Neuropathic Pain centre NL.m4vFrom the centre for the treatment of neuropathy and neuropathic pain, Soest, NL: info@ores.nl www.neuropathie.nu Neuropathic pain is a complex, chronic pain state and the nerve fibers themselves are either damaged, dysfunctional, or injured. Unfortunately, neuropathic pain responds poorly to standard pain treatment and may get worse instead of better over time. The discomfort for patients is significant and is often described as a burning sensation, a sharp, stabbing or shooting pain. Neuropathic pain has a devastating effect onquality of life. Indeed, the quality of treatment is poor, only few patients receiving recommended medications in efficacious dosages. Currently there is no treatment to prevent or cure neuropathic pain, and very often this pain transforms into an intractable chronic painstate. The two major pharmacological treatment options are antidepressants such as the tricyclic antidepressants (TCAs, amitriptyline and nortriptiline) and anticonvulsants such as carbamazepine, gabapentin and its derivative pregabelin. Numbers needed to treat are 3-6 and many patients seem to be refractory to these classical analgesics. In order to help patients one needs to be brave and forget about the much trodden path described above. If patients do not respond satisfactory on antidepressants and anticonvulsants new inroads into other treatment modalities are necessary. As clinicians we are conditioned to think in oral pharmacological interventions only. And we do not often consider polypharmacy, we select only one analgesic drug and dose up to the limit of tolerability. If the patient is a non-responder to drug A we change to drug B. If the patient is a non responder to drug B we tend to become pessimistic and regard the case as a failure. We need to become more flexible and more explorative. Especially in the case of the neuropathic pain patient, the patient him or herself can act as a control, and we need not feel dependent on controlled clinical trials and meta-analyses only. In our center for the treatment of neuropathic pain we explored some new inroads into the treatment of intractable neuropathic pain. There are three principles we follow: polypharmacy, transdermal cremes and the Integrated Medicine concept. Polypharmacy Preclinical research in a variety of animal models of neuropathic pain demonstrates that multiple pathophysiological mechanisms exist in neuropathic pain conditions, and multiple mechanisms may coexist in a single patient. Since the various studied analgesics mentioned above have different mechanisms of action and provide usually only partial pain relief, if used as a single agent, there seems to be a rational for the use of drug combinations based on polypharmacy. Logically one wound select drugs from different classes, and use an add-on step wise dosing scedule. There are much more classes of drugs one can choose from, as the two classes cited above. Centre for the study and treatment of neuropathic pain and neuropathy in Soest, the Nertherlands This site helps patients and treating physicians, neurologists, anesthesiologists and other pain specialists to find the best and most up to date research findings related to neuropathy and neuropathic pain and the treatment thereof. In our centre we are specialised in treating patients suffering from neuropathic pain and neuropathy following an Integrated Medicine concept. Part of our activities are within the field of consultation. We assist pharmaceutical companies in R&D strategies related to finding new drugs to treat neuropathic pain and neuropathy. March 2010, Jan M. Keppel Hesselink, MD, PhD www.neuropathie.nu code pour embarquer la vidéo : >>> http://www.youtube.com/embed/zVld4WW22DM <<< |