Articles: neuralgia.
-
Case Reports
[A complete relief of intractable postherpetic neuralgia with intrathecal methylprednisolone acetate].
A 72-year-old man, 154 cm tall, weighing 53 kg was suffering from severe herpetic neuralgia on his left 10th intercostal nerve area. His pain continued even he was treated with frequent epidural nerve block (4 to 5 times per week) by an anesthesiologist. He was referred to our hospital on his 105th pain day. ⋯ The pain was relieved completely after the block. And he complained nothing about the skin area which had been disturbing his life for a long time. Auditory brainstem response which was recorded during the block showed prolongation of the latency of phase III and phase V at 40 minutes after the intrathecal injection of lidocaine.
-
The anatomic study of the pudendal nerve and its relation allows an approach of the mechanisms of compression likely to engender perineal neuralgia. Two conflictual zones are isolated: the first is linked to the clamp which is produced by the insertion of the sacro-epinous ligament on the ischial spine and the sacro-tuberal ligament; the second is linked to the falciform process of the sacrotuberal which threatens the nerve by its sharp upper edge. This conflict is particularly acute in a sitting position. ⋯ The anesthetic blocks of the pudendal nerve on the ischial spine only have a complimentary diagnostic value. The peridural blocks may also have an interesting therapeutic action (60% of good results 3 months later). In some persistent cases, the nerve has been decompressed firstly by perineal approach, but latterly by transguteal approach.
-
The analgesic efficacy of 5% of EMLA cream (5 or 10 g) when applied for 24 h periods was evaluated in 5 female and 7 male patients (mean age 69 years, range 50-85 years) with refractory post-herpetic neuralgia (PHN). Mean visual analogue pain intensity scores for all patients were significantly improved 6 h after application (P less than 0.05). In a subgroup of patients with facial PHN receiving EMLA cream, 5 g (n = 4), there were significant improvements in pain intensity scores at 6 h (P less than 0.05). 8 h (P less than 0.01) and 10 h (P less than 0.01) after application. Plasma lignocaine and plasma prilocaine concentrations were well below potentially toxic levels in all patients after application.
-
Case Reports
Post-herpetic neuralgia: the relation of pain complaint, sensory disturbance, and skin temperature.
Twelve otherwise healthy patients with longstanding postherpetic neuralgia (PHN) were prospectively studied using clinical examination, infrared thermography and response to local anesthetic skin infiltration. All had at least 2 of 3 possible components to their PHN pain: continuous, neuralgic, or allodynic. In patients with allodynia, maximal reported pain and the location of maximal allodynia on sensory examination were largely overlapping and were often warm thermographically. ⋯ These results suggest that PHN patients can be divided into at least 2 clinical groups: those with predominantly continuous pain localized to a region of significant sensory loss and those in whom allodynia is the most prominent sensory disturbance. The latter group has pain localized to areas with relatively preserved sensation. The differences in clinical features and response to lidocaine suggest that there are at least 2 different mechanisms contributing to the pain of PHN.
-
Schweiz. Rundsch. Med. Prax. · Oct 1989
Review[Palliative neurosurgical treatment of chronic pain following peripheral nerve lesions].
Pathogenesis of pain after traumatic or iatrogenic lesions to peripheral nerves as well as local and conservative therapeutic possibilities are briefly reviewed. If pain subsides or in the case of relapse with establishment of a chronic pain-state the therapy of choice consists in implanting a programmable neuro-stimulator with the electrodes placed near the dorsal sensory roots in the cervical epidural space for the upper extremities or along the posterior columns of the medulla in the thoracic epidural space for the legs. With a success rate for long term pain control of approximately 80% this reversible method which is well tolerated by the nervous system should always be considered for deafferentation-pain (neurogenic pain).