View clinical trials related to Neuralgia.
Filter by:The present study will aim to determine the safety, efficacy, and tolerability of etoricoxib, an NSAID pain reliever, in patients with Neuropathic pain. Neuropathic pain, or pain caused by abnormal activity of sensory neurons, remains undertreated. Post herpetic neuralgia (PHN), which is commonly referred to as post-shingles pain, is the most useful disease to study when investigating the efficacy of pain relievers for Neuropathic pain. Therefore, this study will primarily involve patients with PHN. The hypothesis in this study is that etoricoxib efficacy is superior to that of placebo.
Post herpetic neuralgia (PHN) is an undertreated condition. It is a type of neuropathic pain (NP), or pain caused by abnormal activity of sensory nerves. Its mechanisms are not fully understood, and medication trials for PHN pain and other types of NP are frequently unsuccessful. There has been extensive investigation aimed at identifying and understanding the specific mechanisms of NP. While some of these tests are inexpensive and easy to perform at the bedside, many require expensive tools and highly equipped laboratory facilities. Further, there is no standard method for assessment of pain in NP patients. The investigators aim to test a Bedside Sensory Testing Kit (assessment for Neuropathic Pain) on a small number of patients with PHN. The purpose of the Kit is to identify mechanisms of pain. The goal of this research is to design a way to classify patients with PHN based on what mechanisms are causing their pain, since this may help predict the best medications for individual patients.
Neuropathic pain occurs as a result of damage or disease of the peripheral or central nervous system. Regardless of its cause, neuropathic pain (NeP) leads to a characteristic clinical picture characterized by ongoing pain with steady or dysesthetic pain, such as burning or aching, and paroxysmal pain such as shooting or stabbing. In conditions such as diabetic neuropathy, changes in the membrane-bound proteins that form ion channels may alter the electrical properties of the injured neuron, called remodeling. The net effect of membrane remodeling is greater excitability of neurons, leading to a tendency towards action potential generation and propagation in injured primary sensory neurons which occurs in the context of nerve injury and disease. Over the past decade, a new endogenous cannabinoid receptor-mediated system within the nervous system and upon immune-mediated cells has been described. The cannabinoid receptor system consists of two receptors, CB1 and CB2 receptors, as well as endogenously produced endocannabinoids which agonize these receptors. This is a multicenter trial amongst Western Canadian sites to compare the efficacy of nabilone versus placebo in treating patients with chronic neuropathic pain (NeP) due to diabetic peripheral neuropathy (DPN). A one-week screening period will occur, during which pain scores and sleep scores will be tabulated. Following screening, a 4-week period of single blind treatment with flexible dosing of nabilone at 0.5 - 4 mg/day will initiate. All subjects will begin with nabilone therapy of 1 mg daily for a minimum of 4 days, with the dose of the study medication assessed and adjusted either upwards or downwards as needed to balance efficacy for pain control with tolerability of possible side effects. All subjects who experience at least a 30% reduction in their weekly mean pain score during the single blind flexible dosing phase will be considered a responder, and will be further continued in the study. During the double-blind portion of the study, subjects randomized to nabilone will continue on the dose of nabilone achieved at the completion of the single-blind phase, and this dose will be maintained throughout the double-blind phase. Subjects randomized to placebo will receive 1 mg of nabilone daily for one week, followed by 4 consecutive weeks of placebo. This dose of nabilone will permit a tapering for those subjects achieving a higher daily dose of nabilone during the single-blind phase, or will maintain those who were taking only 1 mg per day in the single-blind phase, preventing an abrupt termination of treatment in subjects who are randomized into the placebo portion of the study.
This project will explore the safety and feasibility of performing a successful intravenous patient controlled analgesia (IV PCA) Oxymorphone titration and conversion to oral ER Oxymorphone (extended release or OPANA ER) in the outpatient setting.
This project addresses a vexing problem that has alluded the best efforts of the medical/scientific community: treatment of resistant neuropathic pain. Neuropathic pain is common and includes conditions such as diabetic neuropathy, post herpetic neuralgia and post stroke pain and is believed to affect at least 3% of adults. Surveys of patients with neuropathic pain indicate that 60% do not receive adequate relief with current treatment. Results from recent laboratory and human studies reveal a new approach to treatment. This approach is based on the findings that neuroinflammation appears to be involved in development and maintenance of neuropathic pain. This study explores the effects of an immune-modulating blood-derived product, intravenous immunoglobulin (IVIG), in treating neuropathic pain. IVIG is thought to reduce neuroinflammation contributing to neuropathic pain. If successful, the study will provide important insights into pain mechanisms and a better understanding of how IVIG relieves neuropathic pain. Hypotheses: 1. Reduction in neuroinflammation (NI) markers will co-vary with clinical indicators of pain relief 2. Patients with higher levels of markers of NI will be more likely to respond to IVIG
The purpose of this study is to determine whether patients with neuropathic pain has abnormal excitability in somatosensory cortex and abnormal sensory-motor connections.
