Abstract

The purpose of this work is to elucidate the principles of treatment of chronic pain syndromes that are considered resistant to conventional treatment, such as pain caused by nerve injury and by advanced cancer. There is a particular emphasis on pain caused by peripheral neuropathies. Such as syndrome occurs in about 5% of patients with AIDS. We focus on pain in patients with painful neuropathy and post-herpetic neuralgia. A study showing amitriptyline to relieve diabetic neuropathy pain in both depressed and non-depressed patients was completed. Thirty-eight of a projected 40 patients with postherpetic neuralgia have completed a crossover study of amitriptyline, lorazepam, and placebo. An interim analysis at n=29 showed a trend towards relief with amitriptyline. Two further studies examining the mechanism of relief of neuropathic pain by antidepressants will begin soon. Amitriptyline potentiates the action of both serotonin and norepinephrine at central synapses. We will examine fluoxetine which is specific for serotonin, and desipramine, which is relatively specific for norepinephrine. We will also collaborate with CC Anesthesiology and NHLBI in a study of catecholamine kinetics in the vascular system of patients with reflex sympathetic dystrophy, to see how alterations in catecholamine release affect their pain.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Intramural Research (Z01)
Project #
1Z01DE000366-04
Application #
3963727
Study Section
Project Start
Project End
Budget Start
Budget End
Support Year
4
Fiscal Year
1986
Total Cost
Indirect Cost

  Institution

Name
Dental & Craniofacial Research
Department
Type
DUNS #
City
State
Country
United States
Zip Code

  Publications

Slade, Gary D; Diatchenko, Luda; Ohrbach, Richard et al. (2008) Orthodontic Treatment, Genetic Factors and Risk of Temporomandibular Disorder. Semin Orthod 14:146-156
Lotsch, Jorn; Belfer, Inna; Kirchhof, Anja et al. (2007) Reliable screening for a pain-protective haplotype in the GTP cyclohydrolase 1 gene (GCH1) through the use of 3 or fewer single nucleotide polymorphisms. Clin Chem 53:1010-5
Khoromi, Suzan; Blackman, Marc R; Kingman, Albert et al. (2007) Low intensity permanent magnets in the treatment of chronic lumbar radicular pain. J Pain Symptom Manage 34:434-45
Belfer, I; Hipp, H; Bollettino, A et al. (2007) Alcoholism is associated with GALR3 but not two other galanin receptor genes. Genes Brain Behav 6:473-81
Khoromi, Suzan; Cui, Lihong; Nackers, Lisa et al. (2007) Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain. Pain 130:66-75
Edwards, Robert R; Klick, Brendan; Buenaver, Luis et al. (2007) Symptoms of distress as prospective predictors of pain-related sciatica treatment outcomes. Pain 130:47-55
Diatchenko, Luda; Anderson, Amy D; Slade, Gary D et al. (2006) Three major haplotypes of the beta2 adrenergic receptor define psychological profile, blood pressure, and the risk for development of a common musculoskeletal pain disorder. Am J Med Genet B Neuropsychiatr Genet 141B:449-62
Diatchenko, Luda; Nackley, Andrea G; Slade, Gary D et al. (2006) Catechol-O-methyltransferase gene polymorphisms are associated with multiple pain-evoking stimuli. Pain 125:216-24
Farrar, John T; Dworkin, Robert H; Max, Mitchell B (2006) Use of the cumulative proportion of responders analysis graph to present pain data over a range of cut-off points: making clinical trial data more understandable. J Pain Symptom Manage 31:369-77
Max, Mitchell B; Wu, Tianxia; Atlas, Steven J et al. (2006) A clinical genetic method to identify mechanisms by which pain causes depression and anxiety. Mol Pain 2:14

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