Analgesic effect of dextromethorphan in neuropathic pain

被引:53
作者
Carlsson, KC
Hoem, NO
Moberg, ER
Mathisen, LC
机构
[1] Univ Oslo, Sch Pharm, Dept Pharmacol, NO-0316 Oslo, Norway
[2] Univ Oslo, Fac Med, Dept Pharmacol, NO-0316 Oslo, Norway
[3] Aker Univ Hosp, Dept Anaesthesia, Pain Clin, Oslo, Norway
关键词
dextromethorphan; dextrorphan; human; neuropathic pain; NMDA receptor antagonist;
D O I
10.1111/j.0001-5172.2004.0325.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Dextromethorphan, a clinically available N-methyl-D-aspartic acid (NMDA) receptor antagonist, has an analgesic effect in patients with diabetic neuropathy. The aim of this study was to evaluate the analgesic and adverse effects of a single high dose of dextromethorphan on spontaneous pain in patients suffering long-term neuropathic pain of traumatic origin. Methods: Fifteen patients with post-traumatic neuropathic pain participated in this placebo-controlled, double-blind, randomized crossover study. On two separate occasions, the participants received 270 mg of dextromethorphan hydrobromide or placebo. Pain intensity, adverse. effects and serum concentrations of dextromethorphan and metabolites were registered. Results: Dextromethorphan had a statistically significant analgesic effect compared with placebo, but the effect varied markedly among the patients. Light-headedness was the most important adverse effect reported. Extensive metabolizers of dextromethorphan had an apparently better analgesic effect than poor metabolizers. Conclusion: This report indicates that a single high dose of dextromethorphan has an analgesic effect in patients with neuropathic pain of traumatic origin. The main metabolite dextrorphan seems to be important for the analgesic effect. At the relatively high dose studied, the clinical usefulness of dextromethorphan is limited to that portion of the patient population experiencing analgesia without an unacceptable level of adverse effects.
引用
收藏
页码:328 / 336
页数:9
相关论文
共 31 条
[1]   SAFETY, TOLERABILITY, AND PHARMACOKINETICS OF THE N-METHYL-D-ASPARTATE ANTAGONIST DEXTRORPHAN IN PATIENTS WITH ACUTE STROKE [J].
ALBERS, GW ;
ATKINSON, RP ;
KELLEY, RE ;
ROSENBAUM, DM .
STROKE, 1995, 26 (02) :254-258
[2]   TOLERABILITY OF ORAL DEXTROMETHORPHAN IN PATIENTS WITH A HISTORY OF BRAIN ISCHEMIA [J].
ALBERS, GW ;
SAENZ, RE ;
MOSES, JA .
CLINICAL NEUROPHARMACOLOGY, 1992, 15 (06) :509-514
[3]  
Albers GW, 1995, ANN NY ACAD SCI, V765, P249
[4]   DEXTROMETHORPHAN - AN OVERVIEW OF SAFETY ISSUES [J].
BEM, JL ;
PECK, R .
DRUG SAFETY, 1992, 7 (03) :190-199
[5]   A PERIPHERAL MONONEUROPATHY IN RAT THAT PRODUCES DISORDERS OF PAIN SENSATION LIKE THOSE SEEN IN MAN [J].
BENNETT, GJ ;
XIE, YK .
PAIN, 1988, 33 (01) :87-107
[6]   Dextrorphan attenuates responses of spinothalamic tract cells in normal and nerve-injured monkeys [J].
Carlton, SM ;
Rees, H ;
Gondesen, K ;
Willis, WD .
NEUROSCIENCE LETTERS, 1997, 229 (03) :169-172
[7]  
CHOI DW, 1987, J PHARMACOL EXP THER, V242, P713
[8]   DIFFERENTIAL-EFFECTS OF DEXTROPHAN AND LEVORPHANOL ON THE EXCITATION OF RAT SPINAL NEURONS BY AMINO-ACIDS [J].
CHURCH, J ;
LODGE, D ;
BERRY, SC .
EUROPEAN JOURNAL OF PHARMACOLOGY, 1985, 111 (02) :185-190
[9]   Intraplantar injection of dextrorphan, ketamine or memantine attenuates formalin-induced behaviors [J].
Davidson, EM ;
Carlton, SM .
BRAIN RESEARCH, 1998, 785 (01) :136-142
[10]   DEXTROMETHORPHAN AND LEVORPHANOL ON DORSAL HORN NOCICEPTIVE NEURONS IN THE RAT [J].
DICKENSON, AH ;
SULLIVAN, AF ;
STANFA, LC ;
MCQUAY, HJ .
NEUROPHARMACOLOGY, 1991, 30 (12A) :1303-1308