Innovations In Clinical Neuroscience

Pain Management August 2016

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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long-term follow-up. The authors discovered that delivering ketamine both as a pre- or perioperative bolus and p ostoperative infusion for up to 48 hours appears to be the most effective method of administration; however, they found a number of studies that showed no benefit in using ketamine versus placebo for controlling postoperative pain. The authors concluded that ketamine may be efficacious in controlling postoperative pain and decreasing opioid usage in limited situations; however, randomized controlled trials are needed to determine the surgical procedures and administrations for which ketamine is best suited. * PMID: 26495312 [Safety and efficacy of ketamine for pain relief]. Niesters M, Dahan A, van Kleef M. Ned Tijdschr Geneeskd. 2016;160:D58. Summary: Here, the authors review the efficacy and safety profile of ketamine for relief of chronic pain. The authors found only a few studies showing intravenous ketamine to have analgesic effects that persisted beyond the infusion period. The authors review several safety concerns of ketamine and suggest that large randomized trials in which ketamine is compared to an "active" placebo must be conducted before any significant conclusions can be drawn regarding the efficacy of ketamine for treatment of chronic pain. * PMID: 27189097 ENDOCANNABINOID SYSTEM Endocannabinoid system: role in depression, reward and pain c ontrol. Huang WJ, Chen WW, Zhang X. Mol Med Rep. 2016 Aug 1. doi: 10.3892/mmr.2016.5585. [Epub ahead of print] Summary: In this review article, the authors explore the literature regarding the effects endocannabinoids may have on pain and depression. The authors discuss the evidence that suggests the endocannabinoid system is involved in eliciting potent effects on neurotransmission, neuroendocrine, and inflammatory processes, which are all affected in depression and chronic pain. The authors review several cannabinomimetic drugs that are being developed to treat pain and depression, and discuss theories regarding mechanisms of action endocannabinoids may have on different targets in the body and whether their effects on pain and depression follow the same or different pathways. * PMID: 27484193 The endocannabinoid system and neuropathic pain. Maldonado R1, Baños JE, Cabañero D. Pain. 2016 Feb;157 Suppl 1:S23-32. Summary: Here the authors review and discuss the available literature regarding the endocannabinoid system's role in neuropathic pain control. The authors describe the preclinical studies that have reported the analgesic effects of cannabinoid agonists in multiple neuropathic pain models and have identified specific targets within this system to develop more effective and safe analgesic c ompounds. The authors then review several of the clinical studies that have suggested that cannabinoids significantly reduce neuropathic pain and discuss how most of these trials fail the required standards of quality. Challenges in conducting systematic reviews of the literature on the endocannabinoid system's role in pain management are discussed as a limitation of the review. * PMID: 26785153 The role of the brain's endocannabinoid system in pain and its modulation by stress. Corcoran L, Roche M, Finn DP. Int Rev Neurobiol. 2015;125:203-55. doi: 10.1016/bs.irn.2015.10.003. Epub 2015 Nov 6. Summary: In this review article, the authors explore the specific role of the endocannabinoid system in the brain in pain and the modulation of pain by stress. The authors provide an overview of the endocannabinoid system and review of the evidence supporting endocannabinoid system's active role in modulating pain. The authors specifically discuss the role of the endocannabinoid system supraspinally, and particularly in the rostral ventromedial medulla, periaqueductal gray, amygdala, and prefrontal cortex, in pain, stress- induced analgesia, and stress- induced hyperalgesia. * PMID: 26638768 JOURNAL WATCH 26 Hot Topics in Pain Management [August 2016]

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