Articles: neuralgia.
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The plethora of terms included in the broad category of sympathetic dystrophies, and causalgia in particular, has made specific disorders, with unique clinical characteristics, very difficult to isolate into discrete clinical entities. Rather, the sympathetic dystrophies currently are regarded as existing along a continuum of varying severity and as having one basic pathophysiological mechanism, with considerable overlap of terms. The purposes of this article are 1) to review the theories of physiological mechanisms of causalgia and other forms of sympathetically maintained pain, 2) to describe their clinical characteristics, and 3) to discuss their physical therapy management.
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Review Case Reports
Herpes zoster and post-herpetic neuralgia: diagnosis and management.
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J. Am. Acad. Dermatol. · Jul 1987
Treatment of chronic postherpetic neuralgia with topical capsaicin. A preliminary study.
Continuing pain following herpes zoster is common in patients 60 years of age or older. Current treatments are generally unsatisfactory. The endogenous neuropeptide substance P is an important chemomediator of nociceptive impulses from the periphery to the central nervous system and has been demonstrated in high levels in sensory nerves supplying sites of chronic inflammation. ⋯ Of the 12 patients completing this preliminary study, 9 (75%) experienced substantial relief of their pain. The only adverse reaction was an intermittent, localized burning sensation experienced by one patient with application of capsaicin. Although these results are preliminary, they suggest that topical application of capsaicin may provide a useful approach for alleviating postherpetic neuralgia and other syndromes characterized by severe localized pain.
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During the 10-year period from 1975 to 1985 20 patients suffering from causalgia were treated. There were 15 men and five women. Ages ranged from 17 to 45 years (mean, 23). ⋯ The diagnosis of causalgia was based on the characteristic clinical picture and was confirmed by sympathetic blocks. All patients were treated by sympathectomy and all had complete dramatic relief in the immediate postoperative period. Followup ranged from 4 months to 10 years (mean, 5.3 yr).
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Seventy-one patients presenting with acute herpes zoster ophthalmicus were followed up for six months for a prospective analysis of the natural history of the disease. Acute and chronic ocular complications, nasociliary nerve involvement, age, sex, rash, and pain were assessed, and the results are presented. Acute pain was measured by a visual analogue scale. ⋯ Duration of rash was longer in patients who developed PHN. No other associations between the parameters studied were found. Nasociliary nerve involvement was associated with subsequent ocular disease.