Treatment Modalities for Neuropathic Pain and Spasticity From the CAPM and R Annual Meeting: A Canadian Thought-Leader Perspective From John Bowering, MD

June 15-18, 2005; Ottawa, Ontario, Canada

John B. Bowering, MD

Disclosures

July 27, 2005

In This Article

Introduction

Editor's Note:
The Canadian Association of Physical Medicine & Rehabilitation (CAPM&R) Annual Meeting was held in Ottawa, Ontario, Canada, from June 15 to 18, 2005. In this article, John B. Bowering, MD, discusses studies presented on quality-of-life issues as well as newer treatment modalities for neuropathic pain and spasticity associated with multiple sclerosis and other common neurodegenerative diseases. Christine A. Short, MD, BSc, also provides her insight into neuropathic pain and spasticity, as well as treatment options, in a recent interview with Medscape.

The Canadian Association of Physical Medicine & Rehabilitation (CAPM&R) Annual Meeting was held recently in Ottawa, Ontario. A variety of studies were presented that focused on quality-of-life issues as well as newer treatment modalities for neuropathic pain and spasticity associated with several common neurodegenerative diseases.

Neuropathic pain results from a primary lesion or dysfunction in the nervous system, which can result from both central and peripheral mechanisms. These mechanisms are not completely understood and can generate a variety of symptoms, including dysesthesia, hyperalgesia, and allodynia, as well as symptoms of autonomic dysfunction presenting in the form of vasomotor and sudomotor changes.

Neuropathic pain can be associated with a number of disease states, including multiple sclerosis, postherpetic and trigeminal neuralgia, diabetes, stroke, and spinal cord injury (SCI). There are also a variety of associated postsurgical neuropathic pain syndromes, including postthoracotomy pain, phantom limb pain following amputation, postmastectomy, postaxillary lymph node dissection, and pain following radical neck dissection.[1]

Optimal management of neuropathic pain continues to present a major challenge to clinicians. It requires an interdisciplinary approach with collaboration between psychologists, physical and occupational therapists, and physicians with a special interest in pain medicine.[2] A variety of pharmacologic agents have been used to assist with management, including antidepressants, anticonvulsants, opioids, topical agents, local anesthetics, alpha-2 agonists, NMDA antagonists, and corticosteroids.[1] In addition, neuraxial catheters, as well as spinal cord and/or deep brain stimulation, have been employed.

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