Efficacy of intrathecal midazolam with or without epidural methylprednisolone for management of post-herpetic neuralgia involving lumbosacral dermatomes
Post herpetic neuralgia is a chronic neuropathic pain syndrome which remains one of the most difficult pain disorders to treat. Epidural injection of methylprednisolone with or without local anesthetic provides relief for neuralgia for a short duration only. Recent studies have shown a promising ant...
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| Veröffentlicht in: | Pain physician 2010-05, Vol.13 (3), p.213-221 |
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| description | Post herpetic neuralgia is a chronic neuropathic pain syndrome which remains one of the most difficult pain disorders to treat. Epidural injection of methylprednisolone with or without local anesthetic provides relief for neuralgia for a short duration only. Recent studies have shown a promising anti nociceptive effect for intrathecal midazolam, a water soluble benzodiazepine, due to its interaction with benzodiazepine-GABA-A receptor complex within the spinal cord.
A randomized, double blind study was conducted at 2 different centers in India.
Two different interventional pain practice centers in India.
To quantify the effectiveness of a single intrathecal injection of midazolam 2 mg with and without epidural methylprednisolone 60 mg for management of pain and allodynia in 150 adult patients with postherpetic neuralgia of 3-6 months duration involving lumbosacral dermatomes.
Patients in Group M-0 (n=50) received epidural methylprednisolone (60 mg), patients in group M-1 (n=50) received midazolam 2 mg in the intrathecal space while patients in Group M-2 (n=50) received methylprednisolone (60 mg) in the epidural space plus midazolam 2 mg in the intrathecal space.
The administration of intrathecal midazolam (2 mg) provided short term improvement in post herpetic neuralgia similar to epidural methylprednisolone. However, the combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia. The need for analgesics was also significantly less in patients who received the combination compared to those who received either intrathecal midazolam or epidural methylprednisolone. No serious adverse effect was reported with the use of intrathecal midazolam except a mild degree of sedation.
The combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia of lumbosacral dermatomes due to the complementary anti nociceptive action of intrathecal midazolam with epidural methylprednisolone on spinal nerve roots.
The dose-response relationship of intrathecal midazolam was not evaluated in our study, so further study should be conducted with different doses of intrathecal midazolam for management of PHN. |
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A randomized, double blind study was conducted at 2 different centers in India.
Two different interventional pain practice centers in India.
To quantify the effectiveness of a single intrathecal injection of midazolam 2 mg with and without epidural methylprednisolone 60 mg for management of pain and allodynia in 150 adult patients with postherpetic neuralgia of 3-6 months duration involving lumbosacral dermatomes.
Patients in Group M-0 (n=50) received epidural methylprednisolone (60 mg), patients in group M-1 (n=50) received midazolam 2 mg in the intrathecal space while patients in Group M-2 (n=50) received methylprednisolone (60 mg) in the epidural space plus midazolam 2 mg in the intrathecal space.
The administration of intrathecal midazolam (2 mg) provided short term improvement in post herpetic neuralgia similar to epidural methylprednisolone. However, the combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia. The need for analgesics was also significantly less in patients who received the combination compared to those who received either intrathecal midazolam or epidural methylprednisolone. No serious adverse effect was reported with the use of intrathecal midazolam except a mild degree of sedation.
The combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia of lumbosacral dermatomes due to the complementary anti nociceptive action of intrathecal midazolam with epidural methylprednisolone on spinal nerve roots.
