Earticle

Neuropathic pain is a chronic disabling condition caused by different pathogenic mechanisms and seriously affects patient’s quality of life. Gabapentinoids, including pregabalin and gabapentin, have been recommended as one of the first-line drugs for the treatment of neuropathic pain. However, optimal dosing of these medications has been limited by adverse events such as dizziness, somnolence, peripheral edema and weight gain. Mirogabalin, a new generation ligand for the α2-δ subunits of voltage-gated calcium channels, provides long-lasting analgesic effects and a wider safety margin for adverse drug reactions due to the characteristic binding and dissociation kinetics for the α2δ-1 and α2δ-2 subunits. This article introduces the action mechanism, pharmacokinetics, clinical application, and reported clinical trials of mirogabalin for treating neuropathic pain.

Intrathecal morphine pump (IT-pump) has been known as an effective treatment of chronic cancer pain. There are some complications of IT-pump implantation such as wound infection, cerebrospinal fluid (CSF) leakage causing intracranial hypotension, catheter-related problems, but uncommon. We report the case of 65-year-old male with bladder cancer. The patient had no underlying disease other than receiving conservative treatment for chronic headache of unknown cause 7 years ago. IT-pump was implanted due to pain in the left lower extremity and low back that did not resolve even with high doses of opioid analgesics. Headache occurred on the 1st day after the procedure, but with conservative treatment, the headache disappeared on the 2nd day but there was only mild neck stiffness. At 2 weeks after the procedure, severe headache and altered mentality were seen, and chronic subdural hemorrhage (SDH) was confirmed bilaterally on the non-contrast computed tomography scan of brain. After Burr hole trephination, the patient's symptoms improved. After one month, the patient no longer complained of headache. In addition, pain in the left lower extremity was alleviated, reducing the need for opioid analgesics and not affecting daily life. SDH is a complication that must be considered in patients who have undergone IT-pump implantation because it can cause neurological problems. SDH is known to be caused by CSF leak. A better prognosis can be expected if the patient complains of symptoms and is identified early and appropriately treated.

Worldwide, the use of opioid analgesics is steadily increasing in non-cancer chronic pain management as well as cancer pain. Along with this trend, serious side effects such as an increase in mortality have been reported. Furthermore, more common side effects with long-term opioid therapy are tolerance, dependence, and addiction to opioids in clinical practice. Coping with withdrawal symptom is the key component in the successful treatment of opioid dependence, and buprenorphine is one of the main stay for that purpose. In this case report, we share our experience of successful treatment of opioid dependence using a buprenorphine transdermal patch in addition to appropriate pain intervention in a patient with low back pain.

Lumbar percutaneous epidural neuroplasty (L-PEN) may be an effective treatment for lumbar disc herniation (LDH) symptoms such as ongoing neuropathic pain brought on by spinal root compression and spinal canal stenosis. L-PEN is a minimally invasive therapy that involves inserting a specially made catheter right into the pathological spinal canal site in order to both manually remove soft tissue adhesions and effectively administer medication to the desired region. We use a mixture of various medication including local anesthetics for reducing the pain during L-PEN. However, unexpected intrathecal or intravascular uptake of local anesthetics can happen occasionally and this may cause adverse reactions. In this report, we would like to share our experience concerning the occurrence of systemic toxicity of local anesthetics during L-PEN.

Intrathecal drug administration system (ITDAS) is a well-known interventional method used for treatment purposes in intractable chronic pain. It is surgically inserted into a subcutaneous pocket and delivers opioid via catheter into intrathecal space. Numerous complications associated with the pump refill procedure can occur, including aberrant intrathecal pump refill. The aberrant refill of ITDAS can be extremely dangerous because the morphine is released into surrounding tissues. Here in, we report a case of complication and treatment following incorrect refill of ITDAS.

Failed back surgery syndrome (FBSS) refers to a chronic spinal pain disorder that persists or recurs even after spinal surgery. Treatment options include medication therapy, physical therapy, nerve block, and epidural endoscopic neural decompression. However, there may be cases where these treatments do not work or are not feasible. Pain scrambler therapy is a non-invasive, safe, and effective treatment for controlling chronic pain. There have been cases where pain scrambler therapy has been successfully and safely used to control pain in patients with FBSS, and we would like to report on this

Complications of herpes zoster, such as postherpetic neuralgia and postherpetic pruritus, can reduce the patient's quality of life if not controlled. To control this, oral medications and various interventions may be tried to treat post-herpetic neuralgia and pruritis. However, if these conservative treatments are not effective, postherpetic neuralgia and pruritis can progress to chronic intractable neuropathic state. Here in, we report a case that subcutaneous injection of botulinum toxin type A was effective in a patient with postherpetic neuralgia and pruritis.

Schmorl's node, defined as the herniation of an intervertebral disc through a vertebral endplate into an adjacent vertebral body, is known to be mostly asymptomatic. However, certain types of Schmorl's nodes, such as multiple Schmorl's nodes and high signal intensity on T2-weighted image on magnetic resonance imaging, may be related to severe back pain. This case report demonstrates that percutaneous vertebroplasty can be a safe and effective option for severe back pain that does not respond to conservative treatment such as medication and physical therapy and epidural nerve block due to Schmorl's node that occurred in the 10th and 11th thoracic vertebrae.

The rise in nonmedical opioid overdoses over the last two decades necessitates improved detection technologies. Manual opioid screening exams can exhibit excellent sensitivity for identifying the risk of opioid misuse but can be time-consuming. Algorithms can help doctors identify at-risk people. In the past, electronic health record (EHR)–based neural networks out- performed Drug Abuse Manual Screenings in sparse studies; however, recent data shows that it may perform as well or less than manual screenings. Herein, a discussion of several different manual screenings and recommendations is contained, along with suggestions for practice. A multi-algorithm approach using EHR yielded strong predictive values of opioid use disorder (OUD) over a large sample size. A POR (Proove Opiate Risk) algorithm provided a high sensitivity for categorizing the risk of opioid abuse within a small sample size. All established screening methods and algorithms reflected high sensitivity and positive predictive values. Neural networks based on EHR also showed significant effectiveness when corroborated with Drug Abuse Manual Screenings. This review highlights the potential of algorithms for reducing provider costs and improving the quality of care by identifying nonmedical opioid use (NMOU) and OUD. These tools can be combined with traditional clinical interviewing, and neural networks can be further refined while expanding EHR.