Articles: neuralgia.
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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.
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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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J Pain Symptom Manage · Jun 1997
Randomized Controlled Trial Clinical TrialThe effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial.
Seventy-two patients older than 60 years of age who received a diagnosis of herpes zoster (HZ) were entered into a randomized, double-blind, placebo-controlled trial of daily amitriptyline 25 mg. Treatment with either amitriptyline or placebo continued for 90 days after diagnosis. Pain prevalence at 6 months was the primary outcome. Results showed that early treatment with low-dose amitriptyline reduced pain prevalence by more than one-half (p < 0.05; odds ratio, 2.9:1) This finding makes a strong case for the pre-emptive administration of amitriptyline, in combination with an antiviral drug, to elderly patients with acute herpes zoster.
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Acta Ophthalmol Scand · Jun 1997
Case ReportsThe use of capsaicin in herpes zoster ophthalmicus neuralgia.
The treatment of neuralgia which occurs during and following herpes zoster ophthalmicus is often unsatisfactory. Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is a drug which depletes substance P and may be effective in inhibiting pain. We utilized topical capsaicin to the affected dermatome five times daily for 4 weeks in 6 patients with acute and post herpetic neuralgia. ⋯ Four patients had side effects including burning sensation at the site of the drug administration (4 cases), dermatitis as a result of overuse of the drug (2 cases) and hyperesthesia (1 case). Our results suggest that capsaicin may be a useful therapy for the alleviation of pain in some individuals with herpes zoster ophthalmicus. However, controlled studies are needed to establish these results.
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We report 170 cases of perineal neuralgia due to pudendal nerve compression within Alcock canal or by ischiatic spine. 117 women and 53 men were investigated. Mean age was 60.3 years and the follow-up one year. Infiltrations of the pudendal nerve in the ischio-rectal fossa (pudendal canal or Alcock canal) with corticoids under CT-scan guidance, were successful immediately in only 1/3 of the cases. ⋯ Surgical treatment (performed in 27 cases) was good (8 or excellent (9). For all treatments, the results are good in 65 p. 100 of the cases. Perineal neurophysiologic examinations are useful to confirm pudendal nerve lesion and propose specific medical and/or surgical treatment.