Articles: neuralgia.
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We investigated the efficacy and safety of twice-daily bilayer sustained-release tramadol hydrochloride tablets (35% immediate-release; 65% sustained-release) in patients with postherpetic neuralgia. ⋯ Sustained-release tramadol tablets with an immediate-release component are effective and well tolerated for managing postherpetic neuralgia.
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Although poorly studied, chronic postsurgical neuropathic pain (CPNP) represents the second most frequent chronic neuropathic pain etiology, probably affecting 0.5% to 75% of patients with a severe impact on quality of life (QoL). No consensus or treatment algorithm has been elaborated to date, despite a large variety of approaches now available. Transversus abdominis plane (TAP) block has been endorsed as an efficient treatment for acute postoperative pain although its effect on CPNP in terms of intensity and QoL has yet to be considered. ⋯ The TAP block is easy to learn, easy to reproduce, and easy to administer. After pooling our results with those from the literature, a TAP block is deemed to be effective for the treatment of CPNP with 82.25% effectiveness over a mean time of 13.9 weeks. A TAP block improves long-term QoL, reduces consumption of painkillers and lowers pain scale scores. Thus, it may reduce health care costs. We argue that A TAP block should be considered early, from the onset of the first pain symptoms.
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Case Reports Randomized Controlled Trial
Dorsal Root Ganglion Stimulation for the Treatment of Joint Pain with Predominantly Nociceptive Characteristics: A Case Series.
Dorsal root ganglion stimulation (DRG-S) has recently emerged as a novel therapy in neuromodulation that demonstrated a higher rate of success than spinal cord stimulation (SCS) in a prospective, head-to-head randomized comparative trial to treat complex regional pain syndrome (CRPS) and causalgia. In contrast to SCS, DRG-S also shows promise in treating conditions that are not purely neuropathic such as axial low back pain, which has a prominent nociplastic pain component. It is not known to what extent the effectiveness of DRG-S for such indications is due to effective treatment of the neuropathic pain component versus the effects of DRG-S on mechanical pain. Although rarely studied, reporting outcomes of DRG-S to treat predominantly mechanical/nociceptive pain may help point toward expanding the utility of this therapy. Here, we present five cases of refractory mechanical pain treated with DRG-S. ⋯ This clinical report illustrates the potential utility DRG-S has in treating pain that clinically presents as predominantly refractory mechanical joint pain without a significant neuropathic component. The physiological reasons for our observations may be that DRG-S is able to directly influence the conduction of nociceptive signaling at the DRG and within the spinal cord. Further investigations are warranted to determine if DRG-S is a potential treatment option for chronic mechanical pain.
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Clinical Trial
Capsaicin treatment in neuropathic pain: axon reflex vasodilatation after four weeks correlates with pain reduction.
Capsaicin, an agonist at the transient receptor potential vanilloid 1, is used for the topical treatment of peripheral neuropathic pain. Reversible receptor defunctionalization and degeneration and subsequent regeneration of cutaneous nociceptors are discussed as its mechanism of action. Here, we hypothesize an accelerated functional recovery of a subclass of nociceptive afferents, the peptidergic vasoactive nociceptors, as the potential cause of capsaicin analgesia. ⋯ Patients with improved heat-evoked neurogenic vasodilatation at week 4 showed a greater pain reduction than those with deterioration. The degree of vasodilatation significantly correlated with pain reduction. These findings suggest that (1) regeneration of peptidergic nociceptors may be the mechanism behind capsaicin-induced analgesia and (2) that a disease-modifying effect of capsaicin on these fibers already occurs 4 weeks after application.
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Zoster-associated pain (ZAP) represents an important medical, social, and economic problem. The treatment approach for ZAP continues to be challenging. Tender point infiltration (TPI) with local anesthetic and steroids has been demonstrated to have potential in the treatment of severe pain, but there are rare reports of the efficacy and security of TPI for acute and subacute ZAP. ⋯ TPI can be a useful and safe option for the control of acute and subacute ZAP with high feasibility. Early application of TPI in the acute phase of herpes zoster pain may show better clinical outcomes.