The result of the coin toss: Michaellumpier, Bobsplitter. - PowerPoint PPT Presentation
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The result of the coin toss: Michaellumpier, Bobsplitter.
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Multiple sclerosis. Peripheral neuropathy (distal symmetric) Diabetic. HIV related ... Multiple sclerosis. Back/neck w/radiculopathy. Diagnostic certainty? Not always ... – PowerPoint PPT presentation
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Title: The result of the coin toss: Michaellumpier, Bobsplitter.
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Presented by Mark Rowbotham, M.D. at
the Anesthetic and Life Support Drugs Advisory
Committee Meeting on May 16, 2002
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The result of the coin toss Michael-lumpier,
Bob-splitter.
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Neuropathic painIs it all the same from a
treatment perspective?Michael C. Rowbotham,
M.D.UCSF Pain Clinical Research Center
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Neuropathic Pain Types
- Central pain
- Post-stroke (or mass lesion)
- Spinal cord injury
- Multiple sclerosis
- Peripheral neuropathy (distal symmetric)
- Diabetic
- HIV related
- Chemotherapy related
- Inherited
- Other acquired
- Post-herpetic neuralgia
- Trigeminal neuralgia
- Focal peripheral nerve injury
- Anesthesia dolorosa
RSD/CRPS 1 ?????
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Problems with splitting
- Response different? PROVE IT!
- i.v. lidocaine
- Tricyclics/ADs
- opioids
- anticonvulsants
- topicals
- Pure neuropathic? Yes and No
- Spinal cord injury?
- Multiple sclerosis
- Back/neck w/radiculopathy
- Diagnostic certainty? Not always
- Different mechanisms? Broad overlap
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Clinical Trials Issues
- Want to encourage study of a broad range of
disorders - Prevalence
- Concomitant medical disorders
- Inhomogeneity within the diagnosis
- Responsivity of disorders may vary
- Central pain - low response rates
- Diabetic neuropathy - high placebo response
- PHN - allodynia prevalent valid outcome measure?
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Special Cases
- PHN?
- Trigeminal neuralgia?
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