Evaluation of composite responder outcomes of pain intensity and physical function in neuropathic pain clinical trials: an ACTTION individual patient data analysis

Integrating information on physical function and pain intensity into a composite measure may provide a useful method for assessing treatment efficacy in clinical trials of chronic pain. Accordingly, we evaluated composite outcomes in trials of duloxetine, gabapentin, and pregabalin. Data on 2287 patients in 9 trials for painful diabetic peripheral neuropathy (DPN) and 1513 patients in 6 trials for postherpetic neuralgia (PHN) were analyzed. All trials assessed pain intensity on a 0 to 10 numeric rating scale and physical function with the 10-item subscale of the Short Form-36, ranging 0 to 100 with higher scores indicating better function. Correlation between change in pain intensity from baseline to posttreatment and change in physical function was small in DPN (ρ = −0.22; P
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research

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ConclusionOur findings indicate a nonlinear relationship between Burst ‐DRGS amplitude and behavioral outcome, with an estimated optimal amplitude of 52% MT. Further optimization and analysis of DRGS driven by insights into the underlying mechanisms related to the various stimulation paradigms is warranted.
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Basic Research Source Type: research
AbstractPainful diabetic peripheral neuropathy (PDPN) is a chronic pain condition with modest response to pharmacotherapy. Participation in mindfulness-based stress reduction (MBSR) leads to improvements in pain-related outcomes but the mechanisms of change are unknown. The present study examined the mediators and moderators of change in 62 patients with PDPN who participated in a randomized controlled trial comparing MBSR to waitlist. Changes in mindfulness and pain catastrophizing were tested simultaneously as mediators. Increased mindfulness mediated the association between participation in MBSR and improved pain severi...
Source: Journal of Behavioral Medicine - Category: Psychiatry Source Type: research
Conclusion: The findings demonstrate that QoL is impaired in painful PN and should not be neglected in clinical practice. Patients' pain management and subsequent impact on QoL should routinely be assessed and monitored. PMID: 31249636 [PubMed - in process]
Source: Pain Research and Management - Category: Anesthesiology Authors: Tags: Pain Res Manag Source Type: research
I was in suburban Chicago recently one morning, hoping to get something to eat for breakfast. I’d heard that the Panera chain was now serving breakfast that you could order any way you wanted. It’s called “Panera Bread,” but I thought I’d give it a try, as I’ve safely consumed their salads in past. At the counter, I placed my order for 3 eggs over easy, sausage, and bacon—not perfect, given our inability to scrutinize foods and ingredients in such places, but I was willing to try. Obviously, I turned down the breads/toasts that were included. The middle-aged Hispanic woman behind t...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly diabetes grain-free grains Inflammation sugar undoctored Source Type: blogs
This study not only provides biological evidence to support the use of duloxetine as the first standard CIPN drug but will also lead to potential new targets for CIPN drug development. Introduction A major dose-limiting complication of chemotherapy is chemotherapy-induced peripheral neuropathy (CIPN). The greatest contributors to CIPN are taxanes (e.g., paclitaxel) and platinum-based (e.g., oxaliplatin) treatments (Krukowski et al., 2015). Paclitaxel (PTX) can effectively treat several of the most common cancers including breast cancer, lung cancer, and ovarian cancer (Ewertz et al., 2015; Cetinkaya-Fisgin et al., ...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
A 58-year-old man with type 1 diabetes mellitus (hemoglobin A1c level, 6.5% [reference range, 4.0%-5.6%]) complicated by diabetic nephropathy (chronic kidney disease stage 3A), retinopathy, and severe peripheral neuropathy presented to his local urgent care center with a 24-hour history of right dorsal midfoot erythema and mild pain. Two weeks previously, the patient sustained a right foot injury after falling out of bed. The patient had not experienced fevers, chills, night sweats, nausea, vomiting, or malaise but reported somewhat labile blood sugar levels that day with an afternoon glucose measurement of 170 mg/dL (refe...
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Residents ’ clinic Source Type: research
ConclusionsThis is the first study to highlight the characteristic features of Stage 0 ACN in Indian Type 2 Diabetes patients. Thorough clinical evaluation, infrared thermometry and radiological findigs on MRI foot leads to early disease detection. Complete offloading, preferably with total contact casts can prevent disease progression and chronic deformities.
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research
Conclusion: These exploratory findings indicate that patients with NeP across different etiologies are medically complex and experience impaired function across multiple domains. PMID: 30662281 [PubMed]
Source: Pain Physician - Category: Anesthesiology Authors: Tags: J Pain Res Source Type: research
Conclusion: Evaluation of chronic pain patients in Brazil yielded a 14.5% probable NeP prevalence. NSAIDs and opioids were commonly used, and there was a high incidence of NeP-related symptoms with varying levels of dysfunction across subtypes. PMID: 30662280 [PubMed]
Source: Pain Physician - Category: Anesthesiology Authors: Tags: J Pain Res Source Type: research
ConclusionThis small multicenter retrospective case series provides preliminary evidence that the painful symptoms of general peripheral neuropathy in the lower extremities, as well as associated pain medication usage, can be effectively managed by DRG stimulation at the L4 ‐S1 spinal level. Importantly, this treatment appears efficacious for peripheral neuropathy.
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Case Series Source Type: research
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