Brain and nerve = Shinkei kenkyū no shinpo
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Musculoskeletal disorders are the most common causes of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. In industrialized countries, which have increasingly aging populations, chronic musculoskeletal pain has become a significant health care burden and major issue in the 1980s and 1990s. On January 13, 2000, The Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland. ⋯ Chronic pain had a significant impact on the occupational and social relationships, and it seriously affected their psychological conditions and quality of life. Such disabling chronic pain is regarded as the result of interrelated physical, psychological, and social or occupational factors requiring multidisciplinary intervention. We introduce a multidisciplinary clinical approach and report on novel multimodal methodologies -- for patients with chronic musculoskeletal pain.
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Different surgical procedures are available for the treatment of many neuropathic pain syndromes. These surgical procedures can be divided into 2 main sections: non-destructive and destructive procedures. In recent years, the non-destructive neurostimulation method has undergone rapid development. ⋯ Currently, destructive surgical procedures have a limited range of indications for pain control. However, the advantages of destructive procedures over non-destructive ones include continuous pain reduction without implantation of a stimulation system. Each of the surgical procedures has great potential for providing patients with significant relief from neuropathic pain.
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Detection of unmyelinated epidermal nerve fibers allows objective, pathologic, and minimally invasive assessment of small myelinated A-delta and unmyelinated C primary afferent fibers. This procedure is especially valuable for diagnosing small fiber neuropathy; this condition is characterized by sensory symptoms and pain in the lower extremities but standard nerve conduction fails to show abnormalities in this condition. ⋯ In this review, we discuss standard technical aspects of skin biopsy introduced for evaluation of epidermal nerve fibers and the feasibility of skin biopsy for diagnosing small fiber neuropathy and neuronopathy. We also describe the usefulness of skin biopsy in diagnosing peripheral neuropathies and other neurological disorders.
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Review
[Pharmacological treatment strategy and mirror visual feedback treatment for neuropathic pain].
Neuropathic pain is a debilitating condition, and pharmacotherapy is the most established treatment strategy. A variety of pharmacotherapies is used for neuropathic pain management: however, pharmacotherapies with evidence for analgesic potency are less common. ⋯ We have treated pharmacotherapy-resistant neuropathic pain with neurorehabilitation techniques such as mirror visual feedback (MVF) treatment. Further to our clinical experience using MVF, we discuss the cerebral mechanism associated with neuropathic pain in this study.
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Evidence regarding the effectiveness of nerve block in treating neuropathic pain is scarce. However, in actual clinical situations, nerve block has been used as a treatment in combination with other methods, such as pharmacotherapy, psychotherapy, and physiotherapy. The goal of neuropathic pain treatment is not a complete recovery but some improvement in the activities of daily living (ADL) as well as the quality of life. ⋯ Therefore, the use of nerve block should be considered from the onset of pain. In recent years, methods such as ultrasound-guided nerve block and thermocoagulation with pulsed radiofrequency have become more commonly used as safer and more accurate nerve block techniques. This article discusses the current clinical status of nerve block against neuropathic pain.