Articles: neuralgia.
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One hundred and fifty-six patients with moderate to severe postherpetic neuralgia (PHN) were followed for up to 11 years. Nearly half of all patients were doing well at the final assessment (median 2 years) and more than half of these were on no therapy at this time. ⋯ More of these patients were noted to be using some form of treatment at follow up. A group of patients seemed to follow a progressive course and were refractory to all treatments used in this study.
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Acta Neurol. Scand. · Aug 1991
Pain and allodynia in postherpetic neuralgia: role of somatic and sympathetic nervous systems.
The immediate effects of selective sympathetic and somatic blockades on pain and tactile allodynia in 12 patients with long-standing ophthalmic or high cervical postherpetic neuralgia were compared. For the duration of the somatic blockade, pain was completely abolished in 11 patients and allodynia in 8 patients. ⋯ After successful somatic blockade, pain and allodynia reappeared with tactile sensation while thermal sensation was still absent. Pain and allodynia appear to be related to sensory impulses travelling along the large rather than the small diameter fibres; and the sympathetic system may only have a limited role.
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Randomized Controlled Trial Clinical Trial
Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia.
We studied the analgesic efficacy of an intravenous infusion of lidocaine and morphine in 19 adults with well-established postherpetic neuralgia in a three-session, randomized, double-blind, placebo-controlled trial. Compared with saline placebo, both lidocaine and morphine reduced pain intensity. ⋯ In the majority of subjects who reported definite pain relief, allodynia also disappeared. The results show that neuropathic pain can respond to opioids and to systemically administered local anesthetic drugs.
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Using reference values from healthy volunteers, thermal and vibration-induced pain thresholds and the sensibility for warm and cold were studied in 18 patients with neuralgia in one hand following a traumatic injury or surgery. All patients had spontaneous pain and allodynia to vibration. They were treated with intravenous regional guanethidine block (RGB). ⋯ After RGB, there was no change in thermal pain thresholds and the allodynia to vibration persisted. These patients were classified as having sympathetically independent pain (SIP). The results indicate that quantitative thermal sensory tests, together with clinical evaluation of the nerve trauma, can help to predict which patients will have long-lasting pain alleviation after RGB treatment.
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Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. ⋯ High-dose acyclovir (800 mg orally five times daily) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and transcutaneous electrical stimulation.