Articles: neuralgia.
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Oral medication is the simplest way in treatment of chronic pain. For cancer pain oral analgesics are efficacious in more than 90% of the patients. When a causal therapy of pain (e.g. chemotherapy, operation) fails an analgesic ladder with oral analgesics is instituted. ⋯ In any state of pain the response to the different groups of drugs should be evaluated first. Then a stepwise pharmacological approach should be performed. In most cases pain can be treated effectively by oral drugs.
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Seventeen years' experience of spinal cord stimulation in the treatment of chronic pain has shown it to be effective only in the case of neuropathic pain--in particular, pain due to lesions in peripheral nerves or posterior roots. In such cases, pharmacological treatment is often unsuccessful, and transcutaneous electrical nerve stimulation is only useful in certain cases. ⋯ Trial stimulation via a temporary extension lead for at least 4-5 days is a prerequisite of good long-term results. It is concluded that spinal cord stimulation is an indispensable tool for treating chronic neuropathic pain, and it merits to be used more frequently.
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20 patients with neuropathic pain syndromes due to tumor-infiltration, who had not responded to conventional analgesics including strong opioids, received additional combination anti-convulsant and anti-depressant treatment. Pain amelioration occurred in all patients within median 46 h, and maximum effect was encountered within one week. ⋯ Replacement by another type of anticonvulsants in 6 cases with either no response or intolerable side effects was successful in 5 patients, both in terms of efficacy and tolerability. One patient stopped taking AD/AC after 48 h.
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Ninety cases of chronic perineal pain of neurological origin are reported. Alcock's canal syndrome, consecutive to damage of the pudendal nerve in the ischiorectal fossa, is the most frequent of these neuralgias. It is characterized by burning pain or paraesthesia increased in sitting position and relieved by standing up. ⋯ Other neurological causes are spinal cord lesions (notably tumours of the conus medullaris), sacral meningoradiculitis (perineal herpes zoster), plexitis and pudendal nerve neuritis. In some cases the responsibility of perineal stretching neuropathy may be considered. In all patients, electrophysiological exploration of the perineum (detection of perineal floor muscles, sacral latency, somatosensory and motor evoked potentials of the pudendal nerve) are necessary to confirm the aetiological diagnosis and guide neurological investigations.