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4 results

  • Chapter 30 - Use of Botulinum Neurotoxin in Neuropathic Pain

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 245-251

  • Summary

    Neuropathic pain refers to pain caused by a lesion or disease of the somatosensory nervous system. Diabetic neuropathy, postherpetic neuralgia, radiculopathy pain, trigeminal neuralgia and complex regional pain syndrome are all neuropathic pain syndromes.

    Local administration of botulinum neurotoxin (BoNT)) has proven significant effects on the treatment of neuropathic pain. Abnormal muscle contractions contribute to chronic pain. Botulinum neurotoxin serotype A (BoNT-A) is well known to have an effect on inhibition of muscle contraction and this may partially explain its effect on chronic pain. In preclinical models, BoNT-A was found to effectively block the release of several pain-related neurotransmitters, including norepinephrine, substance P, glutamate and calcitonin gene-related peptide, from afferent nerve terminals and dorsal root ganglia. These pain-related neurotransmitters can stimulate depolarization of C fibers, which are responsible for propagation of chronic pain. BoNT-A also decreases local inflammation around the nerve terminal.

    This chapter offers clinical description and pictorial illustration for injection of BoNT for the particular conditions of diabetic neuropathy, postherpetic neuralgia and trigeminal neuralgia.

  • 24 - Amyotrophic Lateral Sclerosis

  • from Section 6
  • Edited by Bernard Ravina, Jeffrey Cummings, Michael McDermott, R. Michael Poole
  • Book:
    Clinical Trials in Neurology
    Published online:
    05 May 2012
    Print publication:
    12 April 2012, pp 273-283

  • Summary

    Enrichment designs are being increasingly used in fields such as chronic pain research because they may better reflect routine clinical practice than other study designs. Researchers use a variety of methods to perform the first stage of an enrichment design trial. This chapter examines the varied strategies involved in developing a trial using an enrichment design, the advantages and disadvantages of this method and considers the issues when planning a study using enrichment strategies. Issues related to washout periods were considered in the trial using the enrichment design to examine the use of gabapentin for treatment of postherpetic neuralgia (PHN). The distinction between enrichment by response and enrichment by expected mechanism of action is significant. An enrichment design is well suited to examine treatments with small effect sizes in a general population with increased efficiency, particularly those treatments with a greater expected effect in a particular subpopulation of subjects.

  • Nutrient deficiencies as a risk factor in Taiwanese patients with postherpetic neuralgia

  • Jen-Yin Chen, Chin-Chen Chu, Yung-Song Lin, Edmund Cheng So, Ja-Ping Shieh, Miao-Lin Hu
  • Journal:
    British Journal of Nutrition / Volume 106 / Issue 5 / 14 September 2011
    Published online by Cambridge University Press:
    08 April 2011, pp. 700-707
    Print publication:
    14 September 2011
    • Article
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  • Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The aim of the present study was to compare the nutritional status of PHN patients with that of healthy controls, and then to identify risk factors for PHN using multivariate multiple logistic regressions. In the present cross-sectional study, we prospectively enrolled fifty PHN patients for at least 3 months and fifty healthy controls. We selected nine circulating nutrients including ionised Ca, Zn, retinol, folic acid, vitamin B12, vitamin C, α-tocopherol, γ-tocopherol and lycopene associated with both immunity and the modulation of neuropathic pain, and measured their concentrations in plasma/serum. Concentrations of ionised Ca, Zn, vitamin C and vitamin B12 were significantly lower in PHN patients than in controls after excluding those patients receiving supplements since the outbreak of HZ. The prevalence of either mild/marginal or severe deficiencies for any of the nine selected circulating nutrients in PHN patients (92 %) was much higher than that in controls (46 %) (P < 0·001). Lower concentrations of vitamin C ( ≤ 45·0 μmol/l), ionised Ca ( ≤ 1·05 mmol/l) and Zn ( ≤ 0·91 g/l) were found to increase independently the risk of PHN using binary variable (dichotomy) analyses with both PHN patients and controls in a multivariate logistic regression analysis. No significant correlations existed between the risks of PHN and the concentrations of retinol, folic acid, vitamin B12, lycopene or α:γ-tocopherol ratios. Thus, lower concentrations of circulating nutrients, namely vitamin C, ionised Ca or Zn, are probably a risk factor in Taiwanese patients with PHN.