Intravenous Nefopam Reduces Postherpetic Neuralgia during the Titration of Oral Medications
1
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background: The recently known analgesic action mechanisms of nefopam (NFP) are similar to those of anticonvulsants and antidepressants in neuropathic pain treatment. It is difficult to prescribe high doses of oral neuropathic drugs without titration due to adverse effects. Unfortunately, there are few available intravenous analgesics for the immediate management of acute flare-ups of the chronic neuropathic pain. The aim of this study was to determine the additional analgesic effects for neuropathic pain of NFP and its adverse effects during the titration of oral medications for neuropathic pain among inpatients with postherpetic neuralgia (PHN). Methods: Eighty inpatients with PHN were randomly divided into either the NFP or normal saline (NS) groups. Each patient received a 3-day intravenous continuous infusion of either NFP with a consecutive dose reduction of 60, 40, and 20 mg/d, or NS simultaneously while dose titrations of oral medications for neuropathic pain gradually increased every 3 days. The efficacy of additional NFP was evaluated by using the neuropathic pain symptom inventory (NPSI) score for 12 days. Adverse effects were also recorded. Results: The median NPSI score was significantly lower in the NFP group from days 1 to 6 of hospitalization. The representative alleviating symptoms of pain after using NFP were both spontaneous and evoked neuropathic pain. Reported common adverse effects were nausea, dizziness, and somnolence, in order of frequency. Conclusions: An intravenous continuous infusion of NFP reduces spontaneous and evoked neuropathic pain with tolerable adverse effects during the titration of oral medications in inpatients with PHN.
Abstract
Background: The recently known analgesic action mechanisms of nefopam (NFP) are similar to those of anticonvulsants and antidepressants in neuropathic pain treatment. It is difficult to prescribe high doses of oral neuropathic drugs without titration due to adverse effects. Unfortunately, there are few available intravenous analgesics for the immediate management of acute flare-ups of the chronic neuropathic pain. The aim of this study was to determine the additional analgesic effects for neuropathic pain of NFP and its adverse effects during the titration of oral medications for neuropathic pain among inpatients with postherpetic neuralgia (PHN). Methods: Eighty inpatients with PHN were randomly divided into either the NFP or normal saline (NS) groups. Each patient received a 3-day intravenous continuous infusion of either NFP with a consecutive dose reduction of 60, 40, and 20 mg/d, or NS simultaneously while dose titrations of oral medications for neuropathic pain gradually increased every 3 days. The efficacy of additional NFP was evaluated by using the neuropathic pain symptom inventory (NPSI) score for 12 days. Adverse effects were also recorded. Results: The median NPSI score was significantly lower in the NFP group from days 1 to 6 of hospitalization. The representative alleviating symptoms of pain after using NFP were both spontaneous and evoked neuropathic pain. Reported common adverse effects were nausea, dizziness, and somnolence, in order of frequency. Conclusions: An intravenous continuous infusion of NFP reduces spontaneous and evoked neuropathic pain with tolerable adverse effects during the titration of oral medications in inpatients with PHN.
참고문헌 (19)
- Turk DC, "Bonica's management of pain", pp.16~ (2010), Lippincott Williams & Wilkins
- Heel RC, "Nefopam : a review of its pharmacological properties and therapeutic efficacy", Drugs, 19, pp.249~267 (1980)
- Novelli A, "Nefopam inhibits calcium influx, cGMP formation, and NMDA receptor-dependent neurotoxicity following activation of voltage sensitive calcium channels", Amino Acids, 28, pp.183~191 (2005)
- Verleye M, "Nefopam blocks voltage-sensitive sodium channels and modulates glutamatergic transmission in rodents", Brain Res, 1013, pp.249~255 (2004)
- Biella GE, "Neuronal sensitization and its behavioral correlates in a rat model of neuropathy are prevented by a cyclic analog of orphenadrine", J Neurotrauma, 20, pp.593~601 (2003)
- Novelli A, "Nefopam is more potent than carbamazepine for neuroprotection against veratridine in vitro and has anticonvulsant properties against both electrical and chemical stimulation", Amino Acids, 32, pp.323~332 (2007)
- Czuczwar M, "Nefopam enhances the protective activity of antiepileptics against maximal electroshock-induced convulsions in mice", Pharmacol Rep, 63, pp.690~696 (2011)
- Löscher W, "New Horizons in the development of antiepileptic drugs: Innovative strategies", Epilepsy Res, 69, pp.183~272 (2006)
- Marazziti D, "Analgesia by nefopam: does it act through serotonin?", Drugs Exp Clin Res, 17, pp.259~261 (1991)
- Evans MS, "Nefopam for the prevention of postoperative pain : quantitative systematic review", Br J Anaesth, 101, pp.610~617 (2008)
- Sunshine A, "Nefopam and morphine in man", Clin Pharmacol Ther, 18, pp.530~534 (1975)
- Taniguchi Y, "The effects of nefopam on the gain and maximum intensity of shivering in healthy volunteers", Anesth Analg, 111, pp.409~414 (2010)
- Alfonsi P, "Nefopam and alfentanil additively reduce the shivering threshold in humans whereas nefopam and clonidine do not", Anesthesiology, 111, pp.102~109 (2009)
- Bouhassira D, "Development and validation of the Neuropathic Pain Symptom Inventory", Pain, 108, pp.248~257 (2004)
- Thakur R, "Herpes zoster and postherpetic neuralgia. In: Bonica's management of pain", pp.338~357 (2010), Lippincott Williams & Wilkins
- Magrinelli F, "Neuropathic pain : diagnosis and treatment", Pract Neurol, 13, pp.292~307 (2013)
- Attal N, "Neuropathic pain: mechanisms, therapeutic approach, and interpretation of clinical trials", Continuum (Minneap Minn), 18, pp.161~175 (2012)
- Costigan M, "Pain: molecular mechanisms", J Pain, 1(3 Suppl), pp.35~44 (2000)
- Durrieu G, "Overview of adverse reactions to nefopam: an analysis of the French pharmacovigilance database", Fundam Clin Pharmacol, 21, pp.555~558 (2007)