Effect of Intravenous Sodium Pentobarbital on Pain and Sensory Abnormalities in Patients with Chronic Non-Cancer Pain: Narrative Literature Review, Research Study, and Illustrative Case Reports.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY

Pain and Therapy Pub Date : 2024-08-01 Epub Date: 2024-06-20 DOI:10.1007/s40122-024-00621-6

Shehnaz Fatima Lakha, Angela Mailis

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引用次数: 0

Abstract

Introduction: Sodium pentobarbital (SP), a short- to intermediate-acting barbiturate, has limited information in the existing literature. The objectives of this study are to describe (a) the effect of intravenous (IV) SP infusion on pain and sensory abnormalities, and (b) its utility in the diagnosis and management of patients with chronic pain.

Methods: A narrative review of barbiturate applications for chronic pain was followed by a pragmatic study of 176 consecutive patients admitted to an inpatient pain unit (2004-2009). We collected demographic information upon admission, diagnoses retrieved from chart review, and pain ratings and sensory abnormalities at baseline and after blinded infusion of normal saline (NS) followed by SP.

Results: The study group consisted of 83 men and 93 women (mean age 41 ± 11 years); the mean NS dose was 7.8 ± 2.3 (range 2-10 ml), the SP dose was 223.8 ± 88 mg (range 40-420), and the numeric rating scale (NRS) baseline pain score was 6.0 ± 2. The mean reduction in NRS reached both statistical and clinical significance in 150 responders to either NS/SP or SP only. Collectively, we found (a) an extremely high rate of response to IV SP irrespective of the underlying pathology, (b) greater response for pain than for sensory abnormalities (sensory gains or deficits), (c) greater response for sensory gain than for sensory deficit, and (d) greater response for allodynia than for pinprick hyperalgesia. Illustrative case reports are also presented.

Discussion: IV SP infusion is a diagnostic tool that assists in elucidating pain generators and the nature of sensory abnormalities (central vs. peripheral), with effects similar to those of IV sodium amytal. The test cannot be viewed as a tell-all diagnostic modality and must be used in conjunction with clinical judgment, investigations, and psychological reports.

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静脉注射戊巴比妥钠对慢性非癌性疼痛患者的疼痛和感觉异常的影响：文献综述、研究和说明性病例报告。

简介：戊巴比妥钠（SP）是一种短效至中效巴比妥酸盐，现有文献中的相关信息十分有限。本研究旨在描述（a）静脉注射（IV）戊巴比妥钠对疼痛和感觉异常的影响，以及（b）戊巴比妥钠在诊断和治疗慢性疼痛患者中的作用：方法：对巴比妥类药物在慢性疼痛中的应用进行了叙述性回顾，然后对疼痛住院病房连续收治的 176 名患者进行了实用性研究（2004-2009 年）。我们收集了患者入院时的人口统计学信息、病历中的诊断信息、基线时和盲注生理盐水（NS）后的疼痛评分和感觉异常：研究组包括 83 名男性和 93 名女性（平均年龄为 41 ± 11 岁）；NS 平均剂量为 7.8 ± 2.3（范围为 2-10 毫升），SP 剂量为 223.8 ± 88 毫克（范围为 40-420），数字评分量表（NRS）基线疼痛评分为 6.0 ± 2。在 150 名仅对 NS/SP 或 SP 有反应的患者中，NRS 平均值的降低达到了统计学和临床意义。总之，我们发现：(a) 无论潜在病理情况如何，静脉注射 SP 的反应率极高；(b) 对疼痛的反应大于对感觉异常（感觉增强或缺失）的反应；(c) 对感觉增强的反应大于对感觉缺失的反应；(d) 对异动症的反应大于对针刺痛的反应。讨论：讨论：静脉注射 SP 是一种诊断工具，有助于阐明疼痛的产生和感觉异常的性质（中枢与外周），其效果与静脉注射阿米妥钠相似。该测试不能被视为万能的诊断方式，必须与临床判断、调查和心理报告结合使用。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.