Articles: neuralgia.
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Acta Otolaryngol Suppl · Jan 1996
Case ReportsTwo cases with glossopharyngeal neuralgia treated by nerve reaction: oropharyngeal approach.
Two patients with idiopathic glossopharyngeal neuralgia received glossopharyngeal nerve resection by the oropharyngeal method, and their symptoms were relieved. Both patients had suffered proxysms of severe pain in the unilateral glossopharyngeal innervation for many years, and pharmaceutical treatment had been made in vain and, although surgical intervention in one patient had resulted in temporary relief, it had not been possible to prevent recurrence. As the identification of trigger zones by the method of local nerve block caused us to think that surgical treatment would be more effective in both patients, the glossopharyngeal nerve was resected, using the oropharyngeal method, with a view to attaining permanent symptomatic relief. Consequently, satisfactory results were obtained.
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Acta Derm. Venereol. · Jan 1996
Case ReportsPruritus circumscriptus sine materia: a sequel of postzosteric neuralgia. Evaluation by quantitative psychophysical examination and laser-evoked potentials.
A case of circumscribed pruritus existing since 1 year on clinically uninvolved skin is reported, in which careful history revealed a 5-year previous episode of herpes zoster in the same dermatome. Impairment of cutaneous sensitivity was evaluated by use of a quantitative psychophysical examination and laser-evoked cortical potentials (LEP).
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Acta neurochirurgica · Jan 1996
Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia.
The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. ⋯ Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
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Postherpetic neuralgia, when defined as neuropathic pain persisting 1 month or longer after herpes zoster infection, affects about 10% of all patients who have contracted the disease. The incidence of postherpetic neuralgia increases with age; at age 60, about 50% of herpes zoster patients will suffer significant pain, and this proportion grows with subsequent decades. If therapy is carefully chosen and monitored, it is possible to give satisfactory relief, taking pain from severe to mild, to between 60 and 70% of patients. This article will review current treatment and focus on antidepressant drugs, treatments that are contentious and of current interest such as topical agents, and the use of opioids for this type of chronic neuropathic pain.
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A variety of mechanisms may generate pain resulting from injury to the peripheral nervous system. None of these mechanisms is disease-specific, and several different pain mechanisms may be simultaneously present in any one patient, independent of diagnosis. Diagnosis of neuropathic pain is often easily made from information gathered on neurologic examination and from patient history. ⋯ An adequate trial for each agent tried is key to pharmacologic treatment of neuropathic pain. Tricyclic antidepressants are first-line agents, although other drugs, including anticonvulsants, local anesthetic antiarrhythmics, clonidine, opioids, and certain topical agents, also offer pain relief in some patient populations. The novel antidepressants venlafaxine and nefazodone are potentially useful new drugs that are better tolerated than tricyclic antidepressants.