Hi there,

We have a succesful cohort of patients receiving I.V. Lidocaine (preservative free) @ 5mg/kg over 90 minutes.

Dr James

Hi,

We have fairly good results with Gabapentin and Pregabalin as well as with previously mentioned IV Lidocaine infusion @5-7.5mg/kg of ABW. We also sometimes use Sativex, which has positive studies for the treatment of pain and spasticity if MS patients.

Before suggesting an analgesic drug or any solution I would prefer to begin by pain definition and mentioning one pathophysiological mechanism.

Neuropathic is one of the many surnames are used for pain, other can be chronic and the word that indicate the localization, so first is better to define pain.

Definition: pain is the alteration of one the body functions. Which function? The altered function is Sensibility, touch and thermal sensibility, which are neurological functions.

Observation shows sensibility alterations happens by excess or by default, that is to say, hyper and hypo. As these changes are induced from brain, then neural cells in brain must be arranged in such a way that the named changes can happen, this arrangement is what I have called the Neurocyclic Arrangement (NA) of every sensorial function.

NA means any sensorial function is carried out by some anatomic structures, which are locate in a cyclic way and are formed by one external receptor, one afferent pathway, one primary sensorial area and one efferent pathway; which also function in a cyclic way. See graphic N° 1.

Every time brain is reached by the perception of one external stimulus, it sends a feed back to the external receptor through the efferent pathway, through this message brain regulate the amount of neural impulses (NI) can travel through the afferent pathway; when this road is facilitated, change by excess, it can become a highway and the person begins to feel pain.

To make the NI travel through the afferent pathway to be facilitated brain count on the Brain Basic Functional Circuit, which is a hardware that consist in a group of three neural cells, suitably located to make possible the NI travel through the afferent pathway, can be regulated, increased and decreased, this is the anatomy of the efferent pathway, see graphic N° 2.

In this regulation participates the four main neurotransmitter, those which induce in every synaptic junction a contrary bioelectric effect, first the depolarization and after the repolarization (excitation followed by inhibition, that is to say, binary code, a bite); the neurotransmitters are glutamic and aspartic acids excitatories and GABA and glycine inhibitors. Through the same mechanism brain may inhibit in a temporary or permanent way the interneural cell, which produces GABA or glycine, so the target neural cell is activated releasing the peripheral acetylcholine which blocks the way through the afferent pathway and then hypo sensibility befalls. If the inhibited neural cell is the excitatory that produces glutamic or aspartic acid so the target neural cell is inhibited, peripheral acetylcholine is absent or notably decreased, then hyper sensibility befalls. Pain is this hyper sensibility.

Now the question, how to cure it? The answer is, through the intervention on the dynamic of the four main neurotransmitter syntheses in neural cells cytosol.

How can you achieve such intervention? The intervention can be done by using the co ferments that help the different transaminases, in the process of carrying out the syntheses of neurotransmitters. Such co ferments are pyridoxine, folic acid and magnesium ion, which have been included in Ecosan, a new combination I have designed and filed the application of patent rights.

With this substances combination I have achieved very good results in pain of central origin.

See graphic n° 1

My favourite topic :)

RCTs in this field are scarce. The other problem is that most of the trials have not well defined the type of pain being treated. However, we have recently reviewed all RCTs regarding CNP associated with MS, with number of responders for each drug.

http://www.ncbi.nlm.nih.gov/pubmed/24234347

Clinically, Gabapentin and Amitriptyline are most commonly prescribed for CNP related to MS, however studies show that this type of pain needs chronic treatment and patients withdraw the treatment due to non-tolerable side effects of these drugs.

I have treated some patients suffered MS or NMOSD with pregabalin and found good effect. However, it is a bit expensive and many Chinese patients can not afford long-term medication.