Articles: neuralgia.
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Neurectomy of the inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy inguinal pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique. ⋯ Sensory mapping provides an accurate clinical neuropathic assessment with strong correlation to QST findings of preoperative mechanical and pressure allodynia, and postoperative mechanical and thermal hypoesthesia in CPIP patients undergoing neurectomy.
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Journal of anesthesia · Apr 2017
Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer.
Pain after tumorectomy and sentinel lymph node dissection is poorly reported in the literature. We carried out a prospective survey aimed at assessing pain three months after such minor surgery for breast cancer. ⋯ Pain persisted up to three months after minor surgery for breast cancer in 40% of patients with mostly a neuropathic component (61%).
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Clinically, Microtubule-targeted agents-induced neuropathic pain hampers chemotherapeutics for patients with cancer. Here, we found that application of paclitaxel or vincristine increased the protein and mRNA expression of CXCL12 and frequency and amplitude of miniature excitatory post synaptic currents (mEPSCs) in spinal dorsal horn neurons. Spinal local application of CXCL12 induced the long-term potentiation of nociceptive synaptic transmission and increased the amplitude of mEPSCs. ⋯ Inhibition of STAT3 by intrathecal injection of adeno-associated virus encoding Cre and green fluorescent protein into STAT3 mice or inhibitor S3I-201 into rats suppressed the CXCL12 upsurge by decreasing the acetylation of histone H4. Finally, blockade of CXCR4 but not CXCR7 ameliorated the paclitaxel- or vincristine-induced mechanical allodynia. Together, these results suggested that enhanced interaction between STAT3 and p300 mediated the epigenetic upregulation of CXCL12 in dorsal horn neurons, which contributed to the antitubulin chemotherapeutics-induced persistent pain.
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The styloid process arising from the temporal bone is normally about 2.5 cm in length. For various reasons, including trauma and inflammation, it may become elongated. This elongated styloid process, when symptomatic with clinical signs and symptoms suggestive of local compression or neuropathic pain, is termed Eagle syndrome. ⋯ Interventional and surgical options are pursued when these fail. Fluoroscopy is usually used to position the needle adjacent to the styloid process for injecting steroid and or local anesthetic. We describe a case of a 41-year-old woman with Eagle syndrome who failed conservative management and subsequently underwent an ultrasound-guided peristyloid steroid injection with short-duration pain relief.