chemotherapy-Induced Peripheral Neuropathic Pain and Quality of Life Among Cancer Patients.

Chemotherapy-induced peripheral neuropathy (CIPN) is the presence of tingling, burning, itching, and unpleasant sensations in hands and feet due to nerve damage by chemotherapy. Exercise rehabilitation has potential to prevent or alleviate CIPN. The aim of this study was to assess the effectiveness of muscle strengthening and balancing exercises on CIPN pain and quality of life (QOL) among cancer patients. The randomized controlled trial included 45 cancer patients from a tertiary care hospital in India receiving chemotherapeutic drugs paclitaxel and carboplatin and found to have CIPN. Subjects were randomly allocated to exercise (n1 = 22) and usual care (n2 = 23) groups. The exercise group received home-based muscle strengthening and balancing exercise for 10 weeks. Data regarding demographic, clinical characteristics, CIPN, neuropathic pain, and QOL were collected by structured questionnaires Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, nerve conduction velocity, Leeds Assessment of Neuropathic Symptoms and Signs pain scale, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. The 2 groups were homogenous regarding demographic variables. In clinical characteristics, the exercise group had larger body surface area and received a higher dose of paclitaxel. Significant reduction in neuropathic pain scores (P < .0001) and improvement in Functional QOL (P = .0002), Symptom QOL (P = .0003), Global Health Status QOL (P = .004) scores were observed after intervention in the exercise group than the usual-care group. Muscle strengthening and balancing exercises are effective in reducing CIPN pain and improving QOL among cancer patients. Muscle strengthening and balancing exercises can be used as a complementary therapy for effective management of CIPN.

Efficacy of 50 mg pregabalin for prevention of postoperative neuropathic pain after video-assisted thoracoscopic surgery and thoracotomy: a 3-month prospective randomized controlled trial.

This study analyzed the preventive effect of 50 mg/day pregabalin on postoperative neuropathic pain, and any additional benefits related to sleep and respiratory function. This prospective randomized controlled study included lung resection patients 20-89 years of age. Patients were randomly assigned to the treatment (pregabalin; initial dose, 50 mg/day) or control (non-steroidal anti-inflammatory drugs) group. Pregabalin patients received non-steroidal anti-inflammatory drugs and pregabalin (25 mg, twice daily) from the second postoperative day. Pain scores, neuropathic pain, analgesic use, respiratory function, and insomnia scale scores for 3 months after surgery were evaluated. This study included 46 patients who received pregabalin and 46 control patients. Pregabalin patients had significantly less postoperative neuropathic pain than control patients (19.6% vs. 41.3%; P=0.0404), and their duration of neuropathic pain was significantly shorter (30 vs. 90 days; P=0.024). The onset of postoperative neuropathic pain, insomnia scale scores, and respiratory function were similar between groups. No pregabalin-related adverse events were reported. Pregabalin (50 mg/day) had a significant preventive effect on postoperative neuropathic pain after thoracic surgery, without side effects. Early postoperative administration of pregabalin would help prevent neuropathic pain and provide better pain control after thoracic surgery.

A Multi-centered Study to Evaluate the Efficacy and Safety of Amitriptyline and Mecobalamine in the Management of Neuropathic Pain

Introduction: Neuropathic Pain (NP) is known as ‘nerve pain’- is a type of chronic pain that occurs when nerve in the central nervous system becomes damage or injured. An FDC of Amitriptyline a neuroanalgesia and Mecobalamine (Vitamin B12) a damage nerve rejuvenator have an important role in management of NP. Methodology: Of 786 registered, 666 patients completed the study. Efficacy assessment was made by reduction in mean VAS score and ≥50% reduction in NP was calculated at conclusion visit and used to determine the corresponding NNT which was calculated by using risk reduction. Safety assessment was made by inspecting the adverse events during trial. Results: Reduction in mean VAS score was from 7.3 (baseline) to 5.6 (day 30) and 3.9 (day 45). Nearly all the patients had experience ≥50% reduction in NP and NNT score of 1.21 which was calculated by using risk reduction parameter at conclusion visit. Overall 236 patients experience adverse events and were of mild to moderate intensity, sedation and drowsiness being dominantly seen. Conclusion: A combination of Amitriptyline and Mecobalamine was efficacious, safe and well-tolerated in management of Neuropathic pain (NP).

Evidence of impaired pain modulation in adolescents with idiopathic scoliosis and chronic back pain

BACKGROUND CONTEXTAlthough 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms. PURPOSETo identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain. STUDY DESIGNCross-sectional study. PATIENT SAMPLENinety-four patients diagnosed with AIS and chronic back pain. OUTCOME MEASURESQuantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life. METHODSPatients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children. RESULTSEfficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048). CONCLUSIONSChronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome.

