Physical medicine and rehabilitation clinics of North America
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Much progress has been made in the assessment and management of neuropathic pain over the past 5 years. Assessment has improved with the Neuropathic Pain Scale, a new, easily administered, diagnostic tool. Mechanistically, recent studies indicate that peripheral neuropathic pain is generated through a focal inflammatory process rather than axonal destruction. ⋯ Mexiletine is a reasonable alternative agent in patients who have not had a satisfactory response to, or cannot tolerate, the AEDs or antidepressants. Long-acting opioids should be considered in patients refractory to these adjunctive agents. With the advent of the topical lidocaine patch, the first drug with an FDA-approved indication for postherpetic neuralgia, a revolutionary new agent is now available for the treatment of neuropathic pain that does not have any systemic side effects.
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Phys Med Rehabil Clin N Am · May 2001
ReviewMagnetic resonance imaging of the peripheral nervous system.
An accurate diagnosis is the essential first step toward a successful treatment plan in patients who present with pain and suspected nerve entrapment. Pain and dysfunction are often related to an acute traumatic event or a classic presentation that leads to a straightforward clinical diagnosis. The diagnostic approach to abnormalities of the peripheral nervous system always begins with a thorough history and physical examination. ⋯ MR imaging remains an evolving technique with ongoing improvements in technology and developing clinical experience, resulting in greater diagnostic capacity. In this article current technique and strategies for image analysis and the authors' specific clinical experience with MR imaging of peripheral nerve disorders are reviewed. The exact role of MR imaging in the evaluation of these disorders will be further defined with additional experimental work and published clinical experience.