Advances in Chronic and Neuropathic Pain

Description

This book is an in depth guide to chronic and neuropathic pain. The issue of chronic and neuropathic pain is very prevalent, yet only a fraction of the symptoms and root causes, as well as potential treatment plans, are properly understood. Additionally, less than half of cases are accurately identified and properly treated. The existing drugs, although classified as very strong and powerful, cannot provide lasting relief to chronic and neuropathic pain. Thus, with all the unique features of this condition, this book presents a systematic way of diagnosing and approaching this condition so every practitioner can appropriately treat their patients.  In addition to introducing key concepts, like classification of chronic pain and the challenges patients and practitioners face when dealing with and treating chronic and neuropathic pain, this book also covers different syndromes that can lead to neuropathic pains. It discusses how to monitor progress by using outcome measures, the presence of chronic and neuropathic pain in children and young adults, and the pathophysiology of neuropathic pain as it relates to the release of pro-inflammatory cytokines. Interestingly, the latter is not presently addressed except with the usual pain drugs for general pain―this book aims to revolutionize the approach to chronic and neuropathic pain by exploring it separately from the clinical approach to general pain. It is interesting to note that these cytokines require a specific mode of action if we want to neutralize them in our system, and this concept will be discussed in the regenerative intervention sections. Since it is so necessary to address the many factors to chronic and neuropathic pain as laid out in the proposed table of contents, it is also critical include as varied authors as possible to address this condition from all areas being covered. The team assembled to author the chapters included in this text come from diverse backgrounds of practice and clinical and research interests, from physical medicine and rehabilitation to anesthesiology to radiology and interventional pain medicine. This is an ideal guide for all clinicians caring for patients with chronic and neuropathic pain. Foreword Preface Contents Part I: Understanding Chronic and Neuropathic Pain Chapter 1: Classification of Chronic Pain Types of Pain References Chapter 2: The Challenge in Dealing with Chronic and Neuropathic Pain Introduction Establishing Reasonable Anticipation Accepting That Pain Medications Have Their Limitations Epidemiology of the Chronic Pain Classification of the Chronic Pain Neuroscience of the Chronic Pain Assessment of Chronic Non-malignant and Malignant Pain Challenges in Chronic Pain Management Patient-Related Challenges Health System-Related Challenges Multidisciplinary Approach Challenges References Part II: Pathophysiology Chapter 3: Pathophysiology of Chronic Pain Introduction Normal Physiology Pathway of the Chronic Pain Nociceptors (Pain Receptors) Neuropathic Pain Possible Mechanisms and Pathogenesis Peripheral Sensitization Central Sensitization Glial Cells Pattern Recognition Receptors (PRP) JAK-STAT Pathway Cysteinyl-Aspartate-Specific Proteases (CASPs) Long Non-coding RNAs (lncRNA) GABAergic Plasticity Purinergic Signaling in Microglia Mitochondrial Role in the Pathogenesis of Chronic Pain Conclusion References Chapter 4: The Pathophysiology of Neuropathic Pain Introduction Peripheral Mechanisms Peripheral Sensitization Expression of Ion Channels Phenotypic Switch Sensory Denervation and Sprouting of Collateral Nerve Fibers Sympathetically Maintained Pain Spinal Mechanisms Spinal Glutamatergic Regulation Glial Activation and Proinflammatory Cytokines Supraspinal Mechanisms Disinhibition Spinal Cord Level Supraspinal Level Clinical Neuropathic Pain Syndromes Conclusion References Part III: Age and Pain Chapter 5: Neuropathic Pain in Children Introduction Pathophysiology Diagnosis and Assessment Management Pharmacology