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pISSN 2005-9159
eISSN 2093-0569
eISSN 2093-0569
Korean J Pain 2014; 27(1): 54-62
Published online January 31, 2014 https://doi.org/10.3344/kjp.2014.27.1.54
Copyright © The Korean Pain Society.
Young Chan Joo, Eun Sung Ko, Jae Geun Cho, Young Min Ok, Gyu Yong Jung*, and Kyung Hoon Kim*
Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
*Department of Plastic Surgery, School of Medicine, Dongguk University, Gyeongju, Korea.
Correspondence to: Kyung Hoon Kim. Pain Clinic, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan 626-770, Korea. Tel: +82-55-360-1422, Fax: +82-55-360-2149, pain@pusan.ac.kr
Received: December 5, 2013; Revised: December 12, 2013; Accepted: December 12, 2013
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The recently known analgesic action mechanisms of nefopam (NFP) are similar to those of anticonvulsants and antidepressants in neuropathic pain treatment. It is difficult to prescribe high doses of oral neuropathic drugs without titration due to adverse effects. Unfortunately, there are few available intravenous analgesics for the immediate management of acute flare-ups of the chronic neuropathic pain. The aim of this study was to determine the additional analgesic effects for neuropathic pain of NFP and its adverse effects during the titration of oral medications for neuropathic pain among inpatients with postherpetic neuralgia (PHN).
Eighty inpatients with PHN were randomly divided into either the NFP or normal saline (NS) groups. Each patient received a 3-day intravenous continuous infusion of either NFP with a consecutive dose reduction of 60, 40, and 20 mg/d, or NS simultaneously while dose titrations of oral medications for neuropathic pain gradually increased every 3 days. The efficacy of additional NFP was evaluated by using the neuropathic pain symptom inventory (NPSI) score for 12 days. Adverse effects were also recorded.
The median NPSI score was significantly lower in the NFP group from days 1 to 6 of hospitalization. The representative alleviating symptoms of pain after using NFP were both spontaneous and evoked neuropathic pain. Reported common adverse effects were nausea, dizziness, and somnolence, in order of frequency.
An intravenous continuous infusion of NFP reduces spontaneous and evoked neuropathic pain with tolerable adverse effects during the titration of oral medications in inpatients with PHN.
Keywords: anticonvulsants, antidepressants, nefopam, postherpetic neuralgia, titration
