title: A brief, high-dose remifentanil infusion partially reverses neuropathic pain in a subgroup of post herpetic neuralgia patients.
abstract: Mechanism-based therapy for chronic pain is desperately needed. Recent basic science research demonstrated that remifentanil can reverse long-term potentiation at C-fiber synapses in the dorsal horn of rats. In this exploratory, single group study, patients with chronic post-herpetic pain were treated with a single, one-hour, high-dose remifentanil infusion. The mean overall change of pain intensity seven days after treatment was -18 (-7.5; -28.5, 95%CI, p<0.001) points on the numeric rating scale (0-100) (-33 (±11) points amongst responders only). Eleven of 20 patients responded to treatment (≥30% reduction in pain), the mean relative reduction in pain from baseline amongst responders was 61.0%. These promising preliminary results suggest that a mechanism-based reversal of chronic pain may be impending.
authors.affiliation: Department of Anesthesia, Intensive Care, and Pain Medicine, Vienna Human Pain Research Group, Montlearstrasse 37, Wilhelminen Hospital, 1160 Vienna, Austria; Department of Anesthesia, General Intensive Care, and Pain Therapy, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria. Electronic address: julian.prosenz@meduniwien.ac.at.
authors.forename: Julian
authors.initials: J
authors.lastname: Prosenz
authors.affiliation: Department of Anesthesia, Intensive Care, and Pain Medicine, Vienna Human Pain Research Group, Montlearstrasse 37, Wilhelminen Hospital, 1160 Vienna, Austria. Electronic address: herwig.kloimstein@wienkav.at.
authors.forename: Herwig
authors.initials: H
authors.lastname: Kloimstein
authors.affiliation: Department of Anesthesia, Intensive Care, and Pain Medicine, Vienna Human Pain Research Group, Montlearstrasse 37, Wilhelminen Hospital, 1160 Vienna, Austria. Electronic address: ulrich.thaler@wienkav.at.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Thaler
authors.affiliation: Department of Neurophysiology, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090 Vienna, Austria. Electronic address: ruth.drdla@meduniwien.ac.at.
authors.forename: Ruth
authors.initials: R
authors.lastname: Drdla-Schutting
authors.affiliation: Department of Neurophysiology, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090 Vienna, Austria. Electronic address: juergen.sandkuehler@meduniwien.ac.at.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Sandkühler
authors.affiliation: Department of Anesthesia, Intensive Care, and Pain Medicine, Vienna Human Pain Research Group, Montlearstrasse 37, Wilhelminen Hospital, 1160 Vienna, Austria. Electronic address: burkhard.gustorff@meduniwien.ac.at.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Gustorff
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000188:drug therapy*; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use; D000077208:Remifentanil
chemical_list: D010880:Piperidines; D000077208:Remifentanil
keywords: Chronic pain; Mechanism-based; Neuropathic; Opioid; Post-herpetic neuralgia; Remifentanil