NEUROLOGY
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M DiCAL TR ATM NT
Currently available neuropathic agents, antidepressants, antiinflammatory agents, and opioids do a satisfactory job of controlling
centralized pain if they are aggressively deployed. The goal is to
control pain and help the patient become capable of participating in
normal activities of daily living including eating, sleeping, dressing,
toileting, and socialization. Secondary goals are normalization of serum hormones and inflammatory markers.
New agents
that show promise
in animals are
currently being
clinically investigated
to control
glial cells and
neuroinflammation.
These include
minocycline,
pentoxifylline, and
acetazolamide.
to be deficient, particularly testosterone, cortisol, and pregnenolone,
should be replaced.25,26
Neurogenic hormones and neuroprotective agents are new therapies
in treatment of centralized pain. CNS inflammation is a progressive,
tissue-destructive process, and, if not controlled, brain tissue degeneration will occur.16-20 New agents that show promise in animals
are currently being clinically investigated to control glial cells and
neuroinflammation. These include minocycline, pentoxifylline, and
acetazolamide.27-31
Some hormones, called neurohormones, have been shown in animal
studies to produce neuroprotective and neurogenetic (growth) effects.32 Early clinical trials with these hormones demonstrate significant promise in stabilizing and protecting the patient with centralized pain from deteriorating. In the author’s experience, they usually
reduce or even eliminate opioid use. These agents are human chorionic gonadotropin, progesterone, pregnenolone, and oxytocin.32-39
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CAS STUDi S
with a clinical diagnoses of centralized pain
(Given here are 4 common situations)
CASE-1—postsurgery
A 65-year-old woman had her left hip replaced because standard
medical and physical measures failed to relieve her pain. Unfortunately,
surgery and a hip implant also did not relieve her pain. She has now
suffered constant pain in the hip for over 5 years. Postoperatively she
has been unsuccessfully treated with corticoid injections, electrical stimulation, topical lidocaine, and prolotherapy. At the time of evaluation by
the author she claimed excruciating pain, but pressure and palpation
over the pain site did not elicit pain. She could hardly ambulate. Her
Insomnia and anxiety will almost always have to be treated in mod- erythrocyte sedimentation rate (ESR) was elevated to 65 mm/h (normal
erate or severe cases. The efferent, sympathetic discharge of central- under 30 mm/h), C-reactive protein was 3.3 m