Nihon rinsho. Japanese journal of clinical medicine
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Pain associated with herpes zoster arise from the virul neuritis of the suffered trigeminal or spinal dorsal ganglion. Prolonged neuritis makes an irreversible nerve injury and continuous pain impulse develops a central sensitization. A post-herpetic neuralgia is thought to be a neuropathic pain due to the irreversible nerve injury and sensitization. ⋯ It is also known that some sympathetic mechanisms relate to the development of the sensitization. A sensory nerve block reduces pain impulse to the dorsal horn, and may interfere the sensitization. A cortico-steroid administrated with a nerve block can reduce the neuritis, and may improve the nerve injury.
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Morphine is clinically superior in relieving severe pain such as cancer pain. However, considering misplaced fears of the dangers of dependence potential and abuse liability, doctors have hesitated to treat patients with morphine. ⋯ The present study was then designed to investigate the rewarding effects induced by morphine under chronic pain by inflammatory and neuropathic pain in rodents. Furthermore, we also investigated whether any biological changes to interfere with the effects of morphine could be seen under chronic pain.
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The WHO guidelines have much improved cancer pain management in Japan. In 1987, the Ministry of Health established new policy on palliative care, revised narcotics control measures, and edited guidelines on palliative care. ⋯ In order to further achieve program implementation, educational approach should be much more strengthened. It is also emphasized that each health care professional should recognize the ethics in pain relief and each hospital should urgently has its policy to achieve freedom from cancer pain for all throughout Japan.
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Cancer pain is usually treated by 1) pharmacotherapy, 2) nerve block, 3) radiation therapy, 4) cognitive therapy and 5) alternative medicine. Among these methods, pharmacotherapy is the simplest way to relieve cancer pain without special equipment or special settings. WHO cancer treatment guideline shows morphine is effective to most cancer pain. ⋯ Recently, many biological processes involved in the mechanism of neuropathic pain have been elucidated. Pharmacological treatment aimed at blocking such processes should produce specific effects on the pain. Such mechanism-based pharmacotherapy is the most effective way to treat difficult pain.
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Trigeminal neuralgia is a disease affecting older individuals. The clinical hallmark of trigeminal neuralgia is a sudden, excruciating paroxysm of pain in the area of the trigeminal nerve. Drug therapy is considered the first line of treatment for trigeminal neuralgia. ⋯ Nerve block with neurolytic solutions and radiofrequency thermocoagulation is a simple, less invasive therapy. In order to avoid hypesthesia and dysesthesia, nerve block using a high concentration of local anesthetics is recommended. In recent years, stereotactic radiosurgery for trigeminal neuralgia has emerged as a new therapeutic modality.