LncRNA NONRATT021972 in Neuropathic Pain Patients with Type 2 Diabetes

Objective to explore LncRNA NONRATT021972 in diabetic neuropathic pain and detailed mechanisms in clinical patient. Methods According to inclusion criteria, 154 Chinese patients with type 2 diabetes were enrolled as experimental group, and the same numbers of normal adults were paired as control group with the same baseline status. Patients without diabetes but neuropathy were also enrolled to explore exclusive role of LncRNA NONRATT021972 in neuropathy. Vein blood sampling was performed in both groups for further experiment. Quantitative Real-time PCR was performed to examine expression of LncRNA NONRATT021972 in blood. Neuropathic pain scores were calculated with data collected from Neuropathic Pain Questionnaire in Both groups. Result Compared with control group, patients with type 2 diabetes had a significantly higher concentration of LncRNA NONRATT021972 in blood (P<0.05) and more severe symptoms of neuropathic pain. Moreover, among patients with type 2 diabetes, the concentration of LncRNA NONRATT021972 was positively associated with neuropathic pain scores, suggesting pain-aggravation effect of LncRNA NONRATT021972 was concentration-dependent. However, no association was observed between neuropathy and LncRNA NONRATT021972 in patients without diabetes but neuropathy. Conclusion LncRNA NONRATT021972 was increased in type 2 diabetes, and was positively associated with neuropathic pain scoring in patients with type 2 diabetes.

Neuropathic pain in end-stage hip and knee osteoarthritis: differential associations with patient-reported pain at rest and pain on activity

We investigated whether pain at rest and pain on activity were differentially associated with neuropathic pain scores in individuals with end-stage hip and knee OA. Study participants were 843 patients with hip or knee OA scheduled for total joint arthroplasty. In pre-surgery questionnaires, measures of socio-demographics, health status, medication use, neuropathic pain (painDETECT), pain at rest and pain on activity (WOMAC pain items), depression (HADS) and pain catastrophizing (PCS) were collected. Multivariable linear regression models were estimated for men and women separately to examine the association between neuropathic pain scores (outcome) and study measures, entered in blocks. Sample mean age was 65.1 years (SD: 9.6); 57.1% were women. Mean painDETECT scores were significantly higher (P≤ֹ0.001) for women (11.2±6.6 out of 38) than men (9.3±7.0), with 35.6% of women and 27.7% of men meeting cut-offs for possible or likely neuropathic pain. In the final regression model for women, the coefficients for both types of pain were statistically significant, although the coefficient for pain at rest was 1.6 times greater than that for pain on activity. For men, only pain at rest was significantly associated with neuropathic pain scores. Findings support that possible neuropathic pain is experienced by a notable proportion of patients with end-stage hip and knee OA and is more strongly associated with pain at rest than pain on activity, particularly in men. Clinical presentation of pain at rest may warrant more thorough evaluation for potential neuropathic pain and have implications for appropriate pain management.

Association of Pain Quality with Pain Catastrophizing and Self-efficacy in People with Knee Osteoarthritis.

Patients with chronic pain often have symptoms similar to neuropathic pain (NeP). Such symptoms are also frequently observed in people with knee osteoarthritis (OA). However, pain quality may be related to psychological problems such as high pain catastrophizing and/or low self-efficacy. The objective of the current study was to investigate whether pain quality is associated with pain catastrophizing and self-efficacy in individuals with symptomatic knee OA. This was a cross-sectional study in which 50 subjects with symptomatic knee OA were enrolled. NeP scores were evaluated using the painDETECT questionnaire (PDQ), the pain catastrophizing scores were evaluated using the coping strategy questionnaire, and the self-efficacy scores were evaluated using the self-efficacy scale for rheumatoid arthritis (SERA). Participants were classified as members of the unlikely NeP group (PDQ score ≤12) or the uncertain/likely NeP group (PDQ score >12). The pain catastrophizing scores and the self-efficacy scores were compared between the two groups. Of the 50 participants, 17 (34%) were classified in the uncertain/likely NeP group. The pain catastrophizing score was higher for the uncertain/likely NeP group (6.2 ± 3.3) than for the unlikely NeP group (4.5 ± 2.8; P=0.03). On the SERA scale, the self-efficacy for pain score was lower for the uncertain/likely NeP group (21.9 ± 3.1) than for the unlikely NeP group (24.2 ± 3.1; P=0.03). High pain catastrophizing and low self-efficacy for pain control are significantly associated with the existence of an NeP component on PDQ in people with symptomatic knee OA.

