Articles: neuralgia.
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The specific impact of neuropathic pain and recommended neuropathic pain treatments on the hormonal and immune status of patients has been so far poorly explored. This study aimed at studying, in real life, the hypothalamic-pituitary-adrenal axis and the cytokine profile of patients with neuropathic pain. It also explored their links with cognition, emotion, quality of life, and drug treatment. ⋯ An impairment of the hormonal status and of the immune system was observed in patients. It identified testosterone as a potential pivotal mediator between antidepressants/antiepileptics and quality of life. Further studies must address the exact impact of different types of drugs on central effects, of gender differences, and of the immune system of neuropathic pain.
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Purpose: This study aimed to characterize the sensory profile of patients with post-implant trigeminal neuropathy and identify the association between subjective symptoms and objective signs including psychophysical testing and radiographic imaging. This study further evaluated to the association between quantitative sensory testing (QST)/qualitative sensory testing (QualST) and the severity of nerve injury graded by radiographic imaging. Materials and methods: This retrospective study included 34 patients diagnosed with post-implant trigeminal neuropathy. ⋯ Moderate positive correlations between some positive symptoms and the score of QualST were observed. The Mann-Whitney U test showed that subjective symptoms did not differ according to the severity of nerve damage according to CBCT, but the electric QST and QualST was discriminative. Conclusions: This study suggests that QST/QualST associated with the severity of nerve damage according to CBCT might be useful in assessing numbness in patients with negative and positive symptoms after implant surgery, but may be of marginal utility in the evaluation of neuropathic pain within the limitation of this cross-sectional study with small sample size.
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J Pain Palliat Care Pharmacother · Sep 2019
Case ReportsKetamine: When Delirium and Desperation Call for a Hero.
The use of ketamine in palliative care is becoming more common for challenging symptom management, namely cancer related pain and psychiatric conditions. However, there is much that remains unstudied and uncertain about ketamine's clinical utility. ⋯ Despite concerns regarding baseline delirium we successfully used ketamine to better manage neuropathic pain, decrease overall opioid need, without exacerbating the preexisting delirium. Our case highlights the benefits of ketamine for neuropathic pain control in the face of delirium.
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Pain in Parkinson's disease (PD) is a common and heterogeneous non-motor symptom. Although the characteristics and predictors of pain in general and of central pain in particular are still largely unknown. ⋯ In a consecutive series of 292 patients with PD, almost three quarters of patients with PD reported pain. The study results revealed that pain was related to more severe motor symptoms, anxiety symptoms and comorbidities. Among patients with pain, those with central parkinsonian subtype had distinct demographic and clinical features, including lower levodopa responsiveness for non-axial motor symptoms and greater responsiveness of pain to antiparkinsonian treatment.
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Case Reports
Spinal cord stimulation in the treatment of neuropathic pain in chronic inflammatory demyelinating polyneuropathy.
We describe a case of a 70-year old man with sensorimotor chronic inflammatory demyelinating polyneuropathy (CIDP) with small-fibre involvement resulting in severe diffuse neuropathic pain which was refractory to immunotherapy and anti-neuropathic medication. His pain was successfully treated with implantation of a spinal cord stimulation (SCS) system comprising bilateral cervical and lumbar epidural leads. ⋯ However, this is the first report to our knowledge of SCS utilised effectively for pain in CIDP. This therapy should be considered in painful CIDP for neuropathic pain refractory to medical management, though further studies are required to evaluate its efficacy.