European journal of neurology : the official journal of the European Federation of Neurological Societies
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Review Case Reports Comparative Study
Post-stroke pain case study: clinical characteristics, therapeutic options and long-term follow-up.
Central post-stroke pain (CPSP) is a syndrome characterized by sensory disturbances and neuropathic pain. In 40%-60% of CPSP patients, the onset of central pain following a stroke occurs more than 1 month after the stroke, creating a source of diagnostic uncertainty or significant delay in treatment since healthcare providers familiar with CPSP may no longer be caring for the patient when the symptoms occur. In addition to chronic pain, the presence of somatosensory abnormalities is the most important diagnostic corollary of CPSP. ⋯ Treatment options for CPSP are limited; at present, amitriptyline is the drug of first choice. Other drugs including antidepressants, anticonvulsants, antiarrhythmics, opioids and N-methyl-d-aspartate antagonists may provide relief for some patients who do not respond to amitriptyline. Included in this review is a case study outlining the challenges of managing the patient with CPSP.
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Review Case Reports Comparative Study
Post-herpetic neuralgia case study: optimizing pain control.
Post-herpetic neuralgia (PHN) is a chronic pain syndrome associated with the reactivation of a primary infection with varicella zoster virus (chicken pox), which leads to a chronic infection of the dorsal root ganglia. Under various clinical circumstances, including immunosuppressive diseases or treatments and certain cancers, reactivation of the infection can occur in adults as shingles. Other factors such as psychological distress and stressful life events also appear to play a role in the onset of shingles and the development of PHN. ⋯ Current treatment options aimed at relieving the symptoms of PHN include antidepressants, opioids, anticonvulsants and topical analgesics. It is important for the clinician to establish a baseline pain intensity and character as well as quality of life measures against which to judge the effectiveness of any treatment. This review article features a case study of a patient with PHN to illustrate current diagnostic and treatment approaches.