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  1. Article: Current treatment options in neuropathic pain.

    Hempenstall, Kathleen / Rice, Andrew S C

    Current opinion in investigational drugs (London, England : 2000)

    2002  Volume 3, Issue 3, Page(s) 441–448

    Abstract: Neuropathic pain results from damage to the nervous system due to many diverse processes. It causes persistent, distressing pain that is reputedly unresponsive to conventional analgesics. Treatment is best managed in a multi-therapy pain clinic setting ... ...

    Abstract Neuropathic pain results from damage to the nervous system due to many diverse processes. It causes persistent, distressing pain that is reputedly unresponsive to conventional analgesics. Treatment is best managed in a multi-therapy pain clinic setting and pharmacotherapy is one facet of this treatment. There is no single effective drug treatment and patients have been empirically treated with antidepressants and antiepileptics in the past. This review focuses on evidence from randomized controlled trials to assess the efficacy of the currently available drug treatments.
    MeSH term(s) Analgesics/therapeutic use ; Anesthetics, Local/therapeutic use ; Animals ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Anticonvulsants/therapeutic use ; Antidepressive Agents/therapeutic use ; Central Nervous System/physiopathology ; Humans ; Nerve Growth Factors/therapeutic use ; Pain/drug therapy ; Pain/etiology ; Pain/pathology ; Pain/physiopathology ; Peripheral Nervous System Diseases/complications ; Peripheral Nervous System Diseases/drug therapy ; Peripheral Nervous System Diseases/pathology ; Peripheral Nervous System Diseases/physiopathology ; Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors ; Treatment Outcome
    Chemical Substances Analgesics ; Anesthetics, Local ; Anti-Inflammatory Agents, Non-Steroidal ; Anticonvulsants ; Antidepressive Agents ; Nerve Growth Factors ; Receptors, N-Methyl-D-Aspartate
    Language English
    Publishing date 2002-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2027913-9
    ISSN 2040-3429 ; 1472-4472 ; 0967-8298
    ISSN (online) 2040-3429
    ISSN 1472-4472 ; 0967-8298
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5305: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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  2. Article ; Online: Analgesic therapy in postherpetic neuralgia: a quantitative systematic review.

    Hempenstall, Kathleen / Nurmikko, Turo J / Johnson, Robert W / A'Hern, Roger P / Rice, Andrew S C

    PLoS medicine

    2005  Volume 2, Issue 7, Page(s) e164

    Abstract: Background: Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and ... ...

