Articles: neuralgia.
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Neurol Neurochir Pol · Nov 1986
[Value of testing vibration sensation in diagnosing spondylogenic pain syndromes].
One-hundred patients with cervical vertebral changes, 100 with lumbar vertebral changes and 20 with ankylosing spondylitis were studied carrying out examinations of the sensation of touch, pain and vibration in these dermatomes and sclerotomes which are related to the levels of the most frequently occurring intervertebral disc changes. It was found that disturbances of the vibration sensation occurred significantly more frequently than disturbances of surface sensitivity, and their character suggested that they were a more specific sign of damage to the innervation of the spine than segmental disturbances of superficial sensitivity which are due to root damage.
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The definition of causalgia as a pain state following peripheral nerve injury has been accepted since the term was introduced by Weir Mitchell over a century ago. In the present paper, problems of nomenclature and nosology are discussed, and attention is drawn to the fact that the same clinical features can occur spontaneously, in nontraumatic nerve lesions, in the absence of a part as in phantom limb states, and in diseases confined to the central nervous system. Attention is also drawn to the lack of correlation of pain with the effects mediated by catecholamines in the sympathetic nervous system and with the response to sympathetic blockade. ⋯ Certain authors in the past considered that the central nervous system (CNS) played an important part in causalgia, and current evidence supporting this view is assessed. Involvement of the CNS is suggested by the development of causalgia in diseases confined to the CNS and in phantom pain states; the unusual distribution of pain sometimes experienced; the paradoxical development of widespread pain that can occur after damage to the sympathetic nervous system; the effects of peripheral sympathetic blockade even when the cause lies centrally; and central interactions with motor, sensory and psychological phenomena. Reservations concerning the role of catecholamines in causalgia are outlined, and the possibility is considered that nonadrenergic substances may be implicated.
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Postherpetic pain persisting one month or longer occurs in 9% to 14% of patients with herpes zoster, diminishing with time. The incidence and duration are directly related to age. The pathologic features have been described but the pathogenesis of postherpetic neuralgia is unknown. ⋯ There is some support for the use of local physical modalities. Neurosurgical procedures are a possibility in failed medical cases. Controlled studies of newer approaches are necessary.
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By way of literature review, clarifications are made in the terminology employed in discussing the atypical post-traumatic pain syndromes, particularly reflex sympathetic dystrophy (RSD). Causalgia is a form of RSD and is the focus of a case report presented from the files at St. Anne's Hospital-West, Northlake, Illinois.
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Randomized Controlled Trial Comparative Study Clinical Trial
Iontophoresis of vincristine versus saline in post-herpetic neuralgia. A controlled trial.
Twenty patients with post-herpetic neuralgia (median duration 28.5 months) were randomly allocated to receive transdermal iontophoresis of either vincristine or saline. Although significant improvement in pain by word score and visual analogue scale (P = 0.05) was reported by 6 out of 10 of the vincristine group, none of the patients considered themselves 'cured.' There was no significant change in the saline group. ⋯ The dramatic relief of pain in patients with post-herpetic neuralgia of 3 months or less reported elsewhere was not seen in our group who had pain of a longer duration. This present trial does not confirm the value of vincristine iontophoresis in the treatment of post-herpetic neuralgia of over 6 months duration.