Neurologic clinics
-
Moderate to severe pain is a common feature of central and peripheral demyelinating disorders. Pain in multiple sclerosis tends to occur when the disease is well-established and usually lingers infinitely. ⋯ Pain syndromes are well-defined in each disorder based on the underlying pathophysiology. Treatment involves a variety of pharmacologic and nonpharmacologic approaches individualized for each specific pain syndrome.
-
Cancer presents itself in numerous ways, adding to the complexity of any pain syndrome with which it is associated. Neuropathic pain, unlike many other pain syndromes, is difficult to treat even in the absence of cancer. The combination results in a heterogeneous group of patients with a complex set of symptoms. ⋯ In patients with progressive disease and more refractory painful conditions, spinal anesthetic and neurosurgical therapies must often be considered. Under such circumstances, caregivers are forced to carefully balance uncertain benefits and risks, often without the luxury of time. More careful observation and controlled trials in these patients help facilitate this challenging process.
-
Complex regional pain syndromes (CPRS) may develop as a disproportionate consequence of a trauma affecting the limbs without (CRPS I, reflex sympathetic dystrophy) or with (CRPS II, causalgia) obvious nerve lesions. The clinical picture of CRPS consists of asymmetrical distal extremity pain, swelling, and autonomic (sympathetic) and motor symptoms. Changes in the peripheral and central somatosensory, autonomic and motor processing, and a pathologic interaction of sympathetic and afferent systems are discussed as underlying pathophysiologic mechanisms. Therapeutic strategies include pharmacologic pain relief, sympatholytic interventions, and rehabilitation.
-
This article presents recent observations about different recognized central pain syndromes (CPS) and discusses them in light of contemporary microelectrode and imaging findings. Different theories regarding the generation of CPS are reviewed, with an emphasis on difficulties in diagnosis and treatment. The author discourages destructive procedures for treatment of CPS, favoring, instead, reversible procedures such as stimulation techniques and drug delivery systems.
-
Although most acute conditions of the spine are benign and self-limited, the economic costs and disability resulting from these disorders have reached epidemic proportions in industrialized society. Recent scientific research to determine the causes of common spinal disorders, long attributed to structural abnormalities, have now implicated complex biochemical and neurophysiologic processes which may offer insights for future therapy interventions. This article reviews the functional and pathologic anatomy and correlates with current diagnostic and nonoperative management strategies for common mechanical spinal and radicular pain syndromes.