Articles: neuralgia.
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Central Neuropathic Pain (CNP) is a frequent chronic condition in people with spinal cord injury (SCI). Previously, we showed that using laboratory brain-computer interface (BCI) technology for neurofeedback (NFB) training, it was possible to reduce CNP in people with SCI. In this study, we show results of patient self-managed treatment in their homes with a BCI-NFB using a consumer EEG device. ⋯ Portable NFB is a feasible solution for home-based self-managed treatment of CNP. Compared to pharmacological treatments, NFB has less side effects and provides users with active control over pain.
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Case Reports
Intravenous Ketamine as an Adjunct for Pachyonychia Congenita-Associated Pain: A Case Report.
Pachyonychia congenita (PC) is a rare, inherited disorder of keratin filaments characterized by palmoplantar hyperkeratosis, keratoderma, and extreme pain. Management is largely symptomatic and typically involves multimodal pain control strategies. ⋯ Within 1 night of beginning treatment, his pain diminished to a 0/10 without any adverse effects, with effects lasting 2 weeks. No reported PC pain regimens have made use of intravenous ketamine; thus, we suggest recurrent ketamine infusions as an additional option in the multimodal pain regimen for patients with PC.
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Zhonghua yi xue za zhi · Oct 2019
[Ultrasound-guided erector spinae plane block combined with pregabalin for post-herpetic neuralgia].
Objective: To analyze the clinical effect of ultrasound-guided erector spinae block combined with pregabalin on post-herpetic neuralgia (PHN) in the elderly. Methods: Sixty patients with post-herpetic neuralgia from January 2018 to January 2019 in the Department of Pain, First Affiliated Hospital of Bengbu Medical College were selected. The patients were divided into two groups according to the random number table (n=30): group C and ultrasound-guided erector spinae block (ESPB) group. ⋯ The difference was statistically significant (χ(2)=6.694, P<0.05). Adverse reactions were mild in both groups. Conclusion: Ultrasound-guided erector spinae block can effectively alleviate the pain of elderly patients with PHN in the chest, significantly reduce the dosage of oral drugs, improve the sleep quality of patients, and have higher safety.
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Multicenter Study Comparative Study
Sensory profiles and immune related expression patterns of patients with and without neuropathic pain after peripheral nerve lesion.
In this multicenter cross-sectional study, we determined sensory profiles of patients with (NL-1) and without neuropathic pain (NL-0) after nerve lesion and assessed immune-related systemic gene expression. Patients and matched healthy controls filled in questionnaires and underwent neurological examination, neurophysiological studies, quantitative sensory testing, and blood withdrawal. Neuropathic pain was present in 67/95 (71%) patients (NL-1). ⋯ Gene expression of peptidylglycine α-amidating monooxygenase was higher in NL patients compared with healthy controls (NL-1, P < 0.01; NL-0, P < 0.001). Also, gene expression of tumor necrosis factor-α was higher in NL-1 patients compared with NL-0 (P < 0.05), and interleukin-1ß was higher, but IL-10 was lower in NL-1 patients compared with healthy controls (P < 0.05 each). Our study reveals that nerve lesion presents with small and large nerve fiber dysfunction, which may contribute to the presence and intensity of neuropathic pain and which is associated with a systemic proinflammatory pattern.
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Objectives: Subcutaneous injection of botulinum toxin-A (sBONT-A) is a novel treatment for peripheral neuropathic pain. While its analgesic effects are well documented, this treatment is often not comfortable and fails in patients who show signs of sensory loss but rarely allodynia. There are some case reports about perineural BONT-A injection (pBONT-A) which could be an alternative approach. ⋯ Based on these results, we suggest that future parallel design trials on pBONT-A need to include at least 84 patients. Discussion: Ultrasound-guided pBONT-A injection seems to be a safe treatment leading to a sufficient pain relief for some months without sensory changes. Surprisingly, pBONT-A showed a pronounced analgesic effect also in patients without signs of hyperalgesia.