Nihon rinsho. Japanese journal of clinical medicine
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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.
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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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This article presents the current management of acute pain(posttraumatic and postoperative pain). The management of acute pain, especially postoperative pain, makes a great advance in this twenty years. The discovery of physiology and pharmacology of pain mechanisms made a great contribution to the improvement of the patient care during postoperative period. ⋯ So these days postoperative pain, the major complaint during the postoperative period, is almost improved at the hospital that coordinates pain treatment strategies. The management of pain improves the quality of life for the postoperative patients and the prognosis of postoperative patients. We should take our warning to heart that the management of acute pain(postoperative, posttraumatic, and labor pain) is not only 'procedure' but also 'therapy' against the pain.
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In order to see the patients with low back pain and/or sciatica, it is most important to consider the pathophysiology of symptoms. We should know that the image findings such as X-ray and MRI do not always show the cause of symptom. Because degenerative changes in lumbar spine are common findings in asymptomatic group compared to symptomatic patients with low back pain and sciatica. According to pathophysiology (nerve root syndrome, cauda equina syndrome, facet syndrome, discogenic pain syndrome and intermittent claudication for low back pain), the treatment for low back pain and sciatica were described.
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The sequence of analgesic therapy for cancer pain should follow the WHO ladder regimen. Managing cancer pain with drug therapy provides the best results for the patients by using the combination of opioids, NSAIDs, and adjuvant analgesics. The selection or the combination of the drugs depends on the intensity, quality, and other characteristics of the pain. When the cancer pain is classified as neuropathic pain, we should use antidepressants, anticonvulsants, anxiolytics, or/and anti-arrhythmic drug.