Articles: neuralgia.
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Tricyclic antidepressants that inhibit serotonin and noradrenaline reuptake, such as amitriptyline, are among the first-line treatments for neuropathic pain, which is caused by a lesion or disease affecting the somatosensory nervous system. These treatments are, however, partially efficient to alleviate neuropathic pain symptoms, and better treatments are still highly required. Interactions between neurons and glial cells participate in neuropathic pain processes, and importantly, connexins-transmembrane proteins involved in cell-cell communication-contribute to these interactions. ⋯ Another connexin blocker, carbenoxolone, also improved amitriptyline action. Additional in vitro studies suggested that mefloquine may also directly act on serotonin transporters and on adenosine A1 and A2A receptors, but drugs acting on these other targets failed to amplify amitriptyline action. Together, our data indicate that pharmacological blockade of connexins potentiates the therapeutic effect of amitriptyline in neuropathic pain.
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Pulsed radiofrequency (PRF) stimulation is widely used for intractable pain; however, there is no consensus on treatment protocols and appropriate types of pain. We compared effectiveness of bipolar and unipolar PRF on neuropathic or inflammatory pains, and of targets at the dorsal root ganglion (DRG) and sciatic nerve (SN). We also examined efficacy of repetitive PRF stimulations. This preclinical study could serve as an extensive survey before human trials. ⋯ PRF temporarily attenuates neuropathic and inflammatory pain. Bipolar PRF generates significant analgesia with a much lower electrical power than unipolar PRF. Meanwhile, the minor variant effects between PRF-DRG and PRF-SN may indicate distinct mechanisms. The sustained-analgesia by repetitive treatments suggests implantation technique could be a promising choice.
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Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Scientific studies have shown that neuropathic pain is the result of complex altered signalling processes in the peripheral and central nervous system. ⋯ This review summarizes the contemporary diagnostics of neuropathic pain using frequent diseases as examples and presents the evidence from randomized controlled trials on the treatment of neuropathic pain. Treatment guidelines for pharmacological management of neuropathic pain include evidence-based use of antidepressants, anticonvulsants, opioids, capsaicin and lidocaine.
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Pulsed radiofrequency (PRF) on the dorsal root ganglion (DRG) is a common minimally invasive surgery for herpes zoster (HZ)-related pain, including acute zoster pain and postherpetic neuralgia (PHN); however, some patients still have no obvious pain relief, a high recurrence rate, and short-term recurrence. Radiofrequency thermocoagulation (RF-TC) has a higher temperature; however, it is still unknown whether the degree of complete damage will affect the recurrence rate and if there is any difference compared with the effect of PRF. ⋯ In the treatment of HZ-related pain, the use of PRF is significantly associated with a high short-term recurrence rate. However, compared with RF-TC, PRF results in milder numbness and less intraoperative pain. RF-TC may be a feasible procedure if patients can accept pain relief at the cost of long periods of numbness, whether RF-TC has the value of clinical promotion still needs to be further explored.