New targets for certain pain conditions and why opioids can make pain worse

Came across an interesting article the other day. I will just list the few important take-home messages. The original paper is pretty succinct and worth a read as well.

  • There are 3 kinds of inflammation: classic inflammation, neurogenic inflammation and neuroinflammation.
  • Classic inflammation occurs at the place of tissue injury; neurogenic inflammation is a phenomenon where the nerves are activated and cause inflammation to occur at the tip of the pain fibres; neuroinflammation is inflammation affecting the nerves themselves in the peripheral or central nervous system
  • Nerve block procedures and Botox injections greatly help conditions with neurogenic inflammation such as headache esp migraines, as well as inflammatory pain.
  • Targeting nerves with neuromodulation techniques such as spinal cord stimulation and pulsed radiofrequency can help in chronic post-surgical pain and pain conditions where there is neuroinflammation
  • There are techniques to extract platelet-rich plasma and autologous conditioned serum which have a lot of anti-inflammatory factors, which can be used in pain from conditions like osteoarthritis of the knee if surgery is not an option
  • Neuroinflammation is a big reason for post-operative delirium as well as pain; thus regional anaesthesia techniques can be useful in providing the best possible recovery for a patient
  • Opioid usage results in glial activation and neuroinflammation and can paradoxically result in chronic pain states… the treatment is to slowly withdraw the opioids with or without a course of ketamine infusion

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