The dose-response relationship of intrathecal midazolam was not evaluated in our study, so further study should be conducted with different doses of intrathecal midazolam for management of PHN.</description><identifier>ISSN: 1533-3159</identifier><identifier>EISSN: 2150-1149</identifier><identifier>PMID: 20495585</identifier><language>eng</language><publisher>United States: American Society of Interventional Pain Physician</publisher><subject>Adjuvants, Anesthesia - administration & dosage ; Aged ; Benzodiazepines ; Double-Blind Method ; Drug Therapy, Combination ; Epidural ; Female ; Glucocorticoids - administration & dosage ; Humans ; Injections, Epidural ; Injections, Spinal ; Male ; Methylprednisolone - administration & dosage ; Midazolam - administration & dosage ; Middle Aged ; Neuralgia, Postherpetic - drug therapy ; Treatment Outcome</subject><ispartof>Pain physician, 2010-05, Vol.13 (3), p.213-221</ispartof><rights>2010. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20495585$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dureja, G P</creatorcontrib><creatorcontrib>Usmani, Hammad</creatorcontrib><creatorcontrib>Khan, Mozaffar</creatorcontrib><creatorcontrib>Tahseen, Mohd</creatorcontrib><creatorcontrib>Jamal, Aslam</creatorcontrib><title>Efficacy of intrathecal midazolam with or without epidural methylprednisolone for management of post-herpetic neuralgia involving lumbosacral dermatomes</title><title>Pain physician</title><addtitle>Pain Physician</addtitle><description>Post herpetic neuralgia is a chronic neuropathic pain syndrome which remains one of the most difficult pain disorders to treat. Epidural injection of methylprednisolone with or without local anesthetic provides relief for neuralgia for a short duration only. Recent studies have shown a promising anti nociceptive effect for intrathecal midazolam, a water soluble benzodiazepine, due to its interaction with benzodiazepine-GABA-A receptor complex within the spinal cord.
A randomized, double blind study was conducted at 2 different centers in India.
Two different interventional pain practice centers in India.
To quantify the effectiveness of a single intrathecal injection of midazolam 2 mg with and without epidural methylprednisolone 60 mg for management of pain and allodynia in 150 adult patients with postherpetic neuralgia of 3-6 months duration involving lumbosacral dermatomes.
Patients in Group M-0 (n=50) received epidural methylprednisolone (60 mg), patients in group M-1 (n=50) received midazolam 2 mg in the intrathecal space while patients in Group M-2 (n=50) received methylprednisolone (60 mg) in the epidural space plus midazolam 2 mg in the intrathecal space.
The administration of intrathecal midazolam (2 mg) provided short term improvement in post herpetic neuralgia similar to epidural methylprednisolone. However, the combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia. The need for analgesics was also significantly less in patients who received the combination compared to those who received either intrathecal midazolam or epidural methylprednisolone. No serious adverse effect was reported with the use of intrathecal midazolam except a mild degree of sedation.
The combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia of lumbosacral dermatomes due to the complementary anti nociceptive action of intrathecal midazolam with epidural methylprednisolone on spinal nerve roots.
The dose-response relationship of intrathecal midazolam was not evaluated in our study, so further study should be conducted with different doses of intrathecal midazolam for management of PHN.</description><subject>Adjuvants, Anesthesia - administration & dosage</subject><subject>Aged</subject><subject>Benzodiazepines</subject><subject>Double-Blind Method</subject><subject>Drug Therapy, Combination</subject><subject>Epidural</subject><subject>Female</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Humans</subject><subject>Injections, Epidural</subject><subject>Injections, Spinal</subject><subject>Male</subject><subject>Methylprednisolone - administration & dosage</subject><subject>Midazolam - administration & dosage</subject><subject>Middle Aged</subject><subject>Neuralgia, Postherpetic - drug therapy</subject><subject>Treatment Outcome</subject><issn>1533-3159</issn><issn>2150-1149</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpd0E1r3DAQBmBTGrqbj79QBD30ZJAtjdY-lpA2hUAuydnMyqNdLfpwJTll80vyc-Nt0ktOc3nmneH9VK3bBnjdNLL_XK0bEKIWDfSr6jznA-dC9b34Uq1aLnuADtbVy40xVqM-smiYDSVh2ZNGx7wd8Tk69OyvLXsW078Z58JosuOcToTK_uimRGOwOboYiJnFeQy4I0-hnDKnmEu9pzRRsZoFOm3uLC63nqJ7smHH3Oy3MaM-RY6UPJboKV9WZwZdpqv3eVE9_rx5uL6t7-5__b7-cVfvWiVKLUcwXUebUUkQslF8ROiMlKrjSuFmCy0YDr1GuXTCAdEY3QNpMEpI0aK4qL6_5U4p_pkpl8HbrMk5DBTnPGyEAMX7TbvIbx_kIc4pLM8NrVpMA0rAor6-q3nraRymZD2m4_C_cvEKJ3KByw</recordid><startdate>20100501</startdate><enddate>20100501</enddate><creator>Dureja, G P</creator><creator>Usmani, Hammad</creator><creator>Khan, Mozaffar</creator><creator>Tahseen, Mohd</creator><creator>Jamal, Aslam</creator><general>American