Articles: neuralgia.
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Reg Anesth Pain Med · Sep 2004
ReviewNeuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence.
Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. ⋯ Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.
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J Pain Symptom Manage · Sep 2004
Review Case ReportsThe management of malignant psoas syndrome: case reports and literature review.
Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. ⋯ The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.
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Following chicken pox infection, varicella-zoster virus stays as a latent infection in sensory root ganglia. After many years, the reactivation of this latent virus in sensory ganglia causes "herpes zoster". Herpes zoster (shingles) is an unilateral, dermatomal, localised, painful, vesicular, and contagious skin infection. ⋯ Early intervention with antiviral treatment, analgesic therapy and antidepressant therapy may reduce the risk of these complications. The treatment of PHN is same as for other neuropathic pain syndromes. The clinical importance of PHN is due to the severity and chronicity of pain which is usually not responsive to many treatments, and quality of life may be adversely affected by PHN.
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The generation of neuropathic pain is a complex phenomenon involving a process of peripheral and central sensitization producing enhanced transmission of nociceptive inputs to the brain associated with the loss of discriminatory processing of noxious and innocuous stimuli. This increased flow of abnormally processed nociceptive inputs to the brain may overcome the ability of descending modulatory pathways to produce analgesia, causing further worsening of the pain. Several crucial locations involved in the physiologic generation of pain inputs (eg, peripheral nociceptors, dorsal horns, thalamus, cortex) show evidence of functional reorganization and altered nociceptive processing in association with chronic pain. These locations present the best targets for therapeutic intervention, including systemic administration of drugs able to counteract the chemical storm induced by neural injuries in the nociceptive afferents and dorsal horns, or for more focused intervention, such as neuroablative procedures; intrathecal drug delivery; and spinal cord, deep brain, or motor cortex stimulation.
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Treatment of neuropathic pain is the primary focus of management for many patients with painful peripheral neuropathy. Antidepressants and anticonvulsants are the two pharmacological classes most widely studied and represent first-line agents in the management of neuropathic pain. ⋯ In the current review, we summarize data from randomized, controlled pharmacological trials in painful peripheral neuropathies. Although neuropathic pain management remains challenging because the response to therapy varies considerably between patients, and pain relief is rarely complete, a majority of patients can benefit from monotherapy using a well-chosen agent or polypharmacy that combines medications with different mechanisms of action.