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.
Author(s): Jeimylo de Castro, Yasser El Miedany
Series: Contemporary Rheumatology
Publisher: Springer
Year: 2022
Language: English
Pages: 400
City: Cham
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
