Articles: neuropathic-pain.
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This is the first case report of a patient self-administering local anaesthetics to painful peripheral nerves in the face. Severe chronic pain of neuropathic origin was caused by a trauma of the face and head following a traffic accident 20 years ago. The patient himself chose the method of self-injection for pain control. He applies the local anaesthetic bupivacaine with an insulin syringe while looking in a mirror.
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The number of AIDS patients is steadily increasing. According to the literature these patients are often in severe pain. ⋯ The high incidence of complicated neuropathic pain syndromes in AIDS patients requires a sophisticated therapeutic approach. Closer cooperation between AIDS specialists and pain specialists, comparable to that already existing for other patient groups, is therefore desirable.
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Different therapeutic modalities are available for the treatment of rheumatic pain. The most important one, besides physiotherapy, is medication with analgesics and adjuvant drugs. Analgesics are given orally and by a stepwise approach in keeping with the principles of cancer pain therapy. ⋯ Patients often suffer from constipation, nausea and vomiting, but these side-effects can be treated with laxatives and antiemetic drugs. There is no reason to differentiate between opioid medication in a cancer patient with pain and in a patient with "non-malignant" rheumatic pain. Centrally acting muscle relaxants may be helpful as adjuvant medication in patients with myalgia for example, and tricyclic antidepressants can also be beneficial, especially in neuropathic pain and for patients with psychiatric distress associated with pain.
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Vitamins of the B group have long been used to treat neuropathies of different origins and the accompanying pain. A combination of the vitamins B(1), B(6), and B(12) prevents the slowing of impulse conduction produced by tetanic stimulation in diabetic mice. In patients suffering from diabetic neuropathy, B vitamins alleviate pain in the upper extremities. ⋯ It has recently also been reported that a combination of the vitamins B1, B6, and B12 has analgesic properties in non-neuropathic conditions. In animal experiments, B vitamins diminish nociceptive responses in spinal and thalamic neurones and potentiate the antinociceptive effect of analgesic agents. Similarly, B vitamins potentiate the therapeutic effect of diclofenac in patients suffering from acute low back pain.
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Neuropathic pain is one of the problem areas in the management of cancer pain. In a retrospective study, prevalence and characteristics of neuropathic pain in 1318 cancer patients attending a pain clinic were examined. Of the patients, 135 suffered from neuropathic, 285 from neuropathic and nociceptive, 890 from nociceptive and 8 from unknown pain conditions. ⋯ Of 110 clinically analysed neuropathic pain conditions, 44% were neuralgic, 31% radicular, 13% sympathically maintained, and 10% caused by deafferentiation, while in 3% the nature was unknown. To evaluate the efficacy of cancer pain treatment, nocicepetive pain has to be differentiated from neuropathic pain. In addition to this, neuropathic pain has to be divided into subgroups.