Articles: neuralgia.
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Of 2,667 patients with herpes zoster who visited our hospital between January 1972 and March 1989, 136 patients whose treatments were started after more than 6 months following the onset were subjects of the present study. Thus we performed a retrospective study of the therapeutic effects of sympathetic ganglion block (using alcohol) on postherpetic neuralgia left untreated for more than 6 months after the onset. ⋯ Thus the patients who underwent sympathetic ganglion block with alcohol tended to show better results. The above findings suggest that, in patients with postherpetic neuralgia in whom the initiation of treatment was delayed, treatment mainly consisting of thoracic or lumbar sympathetic ganglion block using alcohol in combination with antidepressants and antianxiety drugs can greatly improve patients' activities of daily life and that, at present, this method is most effective in relieving postherpetic neuralgia.
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Oral baclofen, the most often prescribed antispastic drug, has been shown to be effective in trigeminal neuralgia. Spinal application of baclofen leads to a complete supression of spasticity even in cases in which no previous oral antispastic medication achieved a response. ⋯ Spinal baclofen has also been effective during long-term infusion with an implanted pump for more than 1 year. Spinal baclofen infusion seems to be a possibility in the treatment of severe trigeminal neuralgia resistant to other forms of therapy.
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Journal of neurology · Dec 1991
Clinical TrialTopical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy, predictors of response and long-term course.
In order to evaluate the efficacy, time-course of action and predictors of response to topical capsaicin, 39 patients with chronic post-herpetic neuralgia (PHN), median duration 24 months, were treated with 0.025% capsaicin cream for 8 weeks. During therapy the patients rated their pain on a visual analogue scale (VAS) and a verbal outcome scale. A follow-up investigation was performed 10-12 months after study onset on the patients who had improved. ⋯ Treatment effect was not dependent on patient's age, duration or localization of PHN (trigeminal involvement was excluded), sensory disturbance or pain character. Treatment response was not correlated with the incidence, time-course or severity of capsaicin-induced burning. If confirmed in controlled trials, the long-term results of this open, non-randomized study might indicate that the analgesic effect of capsaicin in PHN is mediated by both interference with neuropeptide metabolism and morphological changes (perhaps degeneration) of nociceptive afferents.
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Pain about the bridge of the nose is often a diagnostic dilemma. There is a small but important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by local anaesthesia is diagnostic and cure is possible by division of the anterior ethmoidal nerve. We present a series of six cases to illustrate this rare cause of facial pain.
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Neuralgic pain during or following herpes zoster infection is a common problem in pain therapy. The current management of neuralgias due to zoster is discussed with reference to patients in a chronic pain clinic within an anesthesiology department. The courses of 80 patients followed up for at least 3 months from the pain clinic at the University Hospital in Kiel were analyzed. ⋯ If the history of zoster pain was less than 1 month, the majority of patients showed good or excellent results. On the other hand, only one-third of patients with a history longer than 6 months had adequate pain relief. Therefore, early and appropriate treatment is desirable for patients suffering from zoster neuralgias.