Articles: neuralgia.
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The effectiveness of systemic lidocaine in relieving acute and chronic pain has been recognized for over 35 years. In particular, systemic lidocaine has been utilized both as a diagnostic and therapeutic tool for intractable neuropathic pain during the last decade. The introduction of oral lidocaine congeners such as mexiletine has significantly extended the usage of lidocaine therapy in chronic pain settings. ⋯ However, there remain inconsistencies in the scientific basis underlying the clinical application of lidocaine therapy. Recent demonstration of changes in tetrodotoxin (TTX)-sensitive and TTX-resistant sodium channels following nerve injury and their link to certain neuropathic pain symptoms may lead to the development of subtype-specific sodium channel blockers. The thoughtful use of lidocaine therapy and the potential application of subtype-specific sodium channel blockers could provide better management of distinctive neuropathic pain symptoms.
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J Pain Symptom Manage · Jul 2000
Clinical TrialAllodynia and pinprick hypesthesia in acute herpes zoster, and the development of postherpetic neuralgia.
Sensory loss and allodynia are hallmark signs of postherpetic neuralgia (PHN). We set out to investigate how frequently these signs are present in patients with acute herpes zoster (HZ) and what their prognostic value might be. We assessed pain, mechanical allodynia, and sensitivity to pinprick in 113 immunocompetent patients with HZ of a median duration of 5 days. ⋯ Mechanical allodynia and pinprick hypesthesia were strongly associated with the development of PHN. They merit addition to the list of potential risk factors for PHN although they cannot be used as a predictive rule for an individual patient. By contrast, lack of allodynia in the early stages of HZ predicts good recovery by three months.
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Primary sensory neurons with myelinated axons were examined in vitro in excised whole lumbar dorsal root ganglia (DRGs) taken from adult rats up to 9 days after tight ligation and transection of the L(5) spinal nerve (Chung model of neuropathic pain). Properties of subthreshold membrane potential oscillations, and of repetitive spike discharge, were examined. About 5% of the DRG neurons sampled in control DRGs exhibited high-frequency, subthreshold sinusoidal oscillations in their membrane potential at rest (V(r)), and an additional 4.4% developed such oscillations on depolarization. ⋯ Tactile allodynia following spinal nerve injury is thought to result from central amplification ("central sensitization") of afferent signals entering the spinal cord from residual intact afferents. The central sensitization, in turn, is thought to be triggered and maintained in the Chung model by ectopic firing originating in the axotomized afferent neurons. Axotomy by spinal nerve injury enhances subthreshold membrane potential oscillations in DRG neurons, augments ectopic discharge, and hence precipitates neuropathic pain.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A placebo-controlled trial of lamotrigine for painful HIV-associated neuropathy.
To investigate the analgesic efficacy of lamotrigine in the treatment of painful HIV-associated distal sensory polyneuropathy (DSP). ⋯ In this small trial, lamotrigine showed promise in the treatment of pain associated with HIV-related DSP. The frequency of rash was greater than in lamotrigine studies in epilepsy. A larger controlled study of lamotrigine is warranted.
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To evaluate the role of gabapentin for the treatment of neuropathic pain. ⋯ Gabapentin appears to be effective in treating various neuropathic pain disorders. Gabapentin may have advantages over current therapies, such as a favorable safety profile and lack of drug interactions; however, cost issues and limited experience may limit the use of gabapentin as a first-line option.