Articles: neuralgia.
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Postherpetic neuralgia (PHN) is a neuropathic pain disorder that occurs most often in the elderly. This painful condition is uniquely suited for clinical research, resulting in an emerging understanding of the pathophysiology of the persistent pain. Until recently, only the tricyclic antidepressants proved effective for PHN. Controlled trials of a wide variety of therapeutic strategies are in progress or have been recently completed.
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Cancer presents itself in numerous ways, adding to the complexity of any pain syndrome with which it is associated. Neuropathic pain, unlike many other pain syndromes, is difficult to treat even in the absence of cancer. The combination results in a heterogeneous group of patients with a complex set of symptoms. ⋯ In patients with progressive disease and more refractory painful conditions, spinal anesthetic and neurosurgical therapies must often be considered. Under such circumstances, caregivers are forced to carefully balance uncertain benefits and risks, often without the luxury of time. More careful observation and controlled trials in these patients help facilitate this challenging process.
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Pain assessment and physical examination are the first crucial steps in diagnosis of neuropathic pain disorders because these are still solely diagnosed on clinical grounds. The physical examination should be conducted in such a way that all of the positive sensory phenomena, such as allodynia, hyperalgesia, hyperpathia, summation, and after-sensation are elicited. Other physical examination findings should corroborate the diagnostic impression of neuropathic pain. Specific pain diagnosis should then lead to more specific therapy.
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Moderate to severe pain is a common feature of central and peripheral demyelinating disorders. Pain in multiple sclerosis tends to occur when the disease is well-established and usually lingers infinitely. ⋯ Pain syndromes are well-defined in each disorder based on the underlying pathophysiology. Treatment involves a variety of pharmacologic and nonpharmacologic approaches individualized for each specific pain syndrome.
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Painful polyneuropathy is one of the most common chronic pain syndromes neurologists are asked to assess for diagnostic and therapeutic purposes. This article reviews the most current clinical guidelines, including history, pain assessment, physical examination findings, treatment recommendations, and pathophysiologic pain mechanisms underlying this condition. As a result of recent advances, the understanding and therapy of pain associated with polyneuropathy has evolved over the past several years and will continue to do so in the years to come.