limaprost and Pain

The purpose of this brief narrative review is to summarize the evidence derived from randomized controlled trials pertaining to the nonsurgical treatment of lumbar spinal stenosis (LSS).. The MEDLINE (January 1950 to the fourth week of January 2010) and EMBASE (January 1980 to 2009, week 53) databases, the MESH term "spinal stenosis", and the key words, "vertebral canal stenosis" and "neurogenic claudication", were searched. Results were limited to randomized controlled trials (RCTs) conducted on human subjects, written in English, and published in peer-reviewed journals. Only RCTs pertaining to nonsurgical treatment were considered. Studies comparing conservative and surgical management or different surgical techniques were not included in the review.. The search criteria yielded 13 RCTs. The average enrolment was 54 subjects per study. Blinded assessment and sample size justification were provided in 85% and 39% of RCTs, respectively. The available evidence suggests that parenteral calcitonin, but not intranasal calcitonin, can transiently decrease pain in patients with LSS. In the setting of epidural blocks, local anesthetics can improve pain and function, but the benefits seem short-lived. The available evidence does not support the addition of steroids to local anesthetic agents. Based on the limited evidence, passive physical therapy seems to provide minimal benefits in LSS. The optimal regimen for active physiotherapy remains unknown. Although benefits have been reported with gabapentin, limaprost, methylcobalamin, and epidural adhesiolysis, further trials are required to validate these findings.. Because of their variable quality, published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS. In this narrative review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. This aspect may represent a limitation as it may serve to overemphasize evidence derived from "weaker" trials. Further well-designed RCTs are warranted.

Topics: Administration, Intranasal; Alprostadil; Amines; Analgesics, Non-Narcotic; Anesthetics, Local; Anti-Inflammatory Agents; Calcitonin; Cyclohexanecarboxylic Acids; Epidural Space; Gabapentin; gamma-Aminobutyric Acid; Humans; Injections, Spinal; Pain; Randomized Controlled Trials as Topic; Research Design; Spinal Stenosis; Vitamin B 12

We aimed to evaluate the incidence of (and risk factors for) postoperative pregabalin and/or limaprost to treat persistent numbness and/or pain of the lower extremities after lumbar spinal stenosis (LSS) surgery.. Medical records of 329 patients (168 men, 161 women; average age 70 years) were retrospectively reviewed for data on the duration of LSS diagnosis; LSS disease; preoperative medication (limaprost, pregabalin, or combined limaprost/pregabalin; duration); symptoms; preoperative/postoperative intermittent claudication (IC); operation type; and postoperative medication and period.. Limaprost, pregabalin, and combined limaprost/pregabalin were prescribed preoperatively for 43%, 7%, and 5% of patients, respectively. At an average of 21 months postoperatively, limaprost, pregabalin, and combined therapy were prescribed in 11%, 8%, 4% of patients, respectively. Medication requirement was significantly lower postoperatively than preoperatively (P < 0.0001). Significant risk factors for required postoperative medication were required preoperative medication (odds ratio [OR] 3.088, 95% confidence interval [CI] 1.679 to 5.681]; postoperative period (OR 1.063, 95% CI 1.031 to 1.096); and postoperative IC (OR 3.868, 95% CI 1.481 to 10.103). A negative impact from postoperative medication was seen in patients who had undergone decompression surgery (OR 0.589, 95% CI 0.377 to 0.918).. Overall, 23% of LSS patients required medication for pain and/or numbness at 21 months postoperatively. Significant factors portending required postoperative medication were preoperative medication, longer postoperative period, and postoperative IC. A negative influence from postoperative medication was seen in patients who had undergone decompression surgery without fusion.

Topics: Aged; Alprostadil; Decompression, Surgical; Female; Humans; Hypesthesia; Lumbar Vertebrae; Male; Middle Aged; Pain; Postoperative Period; Pregabalin; Retrospective Studies; Spinal Stenosis

Topics: Alprostadil; Analgesics; Humans; Pain; Pregabalin; Spinal Stenosis

This is a retrospective case-control study.. To evaluate the influence of medication-related bleeding tendency on the clinical outcomes and complications of transforaminal epidural steroid injection (TFESI).. TFESI may result in serious complications such as epidural hematoma or adhesions in patients with medication-related bleeding tendency. However, little is known about the true relationship between medication-related bleeding tendency and postprocedural complications.. Retrospective review of the medical records of patients who had TFESI from 2010 to 2014 was done. Commonly used medications such as warfarin, heparin, aspirin, clopidogrel, and Opalmon (limaprost alfadex) were included as medications associated with bleeding tendency. Patients were divided into 3 groups and the treatment outcomes for each group were compared: The first group used medications associated with bleeding tendency, but discontinued them in due time before the procedure (discontinued group). The second group used medications associated with bleeding tendency and continued receiving medication (continuing group). The third group did not use any medications associated with a bleeding tendency (nonmedicated group).. Among 2,469 patients, 1,234 were in the discontinued group, 408 patients in the continuing group, and 827 patients in the nonmedicated group. There were no statistically significant differences between groups for the treatment outcomes such as the degree of pain relief, duration of improvement, and complication rates including symptomatic epidural hematoma. Moreover, for the discontinued group and continuing group, the treatment outcomes were compared among patients with same medication, and revealed no differences.. This study demonstrated that continued use of medications associated with bleeding tendency does not increase epidural hematoma or symptomatic exacerbation, and thus should not be considered as a contraindication for TFESI.. Level 3.

Topics: Aged; alpha-Cyclodextrins; Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Case-Control Studies; Clopidogrel; Female; Follow-Up Studies; Hemorrhage; Humans; Injections, Epidural; Male; Middle Aged; Pain; Pain Measurement; Platelet Aggregation Inhibitors; Retrospective Studies; Steroids; Ticlopidine; Time Factors; Treatment Outcome

This study examined in mice whether limaprost, a prostaglandin E(1) analog, would relieve allodynia induced by chemotherapeutic agents. Single intraperitoneal injections of paclitaxel, oxaliplatin, and vincristine sulfate induced and gradually increased mechanical allodynia. Repeated administration of limaprost alfadex inhibited the late, but not early, phase of mechanical allodynia induced by paclitaxel and oxaliplatin, but not vincristine. Paclitaxel and oxaliplatin, but not vincristine, gradually decreased peripheral blood flow, which was prevented by limaprost. These results suggest that limaprost is effective against mechanical allodynia induced by paclitaxel and oxaliplatin, which may be due to inhibition of the decrease in peripheral blood flow.

Topics: alpha-Cyclodextrins; Alprostadil; Animals; Antineoplastic Agents; Drug Administration Schedule; Male; Mice; Mice, Inbred C57BL; Organoplatinum Compounds; Oxaliplatin; Paclitaxel; Pain; Pain Measurement; Vincristine