Articles: neuralgia.
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Fifteen cases of perineal neuralgia are reviewed, the lesion arising from a canal syndrome due to compression of the pudendal nerve in the ischiorectal fossa (Alcock's canal syndrome). The clinical characteristic of the pain syndrome was its postural nature with the existence of a true Tinel sign (increased pain on sitting). ⋯ Treatment was infiltration of cortisone derivatives into the pudendal nerve canal, under CT guidance because of the difficulty of infiltrating the pudendal nerve by an external perineal approach. Results were satisfactory in 9 of the 15 patients.
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During the past 7 years 30 patients were diagnosed as having either ilioinguinal or genitofemoral entrapment neuralgia. A multidisciplinary approach (surgeon, neurologist, and anesthesiologist), as well as local blocks of the ilioinguinal nerve and/or paravertebral blocks of L-1 and L-2 (genitofemoral nerve), were essential to determine accurately which nerve was specifically involved. Fifteen of the 17 patients (88%) diagnosed as having ilioinguinal neuralgia after previous inguinal herniorrhaphy are pain free after resection of the entrapped portion of the nerve. ⋯ Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 10 of 13 (77%) of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of surgery in the inguinal region. When accurately diagnosed, neurectomy of the specific nerve is highly successful in relieving severe pain and paresthesia without significant morbidity.
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The plethora of terms included in the broad category of sympathetic dystrophies, and causalgia in particular, has made specific disorders, with unique clinical characteristics, very difficult to isolate into discrete clinical entities. Rather, the sympathetic dystrophies currently are regarded as existing along a continuum of varying severity and as having one basic pathophysiological mechanism, with considerable overlap of terms. The purposes of this article are 1) to review the theories of physiological mechanisms of causalgia and other forms of sympathetically maintained pain, 2) to describe their clinical characteristics, and 3) to discuss their physical therapy management.
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Review Case Reports
Herpes zoster and post-herpetic neuralgia: diagnosis and management.
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J. Am. Acad. Dermatol. · Jul 1987
Treatment of chronic postherpetic neuralgia with topical capsaicin. A preliminary study.
Continuing pain following herpes zoster is common in patients 60 years of age or older. Current treatments are generally unsatisfactory. The endogenous neuropeptide substance P is an important chemomediator of nociceptive impulses from the periphery to the central nervous system and has been demonstrated in high levels in sensory nerves supplying sites of chronic inflammation. ⋯ Of the 12 patients completing this preliminary study, 9 (75%) experienced substantial relief of their pain. The only adverse reaction was an intermittent, localized burning sensation experienced by one patient with application of capsaicin. Although these results are preliminary, they suggest that topical application of capsaicin may provide a useful approach for alleviating postherpetic neuralgia and other syndromes characterized by severe localized pain.