Find us on:


Neuropathic Corneal Pain: Approaches for Treatment

Neuropathic Corneal Pain: Approaches for Treatment
Publication Type
Journal Article
Research Type
Reported as
October 18, 2017
Dieckmann G, Goyal S, Hamrah P
Tufts University, University of Arkansas

Neuropathic pain is caused by a primary lesion or dysfunction of the nervous system and can occur in the cornea. However, neuropathic corneal pain (NCP) is currently an ill-defined disease. Patients with NCP are extremely challenging to manage, and evidence-based clinical recommendations for the management of patients with NCP are scarce. The objectives of this review are to provide guidelines for diagnosis and treatment of patients with NCP and to summarize current evidence-based literature in this area. We performed a systematic literature search of all relevant publications between 1966 and 2017. Treatment recommendations are, in part, based on methodologically sound randomized controlled trials (RCTs), demonstrating superiority to placebo or relevant control treatments, and on the consistency of evidence, degree of efficacy, and safety. In addition, the recommendations include our own extensive experience in the management of these patients over the past decade. A comprehensive algorithm, based on clinical evaluation and complementary tests, is presented for diagnosis and subcategorization of patients with NCP. Recommended first-line topical treatments include neuroregenerative and anti-inflammatory agents, and first-line systemic pharmacotherapy includes tricyclic antidepressants and an anticonvulsant. Second-line oral treatments recommended include an opioid-antagonist and opiate analgesics. Complementary and alternative treatments, such as cardiovascular exercise, acupuncture, omega-3 fatty acid supplementation, and gluten-free diet, may have additional benefits, as do potential noninvasive and invasive procedures in recalcitrant cases. Medication selection should be tailored on an individual basis, considering side effects, comorbidities, and levels of peripheral and centralized pain. Nevertheless, there is an urgent need for long-term studies and RCTs assessing the efficacy of treatments for NCP.

Regarding LDN, the article indicates: "Second Line Agents. Low-DoseNaltrexone (LDN). Low dose naltrexone (LDN) is an opioid antagonist for the m-opioid and k-opioid receptors. It has been shown to be an antagonist to toll-like receptor 4 that has been linked to neuropathic pain, reducing the release of pro-inflammatory cytokines and modulating microglial activity. LDN (3-5 mg) has recently been used effectively as an off label treatment in patients with chronic neuropathic pain, including fibromyalgia, complex regional pain syndrome, low-back pain, and painful diabetic neuropathy. In an RCT of 31 patients with fibromyalgia, use of LDN 4.5 mg resulted in significant decrease of pain and improved satisfaction with life as compared with placebo. Another recent paper reported a single case of successful treatment with LDN in a patient with refractory painful diabetic neuropathic pain. Common side effects include headache, tachycardia, and vivid dreams. LDN is recommended by us in NCP patients at 1.5 mg at bedtime with gradual biweekly increase of 1.5 mg to a final maximum dose of 4.5 mg taken at bedtime."

wife has no sex drive penus pills stendra generic jelqing tool viagra substitutes beast nutrition sildenafil citrate vs viagra top 10 male enhancement pills reviews nitric oxide viagra rash on shaft over the counter acne pills cvs testo fuel average dick girth sexual urges small penis massage top selling testosterone booster penile surgery enlargement test boost reviews enzyte ingrediants girls in sex position cianix male enhancement cialis generic 2020 what age boys stop growing extenze pills walmart biggest horse penis erectile dysfunction cause the natural vitamins how to use a penis extender natural cures remedies nitric oxide booster side effects mature erections itchy bumps on penile shaft dollar sign icon png blood pressure medicine and ed how long does just for men last buy viagra without prescription man woman sexuality viagra us gold max reviews best rated male enhancement pills dick sizes cialis how it works penis tip contact spotify phone number why does the tip of my penis hurt male enhancement oil in pakistan why do guys get soft during intercourse viotren cost testoboost side effects viagra essential oil 7 day male enhancement pill cock flexing increase semen average dick size usa

vape no A Tag

topamax dosage for weight loss top food for weight loss weight loss after cesarean section weight loss smoothies that work beth from bounty hunter weight loss chinese medicine weight loss weightlifting weight loss medically supervised weight loss cost denver medical weight loss brown rice benefits weight loss norm abrams weight loss bio weight loss pills castor oil pack weight loss 2 month weight loss before and after stomach wrap weight loss fruit juice diet for weight loss sauna weight loss calculator meats for weight loss weight loss clinic miami asenlix diet pills when to drink acv for weight loss weight loss bath no sugar weight loss stories egg diet plan for weight loss short term weight loss numia diet pills vysera weight loss aloe vera juice weight loss reviews weight loss pills nyc sydney greenstreet weight loss molecuslim diet pills review best things for weight loss brilliant diet pills la weight loss diet tapeworms diet pills apedix diet pills diet fuel diet pills dangers of diet pills best kind of diet pills weight loss pills from canada redline diet pills gnc dwayne johnson diet pills diet pills sleep diet patches weight loss rapid fat loss diet pills nutribullet weight loss transitions diet pills thermal diet pills weight pills to lose weight fast vibe diet pills chinese herbal pills to lose weight weight loss shakes best metabolism boosting supplements cranberry pills and weight loss

cbd fx cbd vape oil amazon palmetto harmony cbd oil calories in cbd oil cbd oil cures cbd oil price per gram refillable cbd vape pen ilae classification sabaidee cbd reviews can cbd oil lower triglycerides cbd lamictal green remedy usda cbd oil cbd delivery does cbd oil interfere with medications cbd bubble hash thats natural cbd google movements is cbd good for sore muscles chronic pain managment oil meaning mary janes cbd medical def cbd oil for depression reviews what is microcirculation real cbd online is hemp oil a blood thinner healing is voltage what is arthritis ok google plus diesel exhaust fluid cbd gummies effect drug metabolism and disposition gorilla glue cbd vape can stress cause nosebleeds define stand plasma tank vape cbd tumor amazon 6 tablets is cbd oil flammable who am i related to phyto c experimental and clinical psychopharmacology cbd build up utan cbd pure cannabis how to make cbd mct oil tincture sagely hemp cbd cream review how much does cbd oil cost nebraska cbd papers wisely high potency hemp cbd oil reviews herbal plus products cbd oil retailers in tecas do you need a prescription for cbd oil in illinois