Innovations in Post Herpetic Neuralgia (PHN) Treatment

New Treatment for Post Herpetic Neuralgia

No one who has ever had PHN want this for their worst enemy: it can be that painful.
The below study from Korea shows Ketamin and Magnesium Sulfate helps with pain scores. 

This is an intense protocol for pain management given the way drugs are administered.

Ketamine hydrochloride (Ketara, Parke Davis) or magnesium sulfate (Magnesin) was administered in a double-blind fashion with respect to the assessor and patient. They were given midazolam intravenously (0.1 mg/kg) to render them unconscious. Ketamine (1 mg/kg per hour) and magnesium sulfate (30 mg/kg per hour) were diluted in 0.9% normal saline to a final volume of 100 mL and infused by syringe pump over 1 hour. The drugs were administered on 3 sessions: and each session was performed consecutively every other day. At each of the 3 time points, an electrocardiogram was obtained, and heart rate, noninvasive blood pressure, and pulse oximetry were monitored throughout the drug infusions. Serum magnesium concentrations were measured before the study and at its conclusion and were within normal limits in all patients.

J Clin Anesth. 2015 Mar 17. pii: S0952-8180(15)00053-7. doi: 10.1016/j.jclinane.2015.02.006. [Epub ahead of print]

Is magnesium sulfate effective for pain in chronic postherpetic neuralgia patients comparing with ketamine infusion therapy?

Kim YH1, Lee PB2, Oh TK1.

Author information

• 1Department of Anesthesia and Pain Medicine, National Cancer Center, Goyang, Republic of Korea.
• 2Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea. Electronic address: painsnu@gmail.com.

Abstract

BACKGROUND:

Postherpetic neuralgia (PHN) is a frequent debilitating complication and one of the most intractable pain disorders, particularly in elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapies. Here, the analgesic effects of ketamine or magnesium for PHN were assessed in an open prospective study.

METHOD:

Thirty patients with severe, intractable PHN who were unresponsive to conservative therapy participated. The effects of ketamine hydrochloride (Ketara, Parke Davis) 1 mg/kg and magnesium sulfate (Magnesin) 30 mg/kg were investigated. The patients were randomly divided into 2 groups of 15 patients each, and ketamine 1 mg/kg or magnesium 30 mg/kg was administered intravenously for 1 hour after midazolam sedation. Pain was rated on a visual analog scale (VAS) during a 2-week follow-up. All patients also completed the Doleur Neuropathique 4 questionnaire at baseline and final visits.

RESULTS:

Response to treatment, defined as a 50% reduction in VAS score 2 weeks after, was recorded in 10 of 15 patients in the ketamine group and 7 of 15 patients in the magnesium group. The difference in VAS reduction was not significant between the 2 groups.

CONCLUSIONS:

Ketamine and magnesium showed significant analgesic effects in patients with PHN.

Copyright © 2015. Published by Elsevier Inc.

KEYWORDS:

Ketamine; Magnesium; Postherpetic neuralgia

Innovations in Pain Management: the best Pain Pills to date.

Ann Palliat Med. 2014 Oct;3(4):263-75. doi: 10.3978/j.issn.2224-5820.2014.10.02.

Recent advances in the pharmacological management of acute and chronic pain.

Schug SA1, Goddard C2.

Author information

Abstract

This review focuses on newer medications for the treatment of pain as well as on new guidelines and indications for the use of established medications. With regard to classical analgesics, the use of non-opioids and opioids is reviewed. Here are relevant new data on the use of the old substance acetaminophen as well as on non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and the newer COX-2 selective agents, which continue to be misunderstood. Amongst the opioids the new compound tapentadol with a new mechanism of action is presented as well as a number of new opioid preparations aiming to increase speed of onset of effect and to reduce abuse and diversion. Many medications, which were not originally developed to treat pain, are now used as components of multimodal analgesia or in specific indications. Here are of relevance anticonvulsants such as pregabalin and gabapentin, which were initially used for neuropathic pain, but are now used successfully in a wide range of indications from postoperative pain to fibromyalgia. The reason for this increased range of indications is the realization of the relevance of central sensitization processes for all pain states. Similarly, the use of antidepressants and the old dissociative anesthetic ketamine is increasing for the same reasons. Calcitonin has also found some new indications in difficult to treat pain conditions, while the discussion on the role of cannabinoids in pain management continues, partially driven by political issues. For localized neuropathic pain, there is increasing interest in topical preparations such as lidocaine and capsaicin patches, in particular in view of their minimal systemic adverse effects. Overall, recent advances in the pharmacological management of pain are not so much the result of new 'miracle' drugs, but new preparations and new ways to use old drugs in a variety of settings, often as components of a multimodal approach to pain relief.

