Articles: neuralgia.
-
The pathogenesis and clinical manifestations of herpes zoster and postherpetic neuralgia and the use of nontraditional analgesics in the management of postherpetic neuralgia are reviewed. Herpes zoster represents the reactivation in an immunocompromised host of dormant varicella-zoster virus (Herpesvirus varicellae) contracted during a previous episode of chickenpox. Fever, neuralgia, and paresthesia occur four to five days before skin lesions develop. ⋯ Positive results have been reported with levodopa, amantadine, and interferon, but the role of these agents in the prevention of postherpetic neuralgia remains unclear. Nontraditional analgesic agents are useful in the management of postherpetic neuralgia, but patients must be selected and monitored appropriately. A tricyclic antidepressant (especially amitriptyline) is a reasonable first choice.
-
A 41-year-old female developed spontaneous burning pain (causalgia) and stimulus-induced dysesthesia (allodynia) of the dorso-lateral part of her right foot following trauma. An L3 and L4 sympathectomy eliminated the spontaneous burning pain for only 1 year, but did not affect the stimulus-induced dysesthesia. We evaluated her two years post-sympathectomy with grouped sequential anesthetic blocks and sensory testing. ⋯ When sural block was added to the peroneal block the stimulus-induced dysesthesia was eliminated, and sensation in the sural distribution was lost. We conclude that the sural distribution received overalapping innervation for touch and pin-prick perception, but that heat perception, burning pain and the stimulus-induced dysesthesia were sural nerve dependent. Further, we were able to dissociate causalgia pain from allodynia in this patient.
-
We treated 72 patients, referred to a pain clinic for acute herpes zoster neuralgia, with local anesthetics administered by nerve block and infiltration. Only those patients with severe pain initially proved to be at risk for the development of chronic postherpetic neuralgia (defined as pain in the involved dermatomes lasting at least six months). Although local anesthetic injections effectively relieved the acute pain of active herpes zoster, they did not prevent the development of chronic postherpetic neuralgia.
-
Genitofemoral neuralgia is a syndrome characterized by chronic pain and paresthesia in the region of genitofemoral nerve distribution. Genitofemoral nerve entrapment has been described after inguinal herniorrhaphy, appendectomy, and cesarean section. Failure to distinguish it from ilioinguinal nerve entrapment can result in unnecessary inguinal reexploration, or patients severely debilitated from chronic pain. ⋯ If this is unsuccessful in affecting relief of symptoms, a paravertebral block of L-1 and L-2 should be considered. Using these two blocks, a rational decision can then be made to operate on either the ilioinguinal nerve or the genitofemoral nerve. We describe three cases of genitofemoral neuralgia treated by extraperitoneal excision of the genitofemoral nerve.