Articles: neuralgia.
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Review Meta Analysis
Peripheral Percutaneous Electrical Nerve Stimulation for Neuropathies: A Systematic Review and Meta-analysis.
The main objective of this review is to demonstrate the use of Peripheral Percutaneous Electrical Nerve Stimulation (PENS), together with its most up-to-date protocols, for the treatment of neuropathies. ⋯ PENS requires nurse education on electrode/needle placement and patient instruction, with documentation of key parameters. This review emphasizes the need for further research to establish standardized protocols and optimal application parameters for different neuropathic pain conditions.
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For trigeminal neuralgia (TN), a major role of imaging is to identify the causes, but recent studies demonstrated structural and microstructural changes in the affected nerve. Moreover, an increasing number of studies have reported central nervous system involvement in TN. In this systematic review, recent quantitative magnetic resonance imaging (MRI) studies of the trigeminal nerve and the brain in patients with TN were compiled, organized, and discussed, particularly emphasizing the possible background mechanisms and the interpretation of the results. ⋯ Studies of the affected nerve demonstrated evidence of demyelination and axonal damage, compatible with pathological findings, and have shown its potential value as a tool to assess treatment outcomes. Quantitative MRI has also revealed the possibility of dynamic microstructural, structural, and functional neuronal plasticity of the brain. Further studies are needed to understand these complex mechanisms of neuronal plasticity and to achieve a consensus on the clinical use of quantitative MRI in TN.
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Non-invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic pain (NP), a prevalent and complex condition. However, treating NP remains challenging due to the numerous variables involved, such as different techniques, dosages and aetiologies. It is necessary to provide insights for clinicians and public healthcare managers to support clinical decision-making. This umbrella review aims to consolidate existing evidence on the effectiveness of various NIN in managing chronic NP. ⋯ This paper consolidates the evidence regarding non-invasive neuromodulation for the treatment of neuropathic pain, including differentiating the most effective techniques based on the aetiology of pain, and provides clinicians with easy access to this critical information. It also highlights key aspects that require further research in the field of non-invasive neuromodulation and neuropathic pain.
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This review discusses the diagnosis and treatment of nervus intermedius neuralgia (NIN) and identifies gaps in the literature. ⋯ The nervus intermedius is a branch of the facial nerve. NIN presents as a rare neuralgia of this nerve, causing deep ear pain, which may radiate to the auditory canal, auricle, mastoid, soft palate, temple, and angle of the jaw. NIN most commonly presents in middle-aged women; neurovascular compression involving the anterior inferior cerebellar artery is the most common etiology described. Despite its diagnostic criteria in the International Classification of Headache Disorders, 3rd edition (ICHD-3), NIN may lack a trigger zone and may manifest as achy or neuralgiform pain instead of the typically described sharp or shooting pain. Like trigeminal neuralgia, NIN can be divided into classic, idiopathic, secondary, or painful neuropathy. Although there are no established guidelines for treating NIN, many possible treatments are used. Experience from treating trigeminal neuralgia suggests that carbamazepine or oxcarbazepine can be considered first-line. Patients with medically refractory NIN may benefit from neurosurgery referral for microvascular decompression or nerve sectioning. More research is needed to elucidate the range of clinical presentations in patients with NIN. Current data are limited and suggest that symptoms may diverge from the ICHD-3 diagnostic criteria. Although various treatments have been attempted, they often lack solid evidence and are typically derived from approaches used for other neuralgias. Proper diagnosis is crucial, particularly when considering surgical referral, due to the potential overlap of NIN with other neuralgias affecting the head and neck.
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Cervicogenic headache (CEH) and occipital neuralgia (ON) are headaches originating in the occiput and that radiate to the vertex. Because of the intimate relationship between structures based in the occiput and those in the upper cervical region, there is significant overlap between the presentation of CEH and ON. Diagnosis starts with a headache history to assess for diagnostic criteria formulated by the International Headache Society. Physical examination evaluates range of motion of the neck and the presence of tender areas or pressure points. ⋯ The treatment of CEH preferentially consists of radiofrequency treatment of the facet joints, while for ON, pulsed radiofrequency of the occipital nerves is indicated. For refractory cases, ONS may be considered.