Articles: neuropathic-pain.
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To test whether contralateral sensory abnormalities in the clinically unaffected area of patients with unilateral neuropathic pain are due to the neuropathy or pain mechanisms. ⋯ Mechanisms of sensory loss seem to spread to the contralateral side in both painful and painless neuropathies. Contralateral spread of pinprick hyperalgesia was restricted to the 2 ipsilateral phenotypes that suggest sensitization; this suggest a contribution of descending net facilitation from supraspinal areas, which was reported in rodent models of neuropathic pain but not yet in human patients.
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Cancer-related neuropathic pain (CNP) affects an increasing proportion of cancer patients, given improved survival, but it remains difficult to treat. There are no studies on an extended intravenous ketamine protocol and its synergies with common neuropathy treatments to treat CNP. This study aims to 1) evaluate the safety and effectiveness of an intravenous ketamine protocol to treat refractory CNP and 2) uncover synergies between ketamine and common neuropathy treatments. ⋯ Intravenous ketamine may be a safe and effective adjuvant treatment for CNP, especially with serotonin-norepinephrine reuptake inhibitors. Larger, prospective studies are warranted and should explore parameters to help prognosticate response to ketamine infusions.
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The treatment for neuropathic pain is still a big challenge. Pulsed radiofrequency technique has been widely used to relieve neuropathic pain in recent years. The purpose of this study is to optimize the temperature for pulsed radiofrequency therapy. ⋯ PRF using 50°C could induce less damage while achieving better improvement of mechanical and thermal pain threshold than 42°C and 60°C in CCI rats, which may be achieved by promoting the expression of M-ENK in spinal cord.
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Occipital neuralgia is a painful condition that affects the posterior aspect of the head and can be difficult to distinguish from other common forms of headaches. This article reviews the anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for occipital neuralgia. ⋯ Non-pharmacological treatments aim to alleviate muscle tension and improve posture. Acupuncture shows some promise. The occipital nerve block is considered the first line in a minimally invasive intervention, but the duration of relief may be short term. An onabotulinum toxin A injection may improve the sharp but not the dull component of the pain of occipital neuralgia. Radiofrequency ablation and occipital nerve stimulation may provide effective long-term relief in refractory patients. Surgical decompression, neurotomies, and neurolysis are last-resort treatment options. Occipital neuralgia is a debilitating condition that can be difficult to treat. Studies with larger sample sizes and randomized control trials are needed to further determine the effectiveness and safety of different therapies.
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Chronic pain is associated with persistent but reversible structural and functional changes in the prefrontal cortex (PFC). This stable yet malleable plasticity implicates epigenetic mechanisms, including DNA methylation, as a potential mediator of chronic pain-induced cortical pathology. We previously demonstrated that chronic oral administration of the methyl donor S-adenosyl methionine (SAM) attenuates long-term peripheral neuropathic pain and alters global frontal cortical DNA methylation. However, the specific genes and pathways associated with the resolution of chronic pain by SAM remain unexplored.