How is nerve growth factor related to pain, and what evidence exists for its efficacy and safety? Nerve growth factor (NGF) is a neuropeptide primarily involved in the regulation of growth, maintenance, proliferation, and survival of certain target neurons. It is important in early human development and becomes less important as we age. NGF is …
What are some of the emerging novel analgesics in the pipeline for chronic pain? There are a number of pharmacological agents with novel mechanisms in both preclinical and clinical development. These agents target mechanisms that modulate pain at various levels of the nervous system. Here is the table which lists the most promising emerging analgesics. Emerging …
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How does the pharmacokinetics of the sufentanil sublingual tablet system differ from intravenous morphine? The effector site of action for all opioids is in the CNS, requiring penetration and pharmacokinetics (PK) that match the needs of the patient. Most of the commonly used opioids have inconsistent CNS penetration due to differences in PK or mismatched …
What are the advantages of liposomal bupivacaine over regular bupivacaine? The duration of action of bupivacaine is approximately 4 to 6 hours. Pain from surgery lasts well beyond the duration of bupivacaine, making it ineffective for most postoperative pain patients. The solution for this deficiency is to provide continuous infusion via a catheter; however, peripheral …
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Is intravenous acetaminophen any better than oral delivery? The effector site of action for acetaminophen is mainly located in the central nervous system (CNS); therefore, rapid and consistent penetration into the CNS should improve analgesia. Up until 2001, only oral and rectal delivery of acetaminophen was available. Since 2001, an intravenous (IV) preparation has been …
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What new and emerging therapies exist to treat acute postoperative pain? Opioids continue to be the standard for treating moderate to severe postoperative pain. However, with the current emphasis on multimodal and nonopioid therapies, there has been a recent emergence of new nonopioid therapies, including intravenous acetaminophen and liposomal encapsulated bupivacaine. In addition, a sublingual …
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What are stellate ganglion blocks? Stellate ganglion blocks are performed for patients who present with complaints of sympathetic mediated pain; refractory angina pain to the limb; or head, neck, and upper limb postherpetic neuralgia. This injection is approached at the level of the C6, and sometimes C7, vertebrae. There may be a slightly higher risk …