Wednesday, 18 April 2018

The Depressing State Of Neuropathic Pain Treatment

Today's post from (see link below) is a short but ultimately bleak look at the current state of neuropathic pain treatment in 2018. The statistics alone are enough to make you wonder why the word 'neuropathy' isn't on everyone's lips! The author's conclusion that Gabapentin seems to be the most promising treatment for nerve pain is, in itself, a little disturbing, given the current hoo-ha surrounding the side effects and potential damage Gabapentin may cause. yet this is where we are in 2018...potentially a half billion neuropathy patients across the world and no cure and no effective treatment! Isn't it about time that something was done? After all the situation has been pretty much the same for 50 years! The pharmaceutical companies are waking up to the facts but still seem paralyzed when it comes to nerve damage - don't they realise there are fortunes to be made by coming up with effective treatments? Of course they do but making that elusive breakthrough seems to be always just around the corner and never here!

Etiology and Pharmacology of Neuropathic Pain
April 9, 2018

Treatment Options for Neuropathic Pain

Pain is a common reason for people to seek medical attention. Pain is vital – it is a survival mechanism that protects us from injury. Injury to nerve tissue will cause nerve pain (or neuropathic pain) that can last for months or years after the initial injury has healed.

Many patients with peripheral neuropathy experience neuropathic pain. Its true prevalence is unknown, but it is estimated that about 100-500 million patients are living with neuropathic pain worldwide. Treatment of neuropathic pain is also challenging and available medications are not very effective.

Pharmacological Review

In a recent medical review article entitled, Etiology and Pharmacology of Neuropathic Pain, Sascha R. A. Alles and Peter A. Smith from the University of British Columbia and the University of Alberta tried to explain the medical evidence behind the generation and the maintenance of neuropathic pain and how this can help identify new treatments for neuropathic pain.

They started by taking us through the anatomical pathways of neuropathic pain, and how its generation in the periphery alters normal pain transmission circuitry within the brain and throughout the spinal cord, creating central sensitization or a persistent abnormal memory of pain. This altered pain and sensory perception is mediated by increased firing of certain sensory neurons, an abnormal neurotransmitter response, as well as an abnormal gating of certain channels like calcium and sodium channels.

In this review, Alles and Smith explain how small molecule manipulation of the channels that serve as sensory receptors, such as certain calcium, sodium and potassium channels, the activated cyclic nucleotide gated channels, the transient receptor potential type V1 channel, and/or the Adenosine A3 Receptor – all which could be new therapeutic targets. By manipulating these channels, the perception of pain could be modified.

Prescribing Gabapentinoids

Despite all this progress in our understanding of neuropathic pain, gabapentinoids (Gabapentin and Pregabalin) remain our go-to treatment even though their exact mechanism of action is poorly understood.

Understanding the molecular mechanisms of neuropathic pain also helped shed some light on the mechanisms of action of Gabapentin. Gabapentin binds to a special sub-unit of the calcium channel, producing specific and nonspecific effects in the spinal cord and the brain. This impacts the perception of pain and could be further enhanced by future therapeutics. New therapies that can affect multiple targets simultaneously like Gabapentin seem to have the highest promise.

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