ABSTRACT
Pregabalin is a new synthetic molecule and a structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid. It is an alpha2-delta (alpha2-delta) ligand that has analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. Pregabalin binds potently to the alpha2-delta subunit of calcium channels, resulting in a reduction in the release of several neurotransmitters, including glutamate, noradrenaline, serotonin, dopamine, and substance P. In this review, I will discuss the pharmacology of pregabalin and available efficacy studies in pain management. This review will focus on the advances in pregabalin pharmacology since my previous review in 2005.
Subject(s)
Pain/drug therapy , gamma-Aminobutyric Acid/analogs & derivatives , Animals , Disease Management , Humans , Pain/metabolism , Pregabalin , gamma-Aminobutyric Acid/pharmacology , gamma-Aminobutyric Acid/therapeutic useABSTRACT
COX-2 inhibitors are equally as efficacious as the non-selective NSAIDs for the treatment of postoperative pain, but have the advantages of a better gastrointestinal side-effect profile as well as a lack of antiplatelet effects. There have been recent concerns regarding the cardiovascular side effects of COX-2 inhibitors. Nonetheless, they remain a valuable option for postoperative pain management. The pharmacology of these agents and available studies are reviewed.
Subject(s)
Cyclooxygenase 2 Inhibitors/therapeutic use , Pain, Postoperative/drug therapy , Celecoxib , Cyclooxygenase 2 Inhibitors/pharmacology , Humans , Isoxazoles/pharmacology , Isoxazoles/therapeutic use , Pyrazoles/pharmacology , Pyrazoles/therapeutic use , Sulfonamides/pharmacology , Sulfonamides/therapeutic use , Treatment OutcomeABSTRACT
UNLABELLED: Chronic perineal pain is often a difficult condition to manage. Current treatments include pudendal nerve injections and pudendal nerve release surgery. The obturator internus muscle has a close relationship to the pudendal nerve and might be a potential target for therapeutic intervention. PERSPECTIVE: A case is presented of refractory perineal pain that was successfully treated by injecting the obturator internus muscle with botulinum toxin A.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Musculoskeletal Diseases/drug therapy , Neuromuscular Agents/administration & dosage , Pelvic Pain/drug therapy , Chronic Disease , Female , Humans , Middle Aged , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Musculoskeletal Diseases/complications , Pelvic Floor/innervation , Pelvic Floor/physiopathology , Pelvic Pain/etiology , PerineumABSTRACT
Cyclooxygenase (COX)-2 inhibitors are as efficacious as nonselective nonsteroidal anti-inflammatory drugs for the treatment of postoperative pain but have the advantages of a better gastrointestinal side-effect profile as well as a lack of antiplatelet effects. There have been recent concerns regarding the cardiovascular side effects of COX-2 inhibitors. Nonetheless, they remain a valuable option for postoperative pain management. The pharmacology of these agents and available studies are reviewed.
Subject(s)
Cyclooxygenase Inhibitors/therapeutic use , Pain, Postoperative/drug therapy , Prostaglandin-Endoperoxide Synthases/metabolism , Animals , Contraindications , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Cyclooxygenase Inhibitors/adverse effects , Drug Interactions , Humans , Membrane Proteins , Prostaglandin-Endoperoxide Synthases/biosynthesisABSTRACT
Pregabalin is a new analog of the neurotransmitter gamma-aminobutyric acid (GABA). It is an alpha2-delta (alpha2-delta) ligand that has analgesic, anticonvulsant, and anxiolytic activity. Alpha2-delta is an auxiliary protein associated with voltage-gated calcium channels. Pregabalin binds potently to the alpha2-delta subunit resulting in modulation of calcium channels and reduction in the release of several neurotransmitters, including glutamate, norepinephrine, serotonin, dopamine, and substance P. This review discusses the pharmacology of this medication as well as available studies in patients.
ABSTRACT
In the management of patients with low back pain and radiculopathy, selective nerve root blocks (SNRBs) are now a common procedure for both diagnostic and therapeutic purposes. This article reviews the available studies as well as the relevant anatomy, pathology, technical considerations, and complications.
Subject(s)
Low Back Pain/therapy , Nerve Block/methods , Radiculopathy/therapy , Spinal Nerve Roots , Humans , Low Back Pain/diagnosis , Radiculopathy/diagnosis , Spinal Nerve Roots/anatomy & histology , Spinal Nerve Roots/physiologySubject(s)
Cyclooxygenase Inhibitors/pharmacology , Isoenzymes , Prostaglandin-Endoperoxide Synthases , Analgesics, Non-Narcotic/pharmacology , Analgesics, Non-Narcotic/therapeutic use , Animals , Clinical Trials as Topic , Colorectal Neoplasms/prevention & control , Contraindications , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Cyclooxygenase Inhibitors/adverse effects , Cyclooxygenase Inhibitors/therapeutic use , Drug Hypersensitivity , Drug Interactions , Humans , Isoenzymes/biosynthesis , Isoenzymes/physiology , Membrane Proteins , Prostaglandin-Endoperoxide Synthases/biosynthesis , Prostaglandin-Endoperoxide Synthases/physiology , Substrate SpecificityABSTRACT
OBJECTIVE: The objective was to evaluate whether the Multidimensional Pain Inventory (MPI) is effective for predicting response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Changes in patients' profiles to a predominantly adaptive coping status after treatment also were assessed. DESIGN: A prospective study was conducted of patients with an array of pain conditions. A standard evaluation battery, including measures of self-reported pain and disability, psychosocial functioning, helpfulness of the program, and medication use, was used for all patients before and after treatment. The MPI status of patients was evaluated and differential response to treatment was assessed. METHODS: Sixty-five consecutive patients with chronic pain were evaluated before and immediately after participation in an interdisciplinary pain treatment program. This heterogeneous pain-condition cohort was also differentiated on the basis of the MPI to evaluate potential differential response to treatment. RESULTS: Results revealed significant improvement among these patients with chronic pain when a comprehensive interdisciplinary pain-management program was administered. This improvement was seen across the variety of outcomes evaluated, including narcotic medication use. Most important, the MPI subgroup classification did not significantly predict the degree of positive treatment outcome; all subgroups improved. CONCLUSIONS: Although there were major differences in psychosocial functioning before treatment, the MPI was not found to significantly predict response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Thus, a comprehensive interdisciplinary treatment program may achieve its full effectiveness across a wide array of pain/disability-related outcome variables, regardless of initial MPI profile categorization.
