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Washington DC Pain Treatment

What is Pain?

Pain is the body's response to injury and inflammation. There are nerve cells called pain receptors that are located all over the body, including the internal organs. Paradoxically, the brain itself has no comparable pain receptors, which is why neurosurgeons can perform a procedure called awake craniotomy to perform brain mapping procedures. Pain can be a very simple problem, such as that arising from a nerve being compressed as it exits the spinal cord.

“Neuropathic” or “central” pain, on the other hand, refers to discomfort that arises in the nervous system, but at no specific location. This type of pain is sometimes described as diffuse or burning, although sensations such as cold, numbness, or “pins and needles” fall in this category. An example of neuropathic pain is diabetic neuropathy, which causes numbness and tingling in the hands and feet. In mood disorders such as depression, the perception of pain is sometimes heightened; this is referred to as “somatization,” emotional distress that is expressed as a physical symptom.

Treatment Options for Pain

Pain can be treated with over-the-counter (OTC) acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Aleve); or prescription medications such as indomethacin (Indocin) or celecoxib (Celebrex). Narcotic medications for pain include acetaminophen with codeine (Tylenol-3) or oxycodone (OxyContin). Narcotics carry the disadvantage of being habit-forming, requiring increased dosages over time to treat the same amount of pain. Joint pain can sometimes be relieved by periodic injections of steroidal drugs.

Some types of pain, such as that resulting from injuries, osteoarthritis, or muscular spasms, can be relieved by targeted physical therapy. Regular exercise can both relieve pain and improve the stress often associated with pain. Meditation, stress reduction, and biofeedback techniques that increase physical awareness can also be quite helpful in moderating the body's response to pain.

Chronic Pain Treatment

For persistent pain that is not relieved by drugs, a nerve block can be used to prevent the irritated nerve from communicating pain back to the spinal cord and brain. A nerve block is an injection that contains a numbing drug such as lidocaine, and is delivered directly to the site that is causing pain, such as a vertebral disc. While not a permanent solution, this procedure can often bring about relief for weeks or months. In cases of chronic pain, which is often associated with other medical problems, a pacemaker-like device can be implanted in the brain to interrupt the “pain circuit” with continuous electrical signals. This procedure is called [deep brain stimulation] (DBS).

Clinical Trials

  • WIZARD: A Randomized, Multicenter, Phase 2 Study of DSP-7888 Dosing Emulsion in Combination with Bevacizumab versus Bevacizumab Alone in Patients with Recurrent or Progressive Glioblastoma following Initial Therapy

    This is a randomized, active-controlled, multicenter, open-label, parallel groups, Phase 2 study of DSP-7888 Dosing Emulsion plus Bevacizumab versus Bevacizumab alone in patients with recurrent or progressive glioblastoma multiforme (GBM) following treatment with first line therapy consisting of surgery and radiation with or without chemotherapy. One of the primary outcome measures is to assess the effect of DSP-7888 Dosing Emulsion plus Bevacizumab versus Bevacizumab alone on the Overall Survival of patients with recurrent or progressive GBM following treatment with first line therapy consisting of surgery and radiation with or without chemotherapy.Overall survival is defined as the interval between randomization and death from any cause

  • A Double-Blind, Placebo-Controlled, Inpatient, Dose-Ranging Efficacy Study of Staccato Alprazolam (STAP-001) in Subjects with Epilepsy with a Predictable Seizure Pattern

    This is a multi-center, double-blind, randomized, parallel group, dose-ranging study to investigate the efficacy and clinical usability of STAP-001 in adult (18 years of age and older) subjects with epilepsy with a predictable seizure pattern. These subjects have an established diagnosis of focal or generalized epilepsy with a documented history of predictable seizure episodes. This is an in-patient study. The subjects will be admitted to a Clinical Research Unit (CRU) or Epilepsy Monitoring Unit (EMU) for study participation. The duration of the stay in the in-patient unit will be 2-8 days. One seizure event per subject will be treated with study medication. The duration and timing of the seizure event and occurrence of subsequent seizures will be assessed by the Staff Caregiver(s)1 through clinical observation and confirmed with video electroencephalogram (EEG).

  • Malignant Brain Tumors
    A Multicenter Study of 5-Aminolevulinic Acid (5-ALA) to Enhance Visualization of Malignant Tumor in Patients with Newly Diagnosed or Recurrent Malignant Gliomas: A Safety, Histopathology, and Correlative Biomarker Study This single arm trial is being conducted to establish the safety and efficacy of Gliolan® (5-ALA) in patients undergoing resection of newly diagnosed or recurrent malignant gliomas. The rationale for the study is that Gliolan® (5-ALA), as an adjunct to tumor resection, is safe and will provide surgeons with real-time visualization of malignant tumor.