KEYWORDS:

Pain management; analgesics; central nervous system sensitization; tapentadol

Melatonin helps prevent preoperative anxiety in Adults

Melatonin given as premedication (tablets or sublingually) can reduce preoperative anxiety in adults (measured 50 to 100 minutes after administration). Melatonin may be equally as effective as standard treatment with midazolam in reducing preoperative anxiety in adults (measured 50 to 100 minutes after administration). The effect of melatonin on postoperative anxiety (measured 90 minutes and 6 hours after surgery) in adults is mixed but suggests an overall attenuation of the effect compared to preoperatively.

Cochrane Database Syst Rev. 2015 Apr 9;4:CD009861. [Epub ahead of print]

Melatonin for pre- and postoperative anxiety in adults.

Hansen MV1, Halladin NL, Rosenberg J, Gögenur I, Møller AM.

Author information

• 1Department of Clinical Pharmacology, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen NV, Denmark, 2400.

Abstract

BACKGROUND:

Anxiety in relation to surgery is a well-known problem. Melatonin offers an atoxic alternative to benzodiazepines in ameliorating this condition in the pre- and postoperative period.

OBJECTIVES:

To assess the effect of melatonin on pre- and postoperative anxiety in adults when comparing melatonin with placebo or when comparing melatonin with benzodiazepines.

SEARCH METHODS:

The following databases were searched on 19 April 2013: CENTRAL, MEDLINE, EMBASE, CINAHL and Web of Science. For ongoing trials and protocols we searched clinicaltrials.gov, Current Controlled Trials and the World Health Organization (WHO) International Clinical Trials Registry Platform. We reran the search in October 2014. We will deal with any studies of interest when we update the review.

SELECTION CRITERIA:

Randomized, placebo-controlled or standard treatment-controlled, or both, studies that evaluated the effect of preoperatively administered melatonin on preoperative or postoperative anxiety. We included adult patients of both genders (15 to 90 years of age) undergoing any kind of surgical procedure in which it was necessary to use general, regional or topical anaesthesia.

DATA COLLECTION AND ANALYSIS:

Data were extracted independently by two review authors. Data extracted included information about study design, country of origin, number of participants and demographic details, type of surgery, type of anaesthesia, intervention and dosing regimen, preoperative anxiety outcome measures and postoperative anxiety outcome measures.

MAIN RESULTS:

This systematic review identified 12 randomized controlled trials (RCTs) including 774 patients that assessed melatonin for treating preoperative anxiety, postoperative anxiety or both. Four of the 12 studies compared melatonin, placebo and midazolam, whereas the remaining eight studies compared melatonin and placebo only.The quality of the evidence for our primary outcome (melatonin versus placebo for preoperative anxiety) was high. More than half of the included studies had a low risk of selection bias and at least 75% of the included studies had a low risk of attrition, performance and detection bias. Most of the included studies had an unclear risk of reporting bias.Eight out the 10 studies that assessed the effect of melatonin on preoperative anxiety using a visual analogue scale (VAS) (ranging from 0 to 100 mm, higher scores indicate greater anxiety) showed a reduction compared to placebo. The reported estimate of effect (relative effect -13.36, 95% confidence interval (CI) -16.13 to -10.58; high quality evidence) was based on a meta-analysis of seven studies. Two studies did not show any difference between melatonin and placebo. Two studies comparing melatonin with midazolam using a VAS found no evidence of a difference in preoperative anxiety between the two groups (relative effect -1.18, 95% CI -2.59 to 0.23; low quality evidence).Eight studies assessed the effect of melatonin on postoperative anxiety. Four of these studies measuring postoperative anxiety 90 minutes postoperatively using a VAS did not find any evidence of a difference between melatonin and placebo (relative effect -3.71, 95% CI -9.26 to 1.84). Conversely, two studies showed a reduction of postoperative anxiety measured six hours after surgery using the State-Trait Anxiety Inventory (STAI) when comparing melatonin with placebo (relative effect -5.31, 95% CI -8.78 to -1.84; moderate quality evidence). Two studies comparing melatonin with midazolam using a VAS did not find any evidence of a difference between the two groups in postoperative anxiety (relative effect -2.02, 95% CI -5.82 to 1.78).

AUTHORS' CONCLUSIONS:

When compared to placebo, melatonin given as premedication (tablets or sublingually) can reduce preoperative anxiety in adults (measured 50 to 100 minutes after administration). Melatonin may be equally as effective as standard treatment with midazolam in reducing preoperative anxiety in adults (measured 50 to 100 minutes after administration). The effect of melatonin on postoperative anxiety (measured 90 minutes and 6 hours after surgery) in adults is mixed but suggests an overall attenuation of the effect compared to preoperatively.

PMID:

 

25856551

 

[PubMed - as supplied by publisher]