Articles: neuralgia.
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The treatment of 77 consecutive cases of post-herpetic neuralgia is reviewed. Stellate blockade proved helpful in 75% of patients with pain of less than 1 year's duration; 40% became virtually pain free. ⋯ Stellate blockade carried out within 1 year of the onset of symptoms would appear to be one of the treatments of choice for post-herpetic neuralgia. It would be of interest to see the results of a controlled randomised trial.
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In each of four patients with suspected thoracic outlet syndromes, the transaxillary approach to resection of the first thoracic and cervical ribs resulted in severe and permanent damage to the brachial plexus. The most severe sequela was causalgia. ⋯ Two patients suffered severe psychological depressions, with one committing suicide. Current enthusiasm with transaxillary rib resections in cases of thoracic outlet syndrome should be tempered by the possibility of severe and permanent injury to the brachial plexus and intractable causalgia.
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The pathogenesis and clinical manifestations of herpes zoster and postherpetic neuralgia and the use of nontraditional analgesics in the management of postherpetic neuralgia are reviewed. Herpes zoster represents the reactivation in an immunocompromised host of dormant varicella-zoster virus (Herpesvirus varicellae) contracted during a previous episode of chickenpox. Fever, neuralgia, and paresthesia occur four to five days before skin lesions develop. ⋯ Positive results have been reported with levodopa, amantadine, and interferon, but the role of these agents in the prevention of postherpetic neuralgia remains unclear. Nontraditional analgesic agents are useful in the management of postherpetic neuralgia, but patients must be selected and monitored appropriately. A tricyclic antidepressant (especially amitriptyline) is a reasonable first choice.
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A 41-year-old female developed spontaneous burning pain (causalgia) and stimulus-induced dysesthesia (allodynia) of the dorso-lateral part of her right foot following trauma. An L3 and L4 sympathectomy eliminated the spontaneous burning pain for only 1 year, but did not affect the stimulus-induced dysesthesia. We evaluated her two years post-sympathectomy with grouped sequential anesthetic blocks and sensory testing. ⋯ When sural block was added to the peroneal block the stimulus-induced dysesthesia was eliminated, and sensation in the sural distribution was lost. We conclude that the sural distribution received overalapping innervation for touch and pin-prick perception, but that heat perception, burning pain and the stimulus-induced dysesthesia were sural nerve dependent. Further, we were able to dissociate causalgia pain from allodynia in this patient.