Analgesic

Summary

An analgesic drug, also called simply an analgesic, pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in some instances eliminate, sensation, although analgesia and anesthesia are neurophysiologically overlapping and thus various drugs have both analgesic and anesthetic effects. Analgesic choice is also determined by the type of pain: For neuropathic pain, traditional analgesics are less effective, and there is often benefit from classes of drugs that are not normally considered analgesics, such as tricyclic antidepressants and anticonvulsants. Various analgesics, such as many NSAIDs, are available over the counter in most countries, whereas various others are prescription drugs owing to the substantial risks and high chances of overdose, misuse, and addiction in the absence of medical supervision. Etymolo

Official source

https://en.wikipedia.org/wiki/Analgesic

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Our brain constantly receives and integrates a flow of multisensory bodily inputs that are responsible for the way our body is represented and consciously experienced. However, in some pathological conditions, patients might experience altered perceptions of their body or suffer from abnormal bodily sensations such as chronic pain. Recent studies in cognitive neuroscience demonstrate that it is possible to modulate bodily self-consciousness and related bodily experiences by experimentally manipulating multisensory bodily inputs. Using such approaches, this work aims to investigate abnormal body experiences and to develop new therapeutic solutions for patients suffering from distorted body representation and chronic pain. First, we manipulated visuo-tactile information to investigate alterations of bodily self-consciousness in spinal cord injured patients and demonstrated the potential analgesic effects of such multisensory stimulation (Study 1). Then, we combined neuro-tactile stimulation with visual stimulation via virtual reality in amputees to induce embodiment for their prosthetic hands, and to improve abnormal phantom limb perceptions (Study 2). We then used a similar approach in patients with chronic leg pain and combined spinal cord stimulation with visual stimulation via virtual reality to in-crease analgesia induced by neuromodulation (Study 3). In another series of studies, we investigated the role of inter-oceptive signals in chronic pain. First, we demonstrated that patients suffering from complex regional pain syndrome (CRPS) had reduced abilities in perceiving and processing their heartbeat (Study 4). Then, we manipulated interocep-tive information with visual stimulation via virtual reality to reduced CRPS symptoms (Study 5). Collectively, these five studies demonstrate the possibility to use the latest research on the neuroscience of embodi-ment and virtual technology to study disorders of body representation. Furthermore we aim to develop new cognitive neuroprosthetic approaches including restoring normal body perception, inducing embodiment for a prosthetic limb, and alleviating chronic pain.

EPFL2019

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)

Friedhelm Christoph Hummel, Simone Rossi

A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.

2014

Intrathecal implants of adrenal chromaffin cells are known to release analgesic substances such as catecholamines and opioid peptides. In the present study, bovine chromaffin cells were encapsulated in a permselective polymer membrane which protects the cells from the host immune system and allows grafting of xenogeneic cells without immunosuppression. The effects of such implants were evaluated on the pain behavior resulting from a chronic constrictive injury (CCI) of the rat sciatic nerve. Sprague-Dawley rats with a unilateral lesion were implanted in the lumbar subarachnoid space and tested for mechanical/thermal allodynia and hyperalgesia. A significant reduction in pain was observed after mechanical non-nociceptive stimulation in animals implanted with chromaffin cells. Furthermore, these animals showed decreased signs of spontaneous pain. However, response to thermal non-noxious stimuli or to painful mechanical stimuli was not significantly decreased. Abundant clusters of viable chromaffin cells intensely labeled with the anti-tyrosine hydroxylase antibodies were observed in the retrieved implants. These results establish the analgesic efficacy of intrathecal encapsulated chromaffin cells in a chronic pain model of nerve injury. Immunoprotected allo- or xenogeneic chromaffin cells acting as 'mini pumps' continuously delivering neuroactive substances could be a useful therapy for patients suffering from neuropathic pain.

1998

EPFL2019