Articles: neuralgia.
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Neuropathic pain is suffered by approximately 1% of the UK population and poses a vast socio-economic problem through unemployment and expenditure on medical and social services. It also presents a major therapeutic challenge to healthcare professionals, since it can be difficult to recognize and to treat. With the advent of new and effective medications, the prognosis for patients can be significantly improved by early recognition and aggressive therapy. This article aims to equip nurses with the assessment skills to identify neuropathic pain and a basis from which to expedite pain relief through appropriate intervention and referral within the multidisciplinary team.
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J Pain Symptom Manage · Oct 2004
ReviewTreatment of postherpetic neuralgia: a review of therapeutic options.
Postherpetic neuralgia (PHN) is a disabling consequence of the reactivation of the varicella zoster infection. The observation that patients with PHN experience various types of pain suggests that multiple pathophysiologic mechanisms are involved, which may include the peripheral and central nervous systems. A reasonable initial strategy would involve selecting from among multiple agents that have complementary mechanisms of action and that have been proven effective in controlled clinical trials, such as the lidocaine patch 5%, gabapentin, tricyclic antidepressants, and opioids. ⋯ Physicians can either add another agent to the current regimen or switch to a new type of monotherapy if there is inadequate response to initial therapy. Alternative therapies, (i.e., ketamine, intrathecal corticosteroid injections) have not been adequately studied. Well-designed, multicenter, controlled clinical trials are needed to develop a treatment algorithm that provides an evidence-based, rational approach to treating PHN.
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A systematic review of the literature on postherpetic neuralgia was performed. The authors identified studies using the National Library of Medicine's Medline database and Cochrane Library database. The authors determined absolute reduction rate, number needed to treat (NNT), 95% CI for NNT, and number needed to harm (NNH) for successful therapies of postherpetic neuralgia. Tricyclic antidepressants, gabapentin, pregabalin, opioids, and lidocaine patch were found to be effective in reducing the pain of postherpetic neuralgia.
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Postgraduate medicine · Sep 2004
ReviewThree common neuralgias. How to manage trigeminal, occipital, and postherpetic pain.
The pain experienced by patients with trigeminal, occipital, or postherpetic neuralgia is often severe, chronic, and difficult to treat. In this article, Drs Ashkenazi and Levin outline the pathologic mechanisms of pain in these common neuralgias and discuss individually tailored pharmacologic and surgical approaches to their treatment.