Have you got pain? This post may help. #ClinicSpeak #MSBlog #MSResearch
"Please note that often powerful opiod drugs are prescribed for central pain syndromes, these rarely help myelopathic pain and can paradoxically make it worse. Similarly, non-steroidal anti-inflammatory drugs rarely work in central pain syndromes, but many patients find them helpful. I suspect a response to an NSAID indicates a peripheral musculoskeletal contribution to the pain."
"If the pain does not respond to pharmacological manipulation, it may be worthwhile being referred into the pain service to try add-on alternative non-medical therapies for pain, for example acupuncture, TENS (transcutaneous nerve stimulation), central nerve stimulators, CBT (cognitive behavioural therapy) and other biofeedback techniques."
"If you have pain and it is there all the time you need to be treated. Pain often starts a vicious cycle whereby it lowers mood and may contribute to the development of depression, depression lowers your central pain threshold that makes the pain worse. Therefore chronic pain and depression often coexist and need to be treated together. This is why anti-depressants, and CBT, are commonly used as part of a cocktail to manage MS-related pain."
"Please feel free to share your experiences of your pain management and to ask questions."
Onouchi et al An open-label, long-term study examining the safety and tolerability of pregabalin in patients with central neuropathic pain. J Pain Res. 2014 Jul 28;7:439-447. eCollection 2014.
PURPOSE: Studies of pregabalin for the treatment of central neuropathic pain have been limited to double-blind trials of 4-17 weeks in duration. The purpose of this study was to assess the long-term safety and tolerability of pregabalin in patients with central neuropathic pain. The efficacy of pregabalin was also assessed as a secondary measure.
PATIENTS AND METHODS: This was a 53-week, multicenter, open-label trial of pregabalin (150-600 mg/day) in patients with central neuropathic pain due to spinal cord injury, multiple sclerosis, or cerebral stroke.
RESULTS: A total of 103 patients received pregabalin (post-stroke =60; spinal cord injury =38; and multiple sclerosis =5). A majority of patients (87.4%) experienced one or more treatment-related adverse events, most commonly somnolence, weight gain, dizziness, or peripheral oedema. The adverse event profile was similar to that seen in other indications of pregabalin. Most treatment-related adverse events were mild (89.1%) or moderate (9.2%) in intensity. Pregabalin treatment improved total score, sensory pain, affective pain, visual analog scale (VAS), and present pain intensity scores on the Short-Form McGill Pain Questionnaire (SF-MPQ) and ten-item modified Brief Pain Inventory (mBPI-10) total score at endpoint compared with baseline. Improvements in SF-MPQ VAS and mBPI-10 total scores were evident in all patient subpopulations. Mean changes from baseline in SF-MPQ VAS and mBPI-10 scores at endpoint were -20.1 and -1.4, respectively.
CONCLUSION: These findings demonstrate that pregabalin is generally well tolerated and provides sustained efficacy over a 53-week treatment period in patients with chronic central neuropathic pain.