Multiple sclerosis-induced neuropathic pain

Description

Neuropathic pain (NPP) is a chronic syndrome suffered by patients with multiple sclerosis (MS), for which there is no cure. Underlying cellular mechanisms involved in its pathogenesis are multifaceted, resulting in significant challenges in its management. In addition to its complex pathophysiology, the clinical management of MS-induced NPP is further complicated by the lack of clinical therapeutics trials specific to this population. The primary aim of the work underlying this thesis was to contribute to the evidence-based management of individuals with MS-induced NPP through the completion of two clinical therapeutics trials in this population. A secondary aim was to describe pain variability in this patient population through the development and validation of a pain variability algorithm tool. Resulting from this work, we demonstrated that nabilone – a synthetic oral cannabinoid – represents an effective, well-tolerated and novel treatment for MS-induced NPP. Additionally, we show that the SSRI paroxetine was poorly tolerated in our patient population, with a correspondingly high attrition rate. As a result, we were unable to determine any treatment effect in this trial due to insufficient recruitment due to drop-out. Lastly, we were able to define and describe pain instability in this cohort, noting that approximately 30% of individuals with MS-induced NPP experiencing highly variable daily pain. The results of these projects provide novel information for this patient population. Patients currently living with the daily burden of MS-induced NPP would benefit from additional trials ensuing from this, and other, research in order to initiate a momentum for much-needed clinical research in this complicated patient cohort.

Links & Downloads

1. amaka M, Turcotte D, Leong C, Grossberndt A, et al. (2008). Multiple sclerosis: etiology and treatment strategies. Consultant Pharmacist 23(11):886-96.
2. Namaka, M.P., Gramlich, C., Ruhlen, D., Major, J., Sutton, I., Melanson, M. A treatment algorithm for neuropathic pain. Clin Ther. 2004; 26(7): 951-979
3. Namaka, M.P., Leong, C., Grossberndt, A., Klowak, M., Turcotte, D., Esfahani, F., Gomori, A., Intrater, H. Clinical Review: A treatment algorithm for neuropathic pain: An update. The Consultant Pharmacist., 2009; 24(12):885-902
4. Turcotte, D., Le Dorze, J.A., Esfahani, F., Frost, E., Gomori, A., Namaka, M. Examining the roles of cannabinoids in pain and other therapeutic indications: a review. Expert Opin Pharmacother., 2010 Jan; 11(1):17-31
5. http://hdl.handle.net/1993/23316

Tags

Multiple Sclerosis

Neuropathic Pain

cannabinoids

nabilone

paroxetine

pregabalin

clinical trial

Additional Fields

Identifer	oai:union.ndltd.org:MANITOBA/oai:mspace.lib.umanitoba.ca:1993/23316
Date	January 2010
Creators	Turcotte, Dana
Contributors	Namaka, Mike (Pharmacy), Vercaigne, Lavern (Pharmacy) Ariano, Rob (Pharmacology and Therapeutics) Doupe, Malcolm (Community Health Sciences) Antel, Jack (McGill University)
Publisher	The Consultant Pharmacist, Clinical Therapeutics, The Consultant Pharmacist, Expert Opinion in Pharmacotherapy
Source Sets	University of Manitoba Canada
Detected Language	English