Current review of pain最新文献

This review focuses on the advances in the development of N-type calcium channel blockers as analgesic agents over the last 2 years. Firstly, it highlights the clinical progress with SNX-111 (Ziconotide; Elan Pharmaceuticals, Smithfield, RI) and then secondly, it outlines the various approaches being taken by researchers to design orally active, selective, small molecule modulators without the perceived disadvantages associated with SNX-111.

Postherpetic neuralgia (PHN) is the most common and devastating complication of acute herpes zoster (HZ). HZ occurs more frequently in the patient with human immunodeficiency virus (HIV) and with certain leukemias and lymphomas. PHN occurs more frequently in the elderly, in patients with severe pain in the acute stage, and in patients with lesions in the ophthalmic branch of the trigeminal nerve. Pain from PHN is often debilitating and difficult to treat. A wide variety of therapeutic approaches have been advocated over the years, but most are not very effective. Early aggressive treatment of HZ with antiviral drugs may be the most important step in prophylaxis against PHN. This article reviews the current knowledge of the pathogenesis and treatment of PHN.

Nociception results in peripheral and central changes in sensory processing. These changes are considered to significantly contribute to postoperative pain and its outcome. Objective measures of changes in sensory processing are now being studied in humans after surgery. Surgical nociception leads to both central excitation (eg, spinal sensitization) and central inhibition (eg, descending inhibition), with inhibition being the dominant response during the first day or so after surgery. Analgesia commenced before surgery (preemptive analgesia) depresses central sensitization and enhances central inhibition. Patients operated on under nonanalgesic anesthesia may exhibit rebound central sensitization for up to 5 days postoperatively after the cessation of postoperative opioid analgesia. There is only a weak relationship between the described objective changes in sensory processing after surgical nociception and subjective clinical pain measures such as pain intensity scales or postoperative analgesic consumption.

Failed back surgery syndrome is continued low back pain with or without radicular pain after lumber surgery. The syndrome is difficult to treat due to the variability of pain generators. By examining the anatomy and pathophysiology of the pain mechanisms, a logical progression for an algorithm for treatment is presented.

Coagulation abnormalities and bleeding disorders are frequently encountered in patients undergoing invasive procedures. These are of particular importance in the pain management setting where even small amounts of excessive bleeding can result in devastating complications. It is imperative that physicians treating those patients under-stand the basic concepts of coagulation and be able to identify and manage the common bleeding disorders. This article provides a brief overview of the coagulation system and describes the use of appropriate screening tests and management strategies to limit bleeding in pain management procedures.

Interstitial cystitis (IC) is an enigmatic and frustrating condition to manage as a physician and to cope with as a patient. Many patients are declared as drug addicted and neurotic. Social status and number of sexual partners showed no correlation with incidence. Patients report moderate to excruciating pain in the suprapubic or vaginal area, urgency and frequency (up to 50 micturitions/d), and disruption of their social life. Diagnosis of IC is made by exclusion. Different pathophysiologic mechanisms have been proposed: changes in epithelial permeability, pelvic floor dysfunction, mastocytosis, activation of c-fibers, and increase of nerve growth factors and bradykinin. No single theory can explain IC.

Pain is one of the cardinal presenting symptoms in cancer patients and often seems to progress in the natural history of the disease. In light of the past neglect of this problem, it is becoming crucial for clinicians and researchers in the fields of oncology, pain management, and others dealing with this patient population to have a thorough understanding of the often complex pain syndromes that are relevant to managing cancer. In this article we briefly review the important topics related to cancer pain syndromes with some emphasis on those that typically generate localized pain.

It is well-known that morphine is the king of analgesics. It is widely used, and administered in various ways for the control of acute and chronic pain states. There are, however, certain types of pain and certain clinical conditions in which morphine cannot be used due to the risk of possible complications. These are usually pain states associated with intracranial hypertension, the presence of serious respiratory problems, the onset of major opioid tolerance, persistent vomiting, and so on. The search for "alternative analgesics" has been in progress for a decade, alternatives that could be used alone or in combination for spinal administration in the treatment of complex chronic pain states and with a low incidence of secondary effects. Today, research is carefully assessing the clinical effectiveness and the side effects of a series of drugs for spinal administration, that is, epidural or intrathecal, such as the new narcotics, alpha-2 agonists, central muscle relaxants, calcitonin, and local anesthetics. In this alternative analgesic category we have to mention the somatotrophin-release inhibiting factor (SRIF), which is an ubiquitous native hormone with widespread, predominantly inhibitory actions, and octreotide, its synthetic analogue. In this article we review the literature on the natural drug and its synthetic analogue, paying particular attention to the problems connected with intraspinal administration and analgesic properties.