Articles: neuropathic-pain.
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Although cases of trigeminal neuralgia (TN) induced by brainstem infarct have been reported, the neurosurgical literature lacks a comprehensive review for this subpopulation of patients. We present the first systematic review of the literature to discuss pathology, surgical management, and future directions for therapeutic innovation in this population. ⋯ Brainstem infarcts affecting the trigeminal pathway represent an understudied pathologic cause of TN. Although the neurosurgical literature lacks a clear picture of the most efficacious interventions in this population, we are optimistic that this review will encourage further investigation into the best treatment for these patients.
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Amitriptyline, duloxetine, and pregabalin are among the most pharmacotherapeutic, effective treatments for neuropathic pain control. However, the evaluation of synergism by combining these treatments is still poorly investigated. ⋯ The data demonstrated that combined therapy of pregabalin plus amitriptyline improved the bioavailability of pregabalin and potentiated the efficacy of the antiallodynic effect of pregabalin alone, proving to be advantageous for the treatment of sciatic neuropathic pain.
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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.
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Case Reports
Cognitive-Evaluative Dimension of Pain in Neuropathic Pain Relapse in Sciatica: A Case Report.
The cognitive-evaluative (C-E) dimension of pain is commonly observed in patients with a relatively long duration of pain. However, little is known about the effects of pain relapse on the C-E dimension of pain. Moreover, the improvement process of the C-E dimension of pain following treatment is unknown. ⋯ The C-E dimension of pain was observed with pain relapse even though it was in the acute phase of pain. This case provides a novel insight into the C-E dimension of pain. Moreover, the delay in improving the C-E dimension of pain indicates a difference in the improvement process for each pain dimension.