The effect of pregabalin and duloxetine treatment on quality of life of breast cancer patients with taxane-induced sensory neuropathy: A randomized clinical trial

Background:The primary side effect of adjuvant chemotherapy with taxanes is the taxane-induced peripheral neuropathy (TIPN), which may have substantial negative impacts on patients’ quality of life (QOL). We investigated the effect of pregabalin and duloxetine on QOL of breast cancer patients who experienced TIPN.Materials and Methods:This was a randomized, double-blind clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences, Sari, Iran. Breast cancer patients 18 or more years old were included if they received paclitaxel or docetaxel and experienced neuropathy grade one or higher; and neuropathic pain score of four or more. Patients were treated with pregabalin or duloxetine until 6 weeks. Assessment of sensory neuropathy and QOL was performed at baseline, and 6 weeks after the initiation of the treatment.Results:At baseline, the mean score of global health status/QOL scale for pregabalin and duloxetine groups were 61 (standard deviation [SD]; 5.11) and 60.28 (SD; 5.44), respectively (P = 0.54). After 6 weeks, both interventions were associated with improvement of global QOL compared to baseline. The global health status/QOL score was not different between two groups after 6 weeks. While the emotional functioning was improved more favorably with duloxetine (P < 0.001); pregabalin was associated with more improvement in insomnia and pain scores (P = 0.05 and P < 0.001, respectively).Conclusion:Pregabalin as well as duloxetine improve the global QOL of breast cancer patients with TIPN. Different effects of treatments on subscale of QLQ-C30 could help clinicians to select the appropriate agent individually.

Systemic Inflammatory and Th17 Immune Activation among Patients Treated for Lumbar Radiculopathy Exceeds that of Patients Treated for Persistent Postoperative Neuropathic Pain.

The pathophysiology of lumbar radiculopathy includes both mechanical compression and biochemical irritation of apposed neural elements. Inflammatory and immune cytokines have been implicated, induced by systemic exposure of immune-privileged intervertebral disc tissue. Surgical intervention provides improved symptoms and quality of life, but persistent postoperative neuropathic pain (PPNP) afflicts a significant fraction of patients. To compare the inflammatory and immune phenotypes among patients undergoing structural surgery for lumbar radiculopathy and spinal cord stimulation for neuropathic pain. Consecutive patients undergoing surgical intervention for lumbar radiculopathy or neuropathic pain were studied. Demographic data included age, gender, and VAS and neuropathic pain scores. Serum was evaluated for cytokine levels (IL-6, Il-17, TNF-α) and cellular content [white blood cell (WBC)/differential, lymphocyte subtypes]. The primary analysis differentiated molecular and cellular profiles between radiculopathy and neuropathic pain patients. Subgroup analysis within the surgical radiculopathy population compared those patients achieving relief of symptoms and those with PPNP. Heightened IL-6, Il-17, and TNF-α levels were observed for the lumbar radiculopathy group compared with the neuropathic pain group. This was complemented by higher WBC count and a greater fraction of Th17 lymphocytes among radiculopathy patients. In the lumbar discectomy subgroup, pain relief was seen among patients with preoperatively elevated IL-17 levels. Those patients with PPNP refractory to surgical discectomy exhibited normal cytokine levels. Differences in Th17 immune activation are seen among radiculopathy and neuropathic pain patients. These cellular and molecular profiles may be translated into biomarkers to improve patient selection for structural spine surgery.

Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years’ Follow-Up

Chronic neuropathic pain is estimated to affect 3-4.5% of the worldwide population, posing a serious burden to society. Deep Brain Stimulation (DBS) is already established for movement disorders and also used to treat some "off-label" conditions. However, DBS for the treatment of chronic, drug refractory, neuropathic pain, has shown variable outcomes with few studies performed in the last decade. Thus, this procedure has consensus approval in parts of Europe but not the USA. This study prospectively evaluated the efficacy at three years of DBS for neuropathic pain. Sixteen consecutive patients received 36 months post-surgical follow-up in a single-center. Six had phantom limb pain after amputation and ten deafferentation pain after brachial plexus injury, all due to traumas. To evaluate the efficacy of DBS, patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, University of Washington Neuropathic Pain Score (UWNPS), Brief Pain Inventory (BPI), and 36-Item Short-Form Health Survey (SF-36). Contralateral, ventroposterolateral sensory thalamic DBS was performed in sixteen patients with chronic neuropathic pain over 29 months. A postoperative trial of externalized DBS failed in one patient with brachial plexus injury. Fifteen patients proceeded to implantation but one patient with phantom limb pain after amputation was lost for follow-up after 12 months. No surgical complications or stimulation side effects were noted. After 36 months, mean pain relief was sustained, and the median (and interquartile range) of the improvement of VAS score was 52.8% (45.4%) (p = 0.00021), UWNPS was 30.7% (49.2%) (p = 0.0590), BPI was 55.0% (32.0%) (p = 0.00737), and SF-36 was 16.3% (30.3%) (p = 0.4754). DBS demonstrated efficacy at three years for chronic neuropathic pain after traumatic amputation and brachial plexus injury, with benefits sustained across all pain outcomes measures and slightly greater improvement in phantom limb pain.