Society of Interventional Pain Physician</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20100501</creationdate><title>Efficacy of intrathecal midazolam with or without epidural methylprednisolone for management of post-herpetic neuralgia involving lumbosacral dermatomes</title><author>Dureja, G P ; Usmani, Hammad ; Khan, Mozaffar ; Tahseen, Mohd ; Jamal, Aslam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g263t-4d5f88e7d64534160da58f4468066a7b525f059ca411405aaffc95ec5f63432a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adjuvants, Anesthesia - administration & dosage</topic><topic>Aged</topic><topic>Benzodiazepines</topic><topic>Double-Blind Method</topic><topic>Drug Therapy, Combination</topic><topic>Epidural</topic><topic>Female</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Humans</topic><topic>Injections, Epidural</topic><topic>Injections, Spinal</topic><topic>Male</topic><topic>Methylprednisolone - administration & dosage</topic><topic>Midazolam - administration & dosage</topic><topic>Middle Aged</topic><topic>Neuralgia, Postherpetic - drug therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dureja, G P</creatorcontrib><creatorcontrib>Usmani, Hammad</creatorcontrib><creatorcontrib>Khan, Mozaffar</creatorcontrib><creatorcontrib>Tahseen, Mohd</creatorcontrib><creatorcontrib>Jamal, Aslam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pain physician</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dureja, G P</au><au>Usmani, Hammad</au><au>Khan, Mozaffar</au><au>Tahseen, Mohd</au><au>Jamal, Aslam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of intrathecal midazolam with or without epidural methylprednisolone for management of post-herpetic neuralgia involving lumbosacral dermatomes</atitle><jtitle>Pain physician</jtitle><addtitle>Pain Physician</addtitle><date>2010-05-01</date><risdate>2010</risdate><volume>13</volume><issue>3</issue><spage>213</spage><epage>221</epage><pages>213-221</pages><issn>1533-3159</issn><eissn>2150-1149</eissn><abstract>Post herpetic neuralgia is a chronic neuropathic pain syndrome which remains one of the most difficult pain disorders to treat. Epidural injection of methylprednisolone with or without local anesthetic provides relief for neuralgia for a short duration only. Recent studies have shown a promising anti nociceptive effect for intrathecal midazolam, a water soluble benzodiazepine, due to its interaction with benzodiazepine-GABA-A receptor complex within the spinal cord.
A randomized, double blind study was conducted at 2 different centers in India.
Two different interventional pain practice centers in India.
To quantify the effectiveness of a single intrathecal injection of midazolam 2 mg with and without epidural methylprednisolone 60 mg for management of pain and allodynia in 150 adult patients with postherpetic neuralgia of 3-6 months duration involving lumbosacral dermatomes.
Patients in Group M-0 (n=50) received epidural methylprednisolone (60 mg), patients in group M-1 (n=50) received midazolam 2 mg in the intrathecal space while patients in Group M-2 (n=50) received methylprednisolone (60 mg) in the epidural space plus midazolam 2 mg in the intrathecal space.
The administration of intrathecal midazolam (2 mg) provided short term improvement in post herpetic neuralgia similar to epidural methylprednisolone. However, the combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia. The need for analgesics was also significantly less in patients who received the combination compared to those who received either intrathecal midazolam or epidural methylprednisolone. No serious adverse effect was reported with the use of intrathecal midazolam except a mild degree of sedation.
The combination of intrathecal midazolam with epidural methylprednisolone resulted in prolonged duration of analgesia in patients with post herpetic neuralgia of lumbosacral dermatomes due to the complementary anti nociceptive action of intrathecal midazolam with epidural methylprednisolone on spinal nerve roots.
The dose-response relationship of intrathecal midazolam was not evaluated in our study, so further study should be conducted with different doses of intrathecal midazolam for management of PHN.</abstract><cop>United States</cop><pub>American Society of Interventional Pain Physician</pub><pmid>20495585</pmid><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adjuvants, Anesthesia - administration & dosage Aged Benzodiazepines Double-Blind Method Drug Therapy, Combination Epidural Female Glucocorticoids - administration & dosage Humans Injections, Epidural Injections, Spinal Male Methylprednisolone - administration & dosage Midazolam - administration & dosage Middle Aged Neuralgia, Postherpetic - drug therapy Treatment Outcome |
| title | Efficacy of intrathecal midazolam with or without epidural methylprednisolone for management of post-herpetic neuralgia involving lumbosacral dermatomes |
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