Articles: neuralgia.
-
The purpose of this review was to identify and analyze the controlled clinical trial data for peripheral neuropathic pain (PNP) and complex regional pain syndromes (CRPS). A total of 72 articles were found, which included 92 controlled drug trials using 48 different treatments. The methods of these studies were critically reviewed and the results summarized and compared. ⋯ The methods scores were higher (P < 0.01) for the PNP trials (66.2 +/- 1.5, n = 66) than the CRPS trials (57.6 +/- 2.9, n = 26). The CRPS trials tended to use less subjects and were less likely to use placebo controls, double-blinding, or perform statistical tests for differences in outcome measures between groups. There was almost no overlap in the controlled trial literature between treatments for PNP and CRPS, and treatments used in both conditions (intravenous phentolamine and epidural clonidine) had similar results.
-
To provide a brief review of the current state of topical treatment with capsaicin or acetylsalicylic acid (ASA) for therapy of chronic pain syndromes. ⋯ Capsaicin is a white crystalline parent compound of a group of vanillyl fatty acid amines. Because of its highly specific action in neurons it has become an important tool in neuroscience. Because of its effects, it is obvious to try for the therapy of circumscribed neuropathic pain. Capsaicin acts by depleting stores of substance P and other neurotransmitters, resulting in a blockade of a specific group of sensory afferents. The corresponding clinical findings are initial burning and a desensitization of specific C fiber nociceptors after repeated application. The pain relieving potency was observed in various clinical investigations and even in a few controlled, double-blind studies about neuropathic pain syndromes and (osteo)arthritis. In contrast to these findings, a recent study found no significant benefit of capsaicin, probably because this study was the first to use an active placebo. Therefore, and because clinical efficacy and advantages over other therapies have not been demonstrated up to now, capsaicin cannot be classified as standard therapy. It may be a therapeutic option as an alternative or as an adjuvant treatment. Pain reduction was also observed after topical application of ASA/ether mixture in the one and only controlled double-blind study on this issue. Therefore, topical ASA therapy for (post)herpetic neuralgia is mainly based on a few enthusiastic case reports rather than on well founded investigations. Furthermore, the discrimination of local from systemic effects, the toxicological profile of longterm topical treatment, and the mechanism of action has not been evaluated. In conclusion, topical ASA cannot be recommended for routine clinical use at present.
-
The case is reported of a 58 year-old man with left-sided trigeminal and glossopharyngeal neuralgia, left hemifacial spasm and arterial hypertension. Preoperative MRI angiography examination showed a massively ectatic left vertebral artery. ⋯ Microvascular decompression was performed and postoperatively the patient had complete relief from the trigeminal and glossopharyngeal neuralgia, from the hemifacial spasm, and has sustained normal arterial pressure without medication. The value of MRI in diagnosing of neurovascular compression syndromes and pathophysiology of the "so called" arterial hypertension are discussed.
-
The idea of using Ketamine to treat chronic pain is mainly based on the central antinoceptive effect of the substance acting as a noncompetitive antagonist at the NMDA-receptor. In the present meta analysis over a period from 1/1981 up to 6/1996 twelve publications (1994-1996), which have dealt the use of Ketamine for patients with chronic pain, are evaluated and discussed. The entire positive evaluation of the drug is based on the results of the studies under consideration. ⋯ Here, the therapy had to break off in two cases. In nine cases the side effects could be suppressed by Droperidol. For the future, research with more study power is necessary to establish Ketamine in the therapy of chronic pain.
-
Case Reports Randomized Controlled Trial Clinical Trial
Relief of glossopharyngeal neuralgia by ketamine-induced N-methyl-aspartate receptor blockade.
We examined whether ketamine, which is a noncompetitive blocker of N-methyl-D-aspartate (NMDA) receptors, had the ability to relieve glossopharyngeal neuralgia. A tentative hypothesis is that glossopharyngeal neuralgia involves hyperactivity in the central nociceptive neurons and that the development of this hyperactivity is dependent on activation of NMDA receptors. ⋯ This case report shows that ketamine-induced NMDA receptor blockade significantly relieved glossopharyngeal neuralgia in this patient. Therefore, NMDA receptors may play a significant role in the pathogenesis of the pain syndrome described.