Articles: neuralgia.
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Acta Derm. Venereol. · Jan 1990
Argon laser induced cutaneous sensory and pain thresholds in post-herpetic neuralgia. Quantitative modulation by topical capsaicin.
Sensory and pain thresholds to cutaneous argon laser stimulation were determined in patients with post-herpetic neuralgia before and during treatment with topical capsaicin. Before treatment both thresholds were significantly elevated on the affected side compared to the contralateral normal area. After one week of capsaicin treatment both thresholds were significantly increased compared to the pre-treatment values, and the subjective pain relief, measured on a visual analogue scale (VAS) was 24%. ⋯ Laser stimulations at levels at which the sensory and pain thresholds are reached were initially described as burning or stinging with pain projecting outside the stimulated area. This allodynia to laser stimulations changed during capsaicin treatment towards normal sensory and pain perception qualities. Both sensory and pain thresholds and the subjective pain score evaluated on a visual analogue scale were attenuated during the capsaicin treatment, suggesting a significant role of the cutaneous sensory and pain receptors in postherpetic neuralgia.
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The anatomic study of the pudendal nerve and its relation allows an approach of the mechanisms of compression likely to engender perineal neuralgia. Two conflictual zones are isolated: the first is linked to the clamp which is produced by the insertion of the sacro-epinous ligament on the ischial spine and the sacro-tuberal ligament; the second is linked to the falciform process of the sacrotuberal which threatens the nerve by its sharp upper edge. This conflict is particularly acute in a sitting position. ⋯ The anesthetic blocks of the pudendal nerve on the ischial spine only have a complimentary diagnostic value. The peridural blocks may also have an interesting therapeutic action (60% of good results 3 months later). In some persistent cases, the nerve has been decompressed firstly by perineal approach, but latterly by transguteal approach.
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Randomized Controlled Trial Clinical Trial
Double-blind, placebo-controlled clinical trial of a mixture of gangliosides ('Cronassial') in post-herpetic neuralgia.
A double-blind, parallel-group clinical trial was carried out in 25 patients with post-herpetic neuralgia to determine the efficacy and tolerability of a mixture of gangliosides ('Cronassial') compared with placebo. Patients were allocated at random to receive treatment with either 'Cronassial' (100 mg in 2 ml buffered solution) or placebo given by 11 subcutaneous injections over a period of 27 days, and their symptoms assessed on entry and after 2, 4 and 8 weeks. The four aspects of pain considered (overall pain, hyperaesthesia, stabbing pain and constant ache) all showed maintained reductions in severity with 'Cronassial' treatment, but not with placebo. ⋯ Two of these 5 patients were withdrawn from the study. There were no withdrawals in the placebo group. It is suggested that further studies employing greater numbers of patients should be carried out to confirm the efficacy of gangliosides in improving symptoms of patients with post-herpetic neuralgia.
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Case Reports
[A complete relief of intractable postherpetic neuralgia with intrathecal methylprednisolone acetate].
A 72-year-old man, 154 cm tall, weighing 53 kg was suffering from severe herpetic neuralgia on his left 10th intercostal nerve area. His pain continued even he was treated with frequent epidural nerve block (4 to 5 times per week) by an anesthesiologist. He was referred to our hospital on his 105th pain day. ⋯ The pain was relieved completely after the block. And he complained nothing about the skin area which had been disturbing his life for a long time. Auditory brainstem response which was recorded during the block showed prolongation of the latency of phase III and phase V at 40 minutes after the intrathecal injection of lidocaine.
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The analgesic efficacy of 5% of EMLA cream (5 or 10 g) when applied for 24 h periods was evaluated in 5 female and 7 male patients (mean age 69 years, range 50-85 years) with refractory post-herpetic neuralgia (PHN). Mean visual analogue pain intensity scores for all patients were significantly improved 6 h after application (P less than 0.05). In a subgroup of patients with facial PHN receiving EMLA cream, 5 g (n = 4), there were significant improvements in pain intensity scores at 6 h (P less than 0.05). 8 h (P less than 0.01) and 10 h (P less than 0.01) after application. Plasma lignocaine and plasma prilocaine concentrations were well below potentially toxic levels in all patients after application.