Rationale: Often, incurable cancer patients suffer from severe symptoms as (neuropathic) pain and fatigue with polypharmaceutic interventions as a consequence. Regarding neuropathic pain in incurable cancer patients, pregabalin has been registered for neuropathic non-cancer pain, and amitriptyline is not registered for neuropathic pain, but is recommended as the drug of first choice in the Dutch handbooks of palliative care. As a consequence of an adaptation of a Dutch law (July 2007) about off-label medication prescription, off-label medication is not allowed anymore unless a standard or protocol exists. No clinical trials for this patient group have been published before. Objective: To compare efficacy, side effects and costs of a strategy with amitriptyline as drug of first choice versus a strategy with pregabalin as drug of first choice. Study design: An open label, randomised non-inferiority trial Study population: Incurable cancer patients with neuropathic pain Intervention: When a patient decides to take part in the study, he will be allocated randomly to one of the two study groups. A minimisation algorithm will be used, that balances for the cause of neuropathic pain (tumour related versus treatment related), type of treatment (ongoing chemo- or radiotherapy versus not ongoing chemo- or radiotherapy) and institution. Each drug will be prescribed in a step up procedure. Patients will be followed during 8 weeks. Main study parameters/endpoints: Neuropathic pain, as measured with the mean VAS and McGill questionnaire, strategy success, costs per strategy, side effects, quality of life and concomitant analgesic drugs. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: There are hardly any risks for the patients. The drugs in both arms already are usual care for the target population. If there is no or a too small effect, the drug of the other arm will be added, which strategy also is already usual care. All other medication, except for Tricyclic Antidepressants Drugs (TADs) and Anti Epileptic Drugs (AEDs), as well as radiotherapy and chemotherapy are allowed. The patient has to visit the hospital 2 times during the study period. The patient had to fill in a pain diary daily (5 min), cost diary and EQ-5D every other week (10 min), related questionnaires as HADS, McGill and EORTC-QLQ-C30 monthly (20 min).
Patients with neuropathic pain exhibit hyperalgesia and allodynia. Although both peripheral and central determinants are recognized for the pathophysiological basis of neuropathic pain following peripheral injury, the modulating effect on pain processing in brain by peripheral mechanisms remains elusive. Here, we will systematically compare the sensory symptoms and brain activation to innocuous and noxious thermal stimulation applied to the distal leg, foot dorsum or forearm between patients with peripheral neuropathy and healthy controls. Functional magnetic resonance imaging will be used to define brain activation to somatic stimulation with noxious and innocuous stimuli. The blood-oxygenation-level-dependent signals will be correlated with visual analogue scale scores and sensory and affective components obtained from the Short-Form McGill Pain Questionnaire. Brain activation during thermal stimulation in patients with neuropathic pain will be clarified, and we will also analyze the potential relationships between the topography, quality and intensity of the different painful symptoms (i.e. spontaneous ongoing pain, paroxysmal pain, allodynia, hyperalgesia) and the magnitude and pattern of brain activation during thermal stimulation. This will add in our understanding in the pathophysiology of brain modulation in pain and provide clinically useful message toward the potential therapeutics in the management of neuropathic pain.
To compare the efficacy of two dosages (600mg/day and 1200mg/day) of bicifadine SR with placebo for 14 weeks in reduction of chronic neuropathic patin (measured by a daily rating of pain intensity) associated with diabetic periperal neuropathy in adult outpatients. To compare the tolerability of two dosages of bicifadine SR with placebo in adult outpaitens treated for chronic neuropathic pain for 14 weeks associated with diabetic peripheral neuropathy.
Patients with peripheral neuropathy frequently exhibit treatment-refractory neuropathic pain. Although both peripheral and central determinants are recognized for the pathophysiological basis of neuropathic pain following peripheral injury, the modulating effect on pain processing in brain by peripheral mechanisms remains elusive. Here, we will systematically compare the sensory symptoms and brain activation to painful heat stimulation applied to the foot dorsum between patients with peripheral neuropathy and healthy controls. Functional magnetic resonance imaging will be used to define brain activation to thermal stimulation with noxious heat and innocuous warm thermal stimuli applied by contact heat stimulator. Brain activation during thermal stimulation in patients with neuropathic pain will be clarified, and we will also analyze the potential relationships between the topography, quality and intensity of the different painful symptoms and the magnitude and pattern of brain activation during thermal stimulation. This will add in our understanding in the pathophysiology of brain modulation in pain and provide clinically useful message toward the potential therapeutics in the management of neuropathic pain.