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NMDA-receptor antagonist and morphine decrease CRPS-pain and cerebral pain representation.

S M Gustin1, A Schwarz, N Birbaumer

  • 1Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany Ospedale San Camillo, Instituto di Ricovero e Cura a Carattere Scientifico, Venezia, Italy Traumatology Hospital of the University of Tübingen, Germany Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany Functional Imaging, Institute for Diagnostic Radiology and Neuroradiology, University of Greifswald, Germany.

Pain
|July 16, 2010
PubMed
Summary
This summary is machine-generated.

Combination therapy with morphine and an NMDA-receptor antagonist effectively relieved neuropathic pain in Complex Regional Pain Syndrome (CRPS) patients. This treatment reduced pain and disability, alongside significant changes in brain activity related to pain processing.

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Area of Science:

  • Neuroscience
  • Pain Management
  • Pharmacology

Background:

  • Neuropathic pain, particularly in Complex Regional Pain Syndrome (CRPS), presents a significant clinical challenge.
  • Standard treatments, including morphine, offer limited efficacy for some patients.
  • NMDA-receptor antagonists are explored for their potential to modulate pain pathways.

Purpose of the Study:

  • To evaluate the efficacy of a combination therapy of morphine and an NMDA-receptor antagonist compared to morphine and placebo for neuropathic pain in CRPS patients.
  • To investigate the effects of this combination therapy on brain activity using functional magnetic resonance imaging (fMRI).

Main Methods:

  • A double-blind, randomized, placebo-controlled study was conducted on CRPS patients with upper extremity involvement.
  • Patients received either morphine plus an NMDA-receptor antagonist or morphine plus placebo for 49 days.
  • fMRI was used to assess brain activity during affected and unaffected hand movements before and after treatment.

Main Results:

  • The combination therapy significantly reduced pain at rest and during movement, as well as disability.
  • Following treatment, reduced activation was observed in the contralateral primary somatosensory cortex (cS1) and anterior cingulate cortex during affected hand movement.
  • Pain relief correlated with decreased activation in cS1 and the secondary somatosensory cortex (S2).

Conclusions:

  • Combination therapy of morphine and an NMDA-receptor antagonist demonstrates superior efficacy in managing neuropathic pain and disability in CRPS.
  • This treatment modulates cerebral processing of nociceptive information, particularly affecting sensory-discriminative aspects of pain.
  • The findings support the role of NMDA-receptor antagonists in enhancing pain relief by altering central pain processing mechanisms.