Non-pharmacology References Chapter 6: Pain in Older Adults Introduction Epidemiology of Chronic Pain Changes in Pain Physiology Challenges and Barriers to Chronic Pain Treatment Assessment of Pain Assessment of Pain in the Elderly Obtain Diagnosis Assessing Pain Severity Assessing the Impact of Pain Attitudes and Beliefs Approach to the Treatment of Pain Prescribing for Older People General Principles of Pharmacological Management Non-opioids Paracetamol Non-steroidal Anti-Inflammatory Drugs (NSAIDS) Adjuvants Opioids Interventional Strategies Conclusions References Part IV: Pain Processing Medical Problems Chapter 7: Cancer Pain Introduction Mechanism of Cancer Pain Assessment of Cancer Pain Cancer Pain Syndrome WHO Pain Ladder Pharmacologic Strategies Non-opioid Drugs Opioid Drugs Adjuvants in Cancer Pain Technique Choice [31–37] Central Neural Block [31–33, 38] Epidural Infusion Analgesia [32, 38, 39] Intrathecal Analgesia with ITDD System [34, 38, 40, 41] Intrathecal Neurolysis [32, 42, 43] Sympathetic Blocks [33, 34, 44] Celiac Plexus Block [44–47] Superior Hypogastric Block [44, 48, 49] Ganglion Impar Block [44, 50, 51] Peripheral Nerve Block [36, 52, 53] Neurostimulation [32, 34, 54] Peripheral Nerve Stimulation Spinal Cord Stimulation References Chapter 8: Neurodegenerative Diseases and Pain Introduction Parkinson’s Disease Syringomyelia Stroke Treatment Spinocerebellar Ataxia Amyotrophic Lateral Sclerosis Treatment Huntington Disease Alzheimer’s Disease Spinal Muscular Atrophy Multiple Sclerosis Neurofibromatosis References Chapter 9: Complex Regional Pain Syndrome and Interventions Introduction History Epidemiology Pathophysiology Clinical Presentation Diagnosis Treatment Pharmacologic Therapy Interventional Therapy Algorithmic Approach to CRPS Pain Management Conclusion References Chapter 10: Introduction to Central Pain Syndromes and Painful Peripheral Neuropathy Introduction Central Pain Syndromes History and Definitions Clinical Characteristics Diagnosis Central Post Stroke Pain Definition and Prevalence Onset Diagnostic Standards Location Mechanism Spinal Cord Injury Central Pain Definition and Prevalence Localization Mechanism Treatment Pharmacotherapy Neuropathic Pain Meds Nonneuropathic Pain Medications Non-pharmacotherapy Interventional/Surgical Conclusion Painful Neuropathies (PNS) Definitions and Prevalence Mechanisms/Pathophysiology Diagnosis Painful Neuropathies Infectious and Autoimmune Painful Peripheral Neuropathies Guillain-Barre Syndrome (GBS) and Chronic Inflammatory Demyelinating Polyneuropathy (CIPD) Post-herpetic Neuralgia Painful Peripheral Neuropathies Resulting from Systemic Diseases Diabetic Painful Polyneuropathy Injury and Acquired Painful Peripheral Neuropathies Complex Regional Pain Syndrome Nutritional Deficiency-Induced Peripheral Neuropathy Chemotherapy-Induced Peripheral Neuropathy (CIPN) Hereditary Painful Peripheral Neuropathies Charcot-Marie-Tooth Disease Hereditary Sensory Autonomic Neuropathy Painful Channelopathies Drug-Induced Painful Neuropathy (DIPN) Chemotherapeutics Antibiotics Cardiovascular Agents Immunosuppressants NRTIs Treatments of Painful Peripheral Neuropathies Medications Anticonvulsants Antidepressants Cannabinoids Topical Medications Infusion Medications Therapeutic Modalities Interventional Neuromodulation Sympathetic Ganglion Injections Peripheral Nerve Blocks and Hydrodissection Appendix References Chapter 11: Chronic Neuropathic Pain: Fibromyalgia Introduction Fibromyalgia: The Debate The Science of Pain Types of Pain and Where Fibromyalgia Fits in Fibromyalgia: A Pain Processing Problem Fibromyalgia Is a Brain Disease-Central Sensitization Fibromyalgia Is a Small Fiber Neuropathy Mechanisms Underlying Abnormal Pain Sensitivity Muscle Tissue as a Source of Nociceptive Input The Windup and Fibromyalgia Pain Fibromyalgia and Associated Comorbidities Fibromyalgia Pain in the Clinical Setting Pain Behavior Emotional Behaviour Co-morbid Psychiatric Disorders and Trauma Brain/Mental Fog Centralized Pain