Articles: neuralgia.
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Somatic sensory perception thresholds (warm, cold, hot pain, touch, pinprick, vibration, two-point discrimination), allodynia and skin temperature were assessed in the affected area of 42 patients with unilateral postherpetic neuralgia (PHN) and 20 patients who had had unilateral shingles not followed by PHN (NoPHN), and in the mirror-image area on the other side. There was no difference between the two groups for age or length of time after the acute herpes zoster infection. The PHN group showed significant changes in all sensory threshold measurements when the affected area was compared with the mirror-image area on the unaffected side, while the NoPHN group exhibited no threshold changes. ⋯ No differences in skin temperature were recorded between affected and unaffected regions in either group. Our findings show a deficit of sensory functions mediated by both large and small primary afferent fibres and also suggest major central involvement in the pathophysiology of the condition. If PHN does not occur following acute herpes zoster, recovery of neural functions appears to be good.
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Randomized Controlled Trial Clinical Trial
Double-blind, placebo-controlled clinical trial of a mixture of gangliosides ('Cronassial') in post-herpetic neuralgia.
A double-blind, parallel-group clinical trial was carried out in 25 patients with post-herpetic neuralgia to determine the efficacy and tolerability of a mixture of gangliosides ('Cronassial') compared with placebo. Patients were allocated at random to receive treatment with either 'Cronassial' (100 mg in 2 ml buffered solution) or placebo given by 11 subcutaneous injections over a period of 27 days, and their symptoms assessed on entry and after 2, 4 and 8 weeks. The four aspects of pain considered (overall pain, hyperaesthesia, stabbing pain and constant ache) all showed maintained reductions in severity with 'Cronassial' treatment, but not with placebo. ⋯ Two of these 5 patients were withdrawn from the study. There were no withdrawals in the placebo group. It is suggested that further studies employing greater numbers of patients should be carried out to confirm the efficacy of gangliosides in improving symptoms of patients with post-herpetic neuralgia.
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Acta Derm. Venereol. · Jan 1990
Argon laser induced cutaneous sensory and pain thresholds in post-herpetic neuralgia. Quantitative modulation by topical capsaicin.
Sensory and pain thresholds to cutaneous argon laser stimulation were determined in patients with post-herpetic neuralgia before and during treatment with topical capsaicin. Before treatment both thresholds were significantly elevated on the affected side compared to the contralateral normal area. After one week of capsaicin treatment both thresholds were significantly increased compared to the pre-treatment values, and the subjective pain relief, measured on a visual analogue scale (VAS) was 24%. ⋯ Laser stimulations at levels at which the sensory and pain thresholds are reached were initially described as burning or stinging with pain projecting outside the stimulated area. This allodynia to laser stimulations changed during capsaicin treatment towards normal sensory and pain perception qualities. Both sensory and pain thresholds and the subjective pain score evaluated on a visual analogue scale were attenuated during the capsaicin treatment, suggesting a significant role of the cutaneous sensory and pain receptors in postherpetic neuralgia.