Articles: neuralgia.
-
Pain to light touching of the skin is a hallmark sign of causalgia. The purpose of this study was to determine whether myelinated or unmyelinated afferent fibers signal this hyperalgesia. Sensory testing was performed in 17 patients with long-standing hyperalgesia after nerve injury. ⋯ The mean latency for detection of pain in the hyperalgesic region was 414 +/- 18 msec, compared to 458 +/- 16 msec for the detection of touch to the same stimuli applied to the opposite normal foot. These 3 lines of evidence indicate that myelinated primary afferents, perhaps A beta fibers, signal the hyperalgesic pain in causalgia. These fibers may be sensitized A beta nociceptors or low-threshold mechanoreceptors.
-
Hyperalgesia and allodynia, lasting for months or even years, occurs in the form of post-herpetic neuralgia in approximately 70% of adults previously infected with the varicella herpes zoster virus. The present study aimed at testing the analgesic desensitising actions and reversibility of repeated application of topical capsaicin on disordered polymodal nociceptors and peptidergic sensory fibres mediating warm and pain sensation. Cutaneous nociceptor desensitisation was measured using the Glasgow automated thermal threshold test (Medelec TTT). ⋯ There was a poor correlation between pain relief and elevation of warm detection in response to capsaicin treatment. Generally, it was found that those patients with less initial desensitisation to warm detection as a consequence of post-herpetic neuralgia experienced better pain relief after capsaicin was applied. The method used permits determination of the minimum effective desensitising dose of capsaicin, enables patient compliance and progress to be monitored and should allow the prediction of patients likely to achieve the best response to treatment.
-
Fifteen cases of perineal neuralgia are reviewed, the lesion arising from a canal syndrome due to compression of the pudendal nerve in the ischiorectal fossa (Alcock's canal syndrome). The clinical characteristic of the pain syndrome was its postural nature with the existence of a true Tinel sign (increased pain on sitting). ⋯ Treatment was infiltration of cortisone derivatives into the pudendal nerve canal, under CT guidance because of the difficulty of infiltrating the pudendal nerve by an external perineal approach. Results were satisfactory in 9 of the 15 patients.
-
Zentralbl. Neurochir. · Jan 1988
Crossed transvertebral puncture to block spinal ganglion in treatment of pain.
A simple and highly efficient percutaneous method eliminating the spinal ganglion and its posterior spinal cord root in treating metameric pain is described. Monitored by X-ray the needle crosses the vertebral canal passing e.g. from the right into the left intervertebral space. The intervention itself is made by a mesocaine alcohol block. The first experience with 12 patients is favourable in postdiscotomic syndromes or lumbar and causalgic pains in lower extremities having no mechanical cause discovered by CT.
-
During the past 7 years 30 patients were diagnosed as having either ilioinguinal or genitofemoral entrapment neuralgia. A multidisciplinary approach (surgeon, neurologist, and anesthesiologist), as well as local blocks of the ilioinguinal nerve and/or paravertebral blocks of L-1 and L-2 (genitofemoral nerve), were essential to determine accurately which nerve was specifically involved. Fifteen of the 17 patients (88%) diagnosed as having ilioinguinal neuralgia after previous inguinal herniorrhaphy are pain free after resection of the entrapped portion of the nerve. ⋯ Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 10 of 13 (77%) of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of surgery in the inguinal region. When accurately diagnosed, neurectomy of the specific nerve is highly successful in relieving severe pain and paresthesia without significant morbidity.