Articles: neuropathic-pain.
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Background. Lyme disease is caused by Borrelia, a bacterium transmitted by the bite of a deer tick. A slow developing encephalopathy or an axonal polyneuropathy with distal paresthesia and spinal or radicular pain rarely occurs and can be hard to treat. ⋯ Results. After 18 months of therapy and follow-up, this patient's analgesia, as a result of SCS, continues to be excellent, with almost complete subjective pain relief and cessation of adjuvant analgesic medication. Conclusions. SCS may be efficacious for the treatment of neuropathic pain due to Lyme disease.
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Pain initiated or caused by a primary lesion or dysfunction in the nervous system is defined as neuropathic pain. About 75 -150 million people in the United States are suffering for chronic pain disorder. Neuropathic pain has a great impact on the human wellbeing. ⋯ Current available drugs are usually not acting on the several mechanisms underlying the generation and propagation of pain. Nowadays, pain research is focusing on newer molecular ways, such as stem cell therapy, gene therapy, and viral vectors for delivery of biologic anti-nociceptive molecules. These methods could provide a new therapeutic approach to neuropathic pain relief.
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Spinal cord stimulation (SCS) is an effective technique for the relief of neuropathic pain. Biologic complications are more prevalent within the first 3 months after implantation, are generally minor and reversible, and do not affect patients' acceptance of the treatment. Technically, hardware-related complications are uncommon and occur more frequently in the first 2 years following implantation of the device than after. ⋯ Areas covered by this article include patient positioning, the appropriate use of imaging, insertion of percutaneous and surgical leads, intraoperative stimulation, lead choice and suturing, considerations pre- and postimplantation, stimulation settings and regimens, implantable pulse generator positioning, and control of infections. It is hoped that these guidelines may help physicians to improve their SCS implantation technique and thereby improve the outcomes of the therapy. These guidelines should be of special value for newer centers starting SCS therapy for their patients.
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Objective. We evaluated the efficacy of octreotide when administered in a continuous fashion by intrathecal infusion. Materials and Methods. We used a prospective, randomized, controlled, double-blinded method of analysis to evaluate the efficacy of intrathecal octreotide in a population of patients with noncancer pain diagnoses. The patients in this study had an unacceptable response to intrathecal opioids. ⋯ These patients had pain consistent with a neuropathic pain diagnosis. The patients had noncancer pain, which was not responsive to intrathecal morphine. The lack of side-effects suggests that the dose selected for the study should be increased for future analysis of this agent, and patients with neuropathic pain should be more closely examined.
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The administration of intrathecal drugs has been shown to be efficacious in the treatment of both cancer pain and noncancer pain in patients who do not respond well to conventional treatment, in those who are unable to tolerate side-effects of opioids, and in those who constantly require significant increases in drug dosing. Although morphine represents the "drug of choice" for intrathecal administration, the use of alternative drugs (e.g., bupivacaine, clonidine, and hydromorphone) appears promising for intrathecal therapy of pain in patients who are unresponsive to morphine, those who cannot tolerate its side-effects, and those patients with neuropathic pain. This study analyzes results of studies published from 1990 to 2005 in order to evaluate the efficacy of intraspinal therapy.