Aromatherapy Massage for Neuropathic Pain and Quality of Life in Diabetic Patients.

This study aimed to examine the effects of aromatherapy massage on neuropathic pain severity and quality of life (QoL) in patients suffering from painful diabetic neuropathy. This open-label randomized controlled clinical study was conducted in a university hospital endocrine outpatient clinic in Turkey. The study sample consisted of 46 patients, randomly allocated to an intervention group (n = 21) and a control group (n = 25). The intervention group received aromatherapy massage three times per week for a period of 4 weeks. The control group received only routine care. Data were collected from patients using the Douleur Neuropathique questionnaire, the visual analog scale, and the Neuropathic Pain Impact on Quality of Life questionnaire. Neuropathic pain scores significantly decreased in the intervention group compared with the control group in the fourth week of the study. Similarly, QoL scores significantly improved in the intervention group in the fourth week of the study. Aromatherapy massage is a simple and effective nonpharmacological nursing intervention that can be used to manage neuropathic pain and improve QoL in patients with painful neuropathy. Aromatherapy massage is a well-tolerated, feasible, and safe nonpharmacological method that can be readily integrated into clinical settings by nursing staff. The essential oils rosemary, geranium, lavender, eucalyptus, and chamomile can be safely used by nurses in the clinical setting, if applicable. However, training and experience of nurses in aromatherapy massage is critical to achieving positive results.

Neuropathic Pain Score is More Strongly Associated with Pain at Rest than Pain on Activity in Hip and Knee Osteoarthritis

Neuropathic Pain Score is More Strongly Associated with Pain at Rest than Pain on Activity in Hip and Knee Osteoarthritis

LncRNA NONRATT021972 Was Associated with Neuropathic Pain Scoring in Patients with Type 2 Diabetes.

Background Long noncoding RNAs were involved in the processes of diabetes. Our study was aimed to explore clinical potential of LncRNA NONRATT021972 in diabetic neuropathic pain and investigate detailed mechanisms. Methods 154 patients with type 2 diabetes were enrolled as experimental group paired with control. Patients without diabetes but neuropathy were enrolled to explore exclusive role of LncRNA NONRATT021972 in neuropathy. Real-time PCR and ELISA were performed to examine expression of LncRNA and TNF-α in flood. Neuropathic pain scores were calculated with data from NPQ. Streptozotocin was used for SD adult male rats to establish diabetes for NONRATT021972 siRNA or saline treatment. Neuropathic pain behaviors and expression of TNF-α were assessed. Result Patients with type 2 diabetes had a significantly higher concentration of LncRNA NONRATT021972 in blood and more severe symptoms of neuropathic pain. LncRNA NONRATT021972 was positively associated with neuropathic pain scores of type 2 diabetes. TNF-α level increased in patients with type 2 diabetes. Animal experiment showed that LncRNA NONRATT021972 siRNA attenuated inflammation via decreasing TNF-α and alleviated neuropathic pain. Conclusion LncRNA NONRATT021972 increased in type 2 diabetes and was positively associated with neuropathic pain scoring in type 2 diabetes. LncRNA NONRATT021972 exacerbated neuropathic pain via TNF-α related pathways.

Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study.

We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman’s correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients.

Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer

Pain after tumorectomy and sentinel lymph node dissection is poorly reported in the literature. We carried out a prospective survey aimed at assessing pain three months after such minor surgery for breast cancer. The study was approved by the local ethics committee. Most surgeries followed a standard protocol involving general anesthesia with no regional analgesia technique, laryngeal mask, sufentanil and propofol for induction, and multimodal analgesia during the postoperative period. Three months after the surgery, a questionnaire was sent to the patients with a pre-stamped envelope for return. The questions probed responses required to calculate a Brief Pain Inventory score and modified neuropathic pain score (DN3). Over a 5-month period, 150 patients (aged 60 (11)years, body mass indexof 25 (6)kg/m2) were included in the final analysis. In the recovery room, 43% of patients required morphine at a mean dose of 5.2 (1.8) mg. Three months post surgery, 60 patients (40%) reported persistent pain for which 62% took analgesic drugs. We found no risk factor associated with this persistent pain among our studied population. Neuropathic pain was noted in 61% of patients who reported persistent pain primarily associated with periareolar incision. Pain persisted up to three months after minor surgery for breast cancer in 40% of patients with mostly a neuropathic component (61%).