Processing and Neuroimaging Diagnosis and Screening 2010 ACR Preliminary Diagnostic Criteria Fibromyalgianess Management of Pain in the Fibromyalgia Syndrome Pharmacologic vs. Complementary Interventions Biology and Therapy of Fibromyalgia Pain Pathways and the Pharmacotherapy of Fibromyalgia Activated Ca2+ Channels K+ Channel Modulation Voltage-Gated Sodium (NaV) Channels Modulation N-Methyl-d-Aspartate (NMDA) Antagonists Serotonergic Circuitry Serotonin/Norepinephrine Reuptake Inhibition (SNRI) Selective Serotonin Reuptake Inhibitors (SSRIs) Dopamine Receptor Agonists Opioids Cannabinoids Conclusion References Part V: Clinical Matters Chapter 12: Diagnostic Testing of Neuropathic Pain Introduction Quantitative Sensory Testing Neurophysiological Tests Nerve Conduction Studies Entrapment Neuropathies Polyneuropathy Radiculopathy and Plexopathy Cutaneous Silent Period Somatosensory Evoked Potentials Laser Evoked Potentials Trigeminal Reflexes Microneurography Microstructure Testing Skin Biopsy Nerve Biopsy Neuroimaging Functional Neuroimaging Neuromuscular Ultrasound Magnetic Resonance Neurography Laboratory and Genetic Testing Other Tests Quantitative Sudomotor Axon Reflex Test Sympathetic Skin Response Corneal Confocal Microscopy Conclusion References Chapter 13: Outcome Measures for Chronic Pain References Part VI: Management of Chronic and Neuropathic Pains Chapter 14: Nonpharmacologic Modalities for Chronic Pain Introduction Treatment Rationale Nonpharmacologic Modalities Biological or Physical Treatment Options Thermotherapy Electrotherapy Manual Therapy Therapeutic Exercises Psychological or Behavioral Treatment Options Cognitive-Behavioral Therapy Social or Cultural Treatment Options Future Directions Summary References Chapter 15: Pharmacological Management of Neuropathic Pain Neuropathic Pain Introduction and Epidemiology Diagnosis of Neuropathic Pain The Mechanisms of Neuropathic Pain as Targets for Pharmacotherapy Evidence and Guidance for Pharmacotherapy of Neuropathic Pain Pharmacology of Drugs Implied to Treat Neuropathic Pain Antidepressants Tricyclic Antidepressants Serotonin: Norepinephrine Reuptake Inhibitors Anti-Epileptics Gabapentanoids Other Anticonvulsants Carbamazepine and Oxcarbazepine Lamotrigine Topiramate Lacosamide Valproic Acid Leviteracetam Topical Agents Capsaicin Lidocaine Lidocaine Patch 5% Intravenous Lidocaine Cannabinoids Botulinum Toxin Opioids Tapentadol Tramadol NMDA Receptor Antagonists Future Perspective Cebranopradol Angiotensin Ii Type 2 Receptor Antagonists Conclusion References Part VII: Interventional Therapy Chapter 16: Interventional Procedures for Chronic and Neuropathic Pains Principles of Pain Management and Interventional Pain Management Modalities for Neuroablation Cryoneurolysis Targeted Radiofrequency (RF) Techniques Conventional RF Clinical Application of Conventional RF: Lumbar Medial Branch Radiofrequency Pulsed RF Clinical Application of Pulsed RF: Lumbar DRG Pulsed RF Bipolar RF Cooled RF Chemical Neurolysis Alcohol Phenol Neuromodulation Spinal Cord Stimulation (SCS) Anatomy Mechanism Indications and Evidence [52] Intrathecal Drug Delivery (IDD) Indications Medication for IDD Risks and Complication Image-Guided Techniques Principles of Fluoroscopy-Guided Techniques Fluoroscopy Operating the Fluoroscopy Principles of Ultrasound-Guided Techniques Examples of Dual-Image Guided Technique: Thoracic Transforaminal Epidural Injection Conclusion References Chapter 17: Regenerative Interventions for Chronic and Neuropathic Pains Introduction Biomarkers of Neuropathic Pain Pro-Inflammatory Mediators in Neuropathic Pain Objective Measurements of Neuropathic Pain Conventional Treatment of Neuropathic Pain Regenerative Treatments for Neuropathic Pain Platelet-Rich Plasma Therapy for Neuropathic Pains Role of Interleukin-1 Receptor Antagonist (IL-1Ra) against Neuropathic Pain Stem Cell Therapy for Neuropathic Pain Alpha-2-macroglobulin for Neuropathic Pain Exosomes as a Treatment for Neuropathic Pain Conclusion References Index