Nihon rinsho. Japanese journal of clinical medicine
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Neuropathic pain results from injury to neural structures within the peripheral or central nervous systems. Such injury promotes spontaneous and ectopic firing of nerves as well as reorganization of the nervous system. Neuropathic pain persists chronically. ⋯ This hypersensitivity is manifest as hyperalgesia and allodynia. Complex regional pain syndrome, CRPS is a category of neuropathic pain and is further divided into type I(reflex sympathetic dystrophy: RSD) and type II(causalgia). CRPS is characterized by localized autonomic dysregulation in the affected area with vasomotor and/or sudomotor changes, edema, colour difference, sweating abnormality, and atrophy.
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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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Pharmacology, clinical efficacy and tolerability of serotonin noradrenaline reuptake inhibitors(SNRIs) are overviewed. They include milnacipran, venlafaxine, duloxetine, MCI-225 and nefazodone, however, only milnacipran is currently used in Japan. ⋯ SNRIs are well tolerated in general and safer than TCAs. SNRIs can be considered to be first-line antidepressant drugs.
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Depression in cancer patients is common and occurs throughout the course of cancer illness. We review diagnosing, treatment and palliative care issues as well as epidemiology and etiology of major depression in cancer patients. The prevalence of major depression in cancer patients was reported to range from 6 to 42%. ⋯ To avoid under-diagnosing depression in cancer patient, it should include not only psychological symptoms, but also physical symptoms. The treatment includes patient education, counseling, behavioral techniques and antidepressant medications. In palliative care setting, life review interview would be effective for depression.