Articles: neuralgia.
-
We investigated the analgesic effect of dextromethorphan (DM), a non-selective NMDA receptor antagonist, in 25 patients with postherpetic neuralgia (PHN). We administered DM 45mg.day-1 orally for 14 days and then 90mg.day-1 for next 14 days. ⋯ Side effects with no severe cases occurred in 8 patients (32%) and these were mainly digestive symptoms. We concluded that DM might be useful to treat PHN with allodynia probably due to central sensitization.
-
Glossopharyngeal neuralgia is a rare disease characterized by severe paroxysmal attacks of pain in the distribution of the 9th cranial nerve. The most important differential diagnosis is trigeminal neuralgia. ⋯ Autonomic disturbances may occur during pain attacks in some patients. We describe a patient suffering from glossopharyngeal neuralgia with transitory unconsciousness due to cardiac asystole and arterial hypotension accompanying the attack of pain.
-
Randomized Controlled Trial Clinical Trial
Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia.
Post-herpetic neuralgia (PHN) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly. Topical local anesthetics have shown promise in both uncontrolled and controlled studies. Thirty-five subjects with established PHN affecting the torso or extremities completed a four-session, random order, double-blind, vehicle-controlled study of the analgesic effects of topically applied 5% lidocaine in the form of a non-woven polyethylene adhesive patch. ⋯ The highest blood lidocaine level measured was 0.1 micrograms/ml, indicating minimal systemic absorption of lidocaine. Patch application was without systemic side effect and well tolerated when applied on allodynic skin for 12 h. This study demonstrates that topical 5% lidocaine in patch form is easy to use and relieves post-herpetic neuralgia.
-
In the syndrome of post-herpetic neuralgia (PHN), the nature of the sensory disturbance and its relationship both to the severity and cause of the pain is controversial. To address these issues, sensory mapping and quantitative thermal sensory testing was carried out four times in separate sessions on 35 subjects with established PHN. All subjects had pain affecting the torso or extremities and brush-evoked allodynia. ⋯ This implies that there is no simple relationship between loss of peripheral nerve function and spontaneous or evoked pain. Rather, the preservation of several sensory modalities in their area of maximal pain suggests that in some PHN patients, activity in primary afferent nociceptors that remain connected to both their peripheral and central targets contributes significantly to ongoing pain. Although other mechanisms are likely to contribute to the pain, the demonstrated responsivity of PHN to topical agents including local anaesthetics, capsaicin, and non-steroidal anti-inflammatory drugs, supports this proposed mechanism of pain generation.