Neuropathic Pain Presented At Primed 5.11.09
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The document provides an overview of neuropathic pain, including its definitions, types, epidemiology, clinical features, and management options. It highlights the prevalence of neuropathic pain in the UK and discusses diagnostic tools and pharmacological treatments. Additionally, it addresses physical and alternative treatments, advanced pain management techniques, and the importance of multi-modal approaches in managing neuropathic pain.
Neuropathic Pain Presented At Primed 5.11.09
- 1. Neuropathic PainDr. Christopher A. Jenner MB BS, FRCAConsultant in Pain Medicine, Imperial Healthcare NHS TrustMedical Director London Pain Consultants and Spinal Healthcare 5th November 2009VXXXXDate of preparation October 2009
- 2. AgendaDefinitionNeuropathic v. nociceptive PhysiologyEpidemiologyDiagnosisManagement optionswww.londonpainconsultants.com
- 3. Definitions (1)Pain. ‘An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of tissue damage, or both.’ (IASP 2001)www.londonpainconsultants.com
- 4. Definitions (2)Time-course: • acute • chronic www.londonpainconsultants.com
- 5. Definitions (3)Type: • nociceptive • neuropathic www.londonpainconsultants.com
- 6. Nociceptive Pain www.londonpainconsultants.com
- 12. Neuropathic Pain www.londonpainconsultants.com
- 15. Pain Physiology www.londonpainconsultants.com
- 17. Noxious Stimulus
- 20. Noxious Stimulus
- 23. Spinal cord
- 24. Dorsal Horn
- 25. Synapse
- 26. Ca and Glutamate
- 27. Synaptic Cleft
- 28. Post Synaptic
- 30. Pain perception
- 31. Brain
- 32. Neuropathic Pain
- 35. Neuropathic pain : Classification PeripheralNeuropathies (e.g. diabetes, alcohol)Post-operative nerve injuriesHerpes zosterTrigeminal neuralgia AmputationsPlexus avulsionsSpinal cordSpinal injuryMSTumourArachnoiditisSyrinxBrainStrokeMSTumourEpilepsySyrinxJensen T. 2007
- 36. Neuropathic pain syndromesPeripheralChemotherapy-induced neuropathyComplex regional pain syndromeHIV sensory neuropathyNeuropathy secondary to tumour infiltrationPainful diabetic neuropathyPhantom limb painPostherpetic neuralgiaPostmastectomy painTrigeminal neuralgiaCentral Central post-stroke painMultiple sclerosis painParkinson disease painSpinal cord injury painDworkin R.H. A overview of Neuropathic pain: Syndromes, Symptoms, Signs and several MechanismsClin J Pain (2002) 18:343-349
- 37. Epidemiology of Neuropathic PainThe Neuropathy Trust
- 38. Epidemiology of Neuropathic PainPrevalence of 2-4% in UK
- 39. Over 30% neuropathy prevalence in diabetes
- 40. Predicted by 2010 ~ 1 million diabetes sufferers with neuropathy
- 41. Up to 70% neuropathy patients experience painThe Neuropathy Trust
- 42. Neuropathic Pain in Primary CareCommon after surgery?1 in 6 experience post mastectomy phantom pain
- 43. 1 in 7 experience post-thoracotomy neuralgia
- 44. 1 in 8 experience severe post herniorraphy pain
- 45. 1 in 33 experience phantom tooth pain after extractionMacrae WA. Chronic pain after surgery BJA 87 (2001) 88-98
- 46. How Common is Neuropathic Pain in Primary Care?Epidemiology of conditions (per 100,000 person yrs)Post Herpetic Neuralgia = 40 ↓Trigeminal Neuralgia = 27Phantom Limb Pain = 1 ↓Painful Diabetic Neuropathy = 15 ↑Hall G. et al. Epidemiology and treatment of neuropathic pain: The UK primary care perspective.Pain 2006; 122: 156–162
- 47. Clinical features of Neuropathic Pain
- 48. HistoryPain description- burning/ shooting/ stabbing/ electric shock/ lancinating/ severe/ constant…..Local hypersensitivity- allodynia/ hyperalgesia/ dysaesthesiaDysfunction
- 50. Allodynia (mechanical, thermal & punctate)
- 51. Skin changes (autonomic activity)
- 53. Cold
- 54. Pin
- 55. Vibration
- 56. Soft touchDiagnostic & Screening Tools
- 57. All based on use of pain descriptors and simple examinationLANSS scale Bennett, 2001
- 58. Neurop. Pain Questionnaire Krause, 2003
- 59. DN4 Bouhassira, 2005
- 60. ID Pain Portenoy, 2006
- 61. Pain Detect Freynhagen, 2006Diagnostic & Screening Tools
- 63. Items Common to all Screening ToolsBennett et. al. Using screening tools to identify neuropathic painPain 127 (2007) 199–203
- 64. Pharmacological Treatment • WHO analgesic ladder (abridged) • + tramadol • + opioids- buprenorphine TDD/ oxycontin/ fentanyl TDD (New: sufentanyl TDD/ product X)www.londonpainconsultants.com
- 65. Pharmacological treatment of Neuropathic Painwww.londonpainconsultants.com
- 66. Neuropathic Pain ManagementAntidepressants AmitryptillineAnticonvulsants- Gabapentin/ Pregabalin/ Carbamazepine/ ValproateOpioidsLocal Anaesthetics/AnalgesicsLidocaine/ EMLAwww.londonpainconsultants.com
- 68. Future Agents for Neuropathic PainZiconotide (sea snail, conus magnus)P2X3- (purine) receptor antagonists (ATP) (knockout mice)Epibatidine (Equadorian poison dart frog)Morphine and ketamineRegular gabapentinwww.londonpainconsultants.com
- 71. Lidocaine plaster v. Pregabalin in PHNBaron et al., 2009: Study overview and design* according to SmPCBaron et al., (2009) CMRO. 25: 1663-1676.
- 72. Baron et al., 2009: Results – PHNNRS-3 response rate after 4 weeks, Per protocol (PP)Baron et al., (2009) CMRO. 25: 1663-1676.
- 73. Baron et al., 2009: Results – PHNSubject-based adverse event (AE) evaluation, Safety population* p = 0.0020 * * p = 0.0001Baron et al., (2009) CMRO. 25: 1663-1676.
- 74. Physical and Alternative Treatments
- 75. Physical and Alternative TreatmentsGraded desensitisationMirror box therapyRehabilitation
- 77. Pain ManagementPsychological CBT Operant Conditioning Psychoanalysis Relaxation Biofeedback• Psychiatricwww.londonpainconsultants.com
- 78. Pain Management ProgrammesMedication • Goals (SMART- specific/ measured/ agreed/ realistic/ timed) • Coping • Contingency • Pacing • Education • Pain Behaviours • Reinforcementwww.londonpainconsultants.com
- 79. Advanced Pain Management Techniques www.londonpainconsultants.com
- 83. The Future?DemographicsHealthcare advances↑ Patient expectations and involvementwww.londonpainconsultants.com
- 84. SummaryIncidence of NP increasingNociceptive v neuropathicManagement of NP in primary careWhen to refer www.londonpainconsultants.com
- 85. SummaryVery common (1 in 7 UK)Time course- acute n chronicNociceptive and neuropathicMultiple treatment modalitieswww.londonpainconsultants.com
- 86. Case reports/ Blogs/ Links/ Appointmentsdr.jenner@satellitesec.co.uk0845 045 0250www.londonpainconsultants.com
- 87. Any Questions