Articles: neuralgia.
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Review Comparative Study
Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis.
Capsaicin, the active principle of hot chili pepper, is thought to selectively stimulate unmyelinated C fibre afferent neurons and cause the release of substance P. Prolonged application of capsaicin reversibly depletes stores of substance P, and possibly other neurotransmitters, from sensory nerve endings. This reduces or abolishes the transmission of painful stimuli from the peripheral nerve fibres to the higher centres. ⋯ Topical capsaicin is not associated with any severe systemic adverse effects. However, stinging and burning, particularly during the first week of therapy, is reported by many patients. Topical capsaicin merits consideration as adjuvant therapy in conditions such as post-herpetic neuralgia, diabetic neuropathy and osteoarthritis, where the pain can be chronic and difficult to treat.
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Regional anesthesia · May 1995
ReviewDoes sympathetic ganglionic block prevent postherpetic neuralgia? Literature review.
To examine specifically the role of sympathetic block in the prevention of postherpetic neuralgia by its application in the treatment of acute herpes zoster. ⋯ Considering the degree of uncertainty, and the seriousness of postherpetic neuralgia, sympathetic block in addition to treatment with acyclovir should be considered early during acute herpes zoster. Large controlled trials are needed to provide the necessary scientific evidence.
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Although a number of randomized controlled trials of treatment for herpes zoster have been performed, there is no consensus on how it should be managed in general practice. A systematic review of existing trials, including meta-analysis, was performed to determine the efficacy of available therapies in reducing the incidence of postherpetic neuralgia. The treatments studied included antiviral agents, corticosteroids and other drugs which had been studied in randomized trials. ⋯ Many clinical trials in this area have been too small to give reliable results. Variations in the definition and reporting of postherpetic neuralgia create difficulties in combining data from different studies. Firm recommendations for clinical practice are not possible because existing evidence neither confirms nor refutes the hypothesis that treatment during the acute phase of herpes zoster reduces pain later.
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Postherpetic neuralgia (PHN) is the most feared complication of herpes zoster and remains one of the most common and intractable chronic pain disorders. Recent evidence has shed some light on the possible mechanisms of pain, and on the prophylactic and treatment approaches to PHN. This article reviews the current concepts and management of PHN.