    Abstract Background: Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic pain in general, the evidence base has been substantially enhanced by the recent publication of several major trials. Therefore, we have conducted a systematic review and meta-analysis for both efficacy and adverse events of analgesic therapy for PHN.
    Methods and findings: We systematically searched databases (MEDLINE 1966-2004, EMBASE 1988-2004, CINAHL 1982-2002, and PubMed [29 October 2004]) for trials of PHN. We also searched references of retrieved studies and review articles for further trials. We included trials that examined adult patients with PHN of greater duration than 3 mo, that were blinded, randomised, and had at least one measure of pain outcome. Dichotomous pain outcome data were extracted for 50% decrease in baseline pain using a hierarchy of pain/pain-relief measurement tools. Where available, dichotomous data were also collected for adverse events. Calculated estimates of efficacy included relative benefit and number needed to treat. Of 62 studies identified, 35 were randomised controlled trials. Of these, 31 were placebo controlled and suitable for meta-analysis, from which it was possible to extract dichotomous efficacy outcome data from 25. This meta-analysis revealed that there is evidence to support the use of the following orally administered therapies: tricyclic antidepressants, "strong" opioids, gabapentin, tramadol, and pregabalin. Topical therapies associated with efficacy were lidocaine 5% patch and capsaicin. Finally, a single study of spinal intrathecal administration of lidocaine and methyl prednisolone demonstrated efficacy, although this has yet to be replicated. Data suggest that the following therapies are not associated with efficacy in PHN: certain NMDA receptor antagonists (e.g., oral memantine, oral dextromethorphan, intravenous ketamine), codeine, ibuprofen, lorazepam, certain 5HT1 receptor agonists, and acyclovir. Topical administration of benzydamine, diclofenac/diethyl ether, and vincristine (iontophoresis) are similarly not associated with efficacy, nor are intrathecal administration of lidocaine alone or epidural administration of lidocaine and methylprednisolone, intravenous therapy with lidocaine, subcutaneous injection of Cronassial, or acupuncture. However, many of the trials that demonstrated a lack of efficacy represented comparatively low numbers of patient episodes or were single-dose studies, so it may be appropriate to regard such interventions as "not yet adequately tested" rather than demonstrating "no evidence of efficacy." Topical aspirin/diethyl ether has not been adequately tested.
    Conclusion: The evidence base supports the oral use of tricyclic antidepressants, certain opioids, and gabapentinoids in PHN. Topical therapy with lidocaine patches and capsaicin is similarly supported. Intrathecal administration of methylprednisolone appears to be associated with high efficacy, but its safety requires further evaluation.
    MeSH term(s) Analgesics/pharmacology ; Antidepressive Agents/therapeutic use ; Antidepressive Agents, Tricyclic/therapeutic use ; Clinical Trials as Topic ; Herpes Zoster/drug therapy ; Humans ; Lidocaine/therapeutic use ; Methylprednisolone/administration & dosage ; Narcotics/therapeutic use ; Neuralgia/drug therapy ; Receptors, N-Methyl-D-Aspartate/metabolism ; Time Factors
    Chemical Substances Analgesics ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Narcotics ; Receptors, N-Methyl-D-Aspartate ; Lidocaine (98PI200987) ; Methylprednisolone (X4W7ZR7023)
    Language English
    Publishing date 2005-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2185925-5
    ISSN 1549-1676 ; 1549-1277
    ISSN (online) 1549-1676
    ISSN 1549-1277
    DOI 10.1371/journal.pmed.0020164
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6042: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Analgesic therapy in postherpetic neuralgia

    Kathleen Hempenstall / Turo J Nurmikko / Robert W Johnson / Roger P A'Hern / Andrew S C Rice

    PLoS Medicine, Vol 2, Iss 7, p e

    a quantitative systematic review.

    2005  Volume 164

    Abstract: Background Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic ... ...

    Abstract Background Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic pain in general, the evidence base has been substantially enhanced by the recent publication of several major trials. Therefore, we have conducted a systematic review and meta-analysis for both efficacy and adverse events of analgesic therapy for PHN. Methods and findings We systematically searched databases (MEDLINE 1966-2004, EMBASE 1988-2004, CINAHL 1982-2002, and PubMed [29 October 2004]) for trials of PHN. We also searched references of retrieved studies and review articles for further trials. We included trials that examined adult patients with PHN of greater duration than 3 mo, that were blinded, randomised, and had at least one measure of pain outcome. Dichotomous pain outcome data were extracted for 50% decrease in baseline pain using a hierarchy of pain/pain-relief measurement tools. Where available, dichotomous data were also collected for adverse events. Calculated estimates of efficacy included relative benefit and number needed to treat. Of 62 studies identified, 35 were randomised controlled trials. Of these, 31 were placebo controlled and suitable for meta-analysis, from which it was possible to extract dichotomous efficacy outcome data from 25. This meta-analysis revealed that there is evidence to support the use of the following orally administered therapies: tricyclic antidepressants, "strong" opioids, gabapentin, tramadol, and pregabalin. Topical therapies associated with efficacy were lidocaine 5% patch and capsaicin. Finally, a single study of spinal intrathecal administration of lidocaine and methyl prednisolone demonstrated efficacy, although this has yet to be replicated. Data suggest that the following therapies are not associated with efficacy in PHN: certain NMDA receptor antagonists (e.g., oral memantine, oral dextromethorphan, ...
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2005-07-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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