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study.

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

Mapping painDETECT, a neuropathic pain screening tool, to the EuroQol (EQ-5D-3L).

To map relationships between painDETECT, a neuropathic pain (NeP) screening tool, and EQ-5D-3L health status in a real-world setting. Patients with physician-confirmed NeP and painDETECT score classifications of nociceptive (n=79), transitional (n=141), and NeP (n=386) completed the EuroQol (EQ-5D-3L), which evaluates Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression with three ordinal response levels ("no problem," "some problems," or "extreme problems/unable to do"), and has a health status thermometer (0=worst health, 100=perfect health). Multiple linear and logistic regressions were performed (adjusted for age, gender, race, ethnicity, time since NeP diagnosis, number of comorbidities, NeP conditions). Unadjusted mean (±SD) EQ-5D-3L thermometer scores showed poorer health status across painDETECT classifications from nociceptive (67.3±22.1) to transitional (62.3±20.9) to NeP (53.7±21.8), as did utility scores, 0.695±0.206, 0.615±0.216, and 0.506±0.216. In general, the highest odds of health problems were observed for NeP and the lowest for nociceptive, e.g., the NeP group was 6.2 (95% confidence interval 3.4-11.4) times as likely to have a more severe problem of Usual Activities compared with the nociceptive group. Relative to nociceptive and transitional, NeP had lower adjusted mean thermometer scores, by 12.1 (P<0.0001) and 7.8 (P=0.0004) points, respectively, and lower mean utility scores by 0.157 (P<0.0001) and 0.092 points (P<0.0001). This study, the first to map relationships between painDETECT and the EQ-5D-3L in a real-world setting, indicates that the patient burden with respect to pain classification can be characterized and quantified by decrements in health status overall and in specific domains. These data support the psychometric soundness of painDETECT, enhancing its use in pain management.

Evaluation of a Methadone Protocol for Severe Chronic Pain Management in Thai Patients: A Prospective Study

Background: Methadone is a synthetic opioid that is clinically effective in chronic pain management. However, the use of methadone is very limited in Thailand because physicians are not familiar with its dosing and are concerned about risks relating to drug accumulation and cardiac arrhythmias. Objective: The purpose of this study was to develop and implement a methadone protocol for patients with severe chronic pain in order to assure efficacy and safety of methadone. Methods: The protocol was developed based on published clinical studies and guidelines. The validated protocol was implemented in 34 patients at the Pain Clinic, Siriraj Hospital, Bangkok, Thailand. During the study period, pain score, pain interference score, neuropathic pain score, severity of adverse effects, and QTc intervals were investigated over a 3 month period. Results: The results obtained from 21 patients that completed the study showed a significant reduction in median pain intensity (p < 0.001) and other chronic pain interferences based on BPI-T (p < 0.001), excepted for the emotional score (p < 0.004) using methadone doses ranging from 2-30 mg daily. Neuropathic pain was also significantly reduced (p < 0.001). Common adverse effects were drowsiness (55.88%), constipation (35.29%), and nausea and/or vomiting (11.76%). Regarding ECG monitoring, seven patients without QTc prolongation at baseline developed QTc prolongation after methadone initiation. However, QTc interval greater than 500 msec or presentation of Torsades de Pointes were not found. No significant change in the mean QTc interval was observed after initiating methadone (p=0.951). Conclusion: Administration of methadone according to the protocol described in this study was found to be effective and safe for severe chronic pain management. ECG monitoring and drug interaction screening in patient treatment plan is advised when prescribing methadone.

Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus

AimWe aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice. MethodsWe included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP. ResultsThe mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min–max: 1–45) years, mean HbA1c level was 7.8±1.6% (min–max: 5–16.2%), (61.7±6.0mmol/mol; min–max: 31.1–153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00–1.04, p=0.007), elevated HbA1c levels (1.11, 1.02–1.21, 0.015), presence of retinopathy (1.41, 1.20–1.64, <0.001), management with at least one OHA (1.47; 1.12–1.92; 0.004) or any insulin regimen (1.62; 1.16–2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP. ConclusionUtilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.