Articles: neuralgia.
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Observational Study
Exponential correlations among neuropathic components, pain intensity, and catastrophic thoughts in patients with musculoskeletal pain disorder.
Neuropathic components and catastrophic thoughts contribute to the quality of life impairments in patients with chronic pain. This retrospective cross-sectional observational study examined the extent to which neuropathic components affect pain intensity and catastrophic thoughts using a mathematical model. ⋯ Mathematical models indicate neuropathic components demonstrate linear correlations with NRS and PCS generally, but exponential correlations in a cluster of the patients with musculoskeletal pain. We developed and validated the discriminant based on pain characteristics to identify such patients; "pressure-evoked pain" was the most significant contributor.
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Case Reports
Expanding frontiers in telehealth: video assisted at-home application of capsaicin 8% patch.
In recent years, the delivery of health services has undergone a major paradigm shift towards expanded outpatient services and widespread use of telemedicine. Post-herpetic neuralgia (PHN) is a treatment recalcitrant neuropathic pain condition referring to pain persisting more than three months from the initial onset of an acute herpes zoster. QUTENZA® (capsaicin 8% patch) is a single 1-hr localized treatment for PHN and can provide several months of pain relief per application. ⋯ SIGNIFICANCE: This is a case report of the successful treatment of post-herpetic neuralgia at-home using Capsaicin 8% patch. The procedure was performed under full supervision and instruction from a physician using video telehealth services. Not only did the patient tolerate the procedure and have significant efficacy, she voiced preference to repeat treatment in this manner versus going back to the office.
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Randomized Controlled Trial Multicenter Study
Transforaminal Epidural Steroid Injection for Zoster-Related Pain: The Golden Period for the Best Outcome.
Zoster-related pain (ZRP) has many negative effects on a patient's quality of life. The transforaminal steroid injection (TFESI), which reduces neural inflammation and pain, has been advocated by pain physicians. Many reports demonstrated that early administration of TFESI showed better efficacy; however, the golden period during which TFESI is most effective remains unclear. ⋯ TFESI is more effective when administered within 12 weeks of onset of herpes zoster.
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Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. ⋯ Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71.Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds.Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.
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Review Meta Analysis
Human surrogate models of central sensitization: a critical review and practical guide.
As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock-like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting sensitization of neural transmission. ⋯ Being able to mimic aspects of pathological pain directly in humans has a huge potential to understand pathophysiology and provide animal research with translatable biomarkers for drug development. One group of human surrogate models has proven to have excellent predictive validity: they respond to clinically active medications and do not respond to clinically inactive medications, including some that worked in animals but failed in the clinics. They should therefore inform basic research for new drug development.