Articles: neuralgia.
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The occurrence of sever pain is one of the most disabling symptoms after the traumatic lesion of the brachial plexus. Avulsion of one or more cervical roots of the brachial plexus is the main cause of severe pain, known as deafferentation pain. Lesion of the dorsal horn of the cervical spinal cord due to root avulsion may lead to important pathological changes and scarring that are responsible for the induction of pain sensations. ⋯ In contrast to drug therapy, which usually offers only limited benefit, surgical treatment over the last years has shown positive results. Coagulation of the dorsal root entry zone (DREZ) is one of the most efficient surgical treatments for these patients. Understanding of the pathophysiological changes and different pain mechanisms induced by traumatic injury of the brachial plexus is fundamental for the planning and step-wise treatment of such patients.
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Brain injury : [BI] · Jul 1997
Case ReportsPsychomotor agitation following gabapentin use in brain injury.
Gabapentin, an anticonvulsant structurally related to gamma-aminobutyric acid (GABA) was recently reported to be effective in pain associated with reflex sympathetic dystrophy (RSD) and in pain associated with neuropathy. Yet, to our knowledge, the use of gabapentin for neuropathic pain in the presence of cognitive impairment has not been reported. In this report, we describe two patients (one with a traumatic brain injury, one with a putative acquired brain injury) who presented to a neurorehabilitation unit complaining of pain that was diagnosed as neurologically mediated. ⋯ Correspondingly, each reported a diminution of psychological symptoms within 48 hours of gabapentin cessation. These two cases suggest that gabapentin may cause agitation in cognitive impaired patients. Physicians treating brain-injured patients and prescribing gabapentin for neuropathic pain may wish to closely monitor patients for similar signs of restlessness or anxiety.
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The number of refugees around the world who have fled political or ethnic persecution has increased. An increasing proportion of these refugees are survivors of torture. Many of these suffer physical as well as psychological sequelae to torture. ⋯ After positional torture, in which the victims are suspended by their wrists which are tied behind their back (Palestinian hanging), severe lasting nerve, ligament, or tendon damage is seen. In this paper we present two cases of brachial plexus injury. Only sensory nerves were affected causing a neurogenic pain condition including dysaesthesia and neuralgia.
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The risk factors for postherpetic neuralgia (PHN), the most common complication of herpes zoster, have not been well established. ⋯ Increased age and prodromal symptoms are associated with higher prevalence of PHN 1 and 2 months after onset of zoster. Overall, systemic acyclovir appears not to confer any protection against PHN, although benefit among elderly patients cannot be excluded.
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The last 40 years was a period during which the incidence of herpes zoster appears to have increased substantially. ⋯ The apparent increase in the incidence of herpes zoster was not accompanied by a change in the risk of specific or overall complications in a population-based sample. Advanced age and other conditions associated with waning cellular immunity may confer an increased risk of experiencing a complicated course of herpes zoster.