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Neuropathic Pain Treatment Update at NeuPSIG 2017

Neuropathic Pain Treatment Update : an overview of recent neuropathic pain treatments show especially sodium channel blockers are hot in the early clinic.

Bouhassira presented Neuropathic Pain Treatment Update

At the at plenary session of the NeuPSIG 2017 at Gothenburg, Sweden (June 2017) an overview was given of all new treatments in neuropathic pain. There were only 2 Industry Sponsors at the NeuPsych and no industry sponsored symposia. Perhaps NeuPsyg had to compete with EFIC (september 2017, Denmark) was a suggestion heard.

At the Plenary Session III Chaired by Andrea Truini and Volker Tronnier, professor Didier Bouhassira from France presented a state of the art lecture on: ‘New Treatments for Neuropathic Pain’.

Neuropathic Pain Treatment Update

Bouhassira started pointing out that there is not much news in general.
He pointed out that new treatments for old drugs are quite important in the dessert currently of new treatment options (repositioning).

Of course there are some new molecules, such as MAP kinase inhibitors and Nerve Growth Factors, Tumor Necrosis Factor Receptor Superfamily Member 16, Bradykinin B1 Receptor, Opioid Receptor-Like-1 Receptor, Purinoceptors, Metabotropic Glutamate Receptors 6 and 7, Calcitonin Gene-Related Peptide Type-1 Receptors etc. However, most of these are in preclinical phase. At an earlier workshop it was stipulated how much of these preclinical data are difficult to relay on, due to the lack of replication data, absence of blinded rating and other methodological issues.

Only two recent papers are remarkable according to the speaker and were referred to, both on the clinical data related to a new sodium channel blocker, TV-45070 drug from TEVA. This sodium channel blocker is currently analysed in a Phase 2b study in post-herpetic neuralgia (PHN).

The new indications for old drugs (repositioning) chapter was illustrated by a second example, botulum BTX-A role in neuropathic pain.

Interestingly earlier at the congres new clinical data were presented at a workshop on the sodium channel target, on the old drug and sodium channel blocker phenytoin [1], currently under development via a patented repositioning strategy by Topical Innovations for neuropathic pain.

Non-pharmacological treatments of Neuropathic Pain

Furthermore, he discussed some non-pharmacological treatments based on repetitive transcranial magnetic stimulation (r-TMS), which possibly might work via long lasting neuroplastic effects. Naloxone can reverse the r-TMS effects. At least 20 controlled studies have supported this method, and especially frequenties higher than 5Hz seems useful. The long term effects however are still quite unknown.

Transcranial direct current stimulation (tDCs) is a second non invasive technique, and at the poster sessions the inhalation of NO was presented in neuropathic pain patients, with good effects in preliminary tests.

Neuropathic Pain Plenary Session on New Neuropathic Pain Treatment

Gotenburg, June 16th 2017, Jan M Keppel Hesselink, MD, PhD

Referentie

[1] Keppel Hesselink JM1. | Phenytoin: a step by step insight into its multiple mechanisms of action-80years of mechanistic studies in neuropharmacology. | J Neurol. | 2017 Mar 27. doi: 10.1007/s00415-017-8465-4. [Epub ahead of print]