Articles: neuralgia.
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Pediatric neurology · Jun 2006
ReviewNonepileptic uses of antiepileptic drugs in children and adolescents.
Antiepileptic drugs are often prescribed for nonepileptic neurologic and psychiatric conditions. The United States Food and Drug Administration has approved several antiepileptic drugs for the treatment of neuropathic pain, migraine, and mania in adults. For pediatric patients, use of antiepileptic drugs for non-seizure-related purposes is supported mainly by adult studies, open-label trials, and case reports. ⋯ Valproate and carbamazepine are "possibly effective" in the treatment of Sydenham chorea, and valproate is "probably effective" in decreasing aggressive behavior. Carbamazepine is "probably ineffective" in the treatment of aggression, and lamotrigine is "possibly ineffective" in improving the core symptom of pervasive developmental disorders. Despite the frequent use of antiepileptic drugs in the treatment of juvenile bipolar disorder, migraine, and neuropathic pain, the data are insufficient to make recommendations regarding the efficacy of antiepileptics in these conditions in children and adolescents.
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Herpes zoster (HZ), also known as shingles, is a painful vesicular rash resulting from reactivation of the virus that also causes chickenpox - Varicella zoster virus (VZV). Typically, the rash runs its course in a matter of 4-5 weeks. The pain, however, may persist months, even years, after the skin heals. ⋯ Conventional therapies include prescription antivirals, corticosteroids, and analgesics, both oral and topical. Other considerations include use of over-the-counter anti-inflammatory agents, physiotherapy, and nerve block injections. This article reviews herpes zoster and postherpetic neuralgia, and presents the most effective conventional treatment options currently available, as well as select botanical, nutritional, and other considerations that may be beneficial in the management of this condition.
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Curr Pain Headache Rep · Jun 2006
ReviewPregabalin for neuropathic pain based on recent clinical trials.
Pregabalin is a ligand for the alpha-2-delta subunit of voltage-gated calcium channels with anticonvulsant, analgesic, and anxiolytic properties. It has predictable absorption across the gastrointestinal tract, is neither metabolized nor protein-bound, and has minimal drug-drug interactions. It is effective with two or three-times daily dosing in a dose range of 150 to 600 mg daily. ⋯ The 50% responder rates for PHN and DPN compare favorably with other first-line agents for neuropathic pain. Pregabalin is well tolerated in most patients with infrequent severe adverse effects. Pregabalin is an important addition to the treatment armamentarium for neuropathic pain.
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Eight measures of neuropathic pain exist that have been designed to discriminate neuropathic from non-neuropathic pain and detect treatment effects. The current paper describes these measures and summarizes the evidence supporting their validity. ⋯ However, given the lack of overlap in measures designed for this purpose, it is likely that the validity of any one measure could be improved by incorporating items from the others. The Neuropathic Pain Scale (NPS) has the most empirical support as a measure of treatment outcome, although a new measure that includes the NPS items (the Pain Quality Assessment Scale) will likely prove to be even more useful, because it includes pain descriptors common to people with neuropathic and other chronic pain conditions not included on the NPS.
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Curr Pain Headache Rep · Jun 2006
ReviewNeuropathic pain: translational research and impact for patient care.
Neuropathic pain syndromes (ie, pain after a lesion or disease of the peripheral or central nervous system) are clinically characterized by spontaneous pain (ongoing, paroxysms) and evoked types of pain (hyperalgesia, allodynia). Different pathophysiologic mechanisms occur solitarily or combined at peripheral nociceptors, spinal cord, or in the brain, which cause a broad variety of signs and symptoms. ⋯ Therefore, a new concept was proposed in which pain is analyzed on the basis of underlying mechanisms. The increased knowledge of pain-generating mechanisms and their translation into signs and symptoms may allow for a dissection of the individual mechanisms, and it ultimately should be possible to design optimal treatments for each patient.