Articles: neuralgia.
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Post-herpetic neuralgia (PHN) is a disease caused by having had herpes zoster; it is not a continuation of shingles. Up to 50% of elderly patients who have had shingles may develop PHN. PHN is defined as pain recurring or continuing at the site of shingles, 1 or more months after the onset of the rash. ⋯ If patients with acute shingles are given low dose amitriptyline from the onset, only half as many are in pain at 6 months as a group not so treated, irrespective of the antiviral treatments given. The most effective treatment of established PHN to date consists of adrenergically active antidepressants. There is a strict correlation with the brevity of the interval between acute shingles and initiation of such treatment. 75% of patients starting treatment with antidepressants within 3 to 6 months after shingles obtain pain relief, whereas if antidepressants are not started for 2 years, only 25% obtain pain relief.(ABSTRACT TRUNCATED AT 250 WORDS)
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Current opinion on "neuropathic" pain is chaotic and divided. This review is a summary attempt at describing the principal hypotheses that are currently entertained and at interpreting the basic underlying mechanisms of these pains. ⋯ Issues such as the concept of "centralization" of neuropathic pain mechanisms, which dwell excessively upon extrapolation from animal experiment to human clinical reality, are highlighted as questionable. Psychogenic pseudoneuropathy, an entity of high clinical prevalence and low appreciation by basic scientists and the reflex sympathetic dystrophy establishment, is also given the emphasis it deserves.
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In the paper the possibilities of therapeutic use of capsaicin are presented. This drug seems to be very effective in neuralgia after zoster, and less effective in painful diabetic neuropathy. Attempts are also undertaken at its use in cluster headache, trigeminal neuralgia and arthralgia. Confirmation of the effectiveness of the discussed drug in these pain syndromes requires further studies.
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Herpes zoster is an infection caused by reactivation of dormant varicella-zoster virus. The acute course of herpes zoster is generally benign; however, some patients will experience postherpetic neuralgia characterized by severe, relentless, and at times disabling pain that is often refractory to treatment. While herpes zoster responds to acyclovir, cost-benefit considerations limit the drug's usefulness to only a select group. Postherpetic neuralgia requires a holistic approach, including pharmacologic therapy using several different classes of drugs.