Articles: neuralgia.
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This article highlights painful conditions involving the eyes that are encountered in practice, emphasizing those that do not have obvious findings on the neurologic examination. ⋯ Eye pain is a common concern and one of the most difficult symptoms for the clinician to evaluate. Eye pain may be a manifestation of a primary headache disorder, as is common in migraine, the trigeminal autonomic cephalalgias, and primary stabbing headache. Secondary headache disorders, such as posterior communicating artery aneurysm, Tolosa-Hunt syndrome, and microvascular ocular motor neuropathies, frequently produce eye pain. Ophthalmic conditions producing eye pain include orbital masses, angle-closure glaucoma, intraocular inflammation, and ocular surface (corneal) disease. Of these, corneal problems are the most commonly encountered.
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Pain arising from cranial neuralgias represents a significant health burden. Successful treatment depends on accurate diagnosis, which requires knowledge of neuroanatomy and pathophysiology as well as familiarity with the varied clinical presentations encountered in neurologic practice. This article delineates the relevant anatomy, clinical features, and management of the most common primary and secondary cranial neuralgias. ⋯ In patients presenting with a cranial neuralgia, unless the etiology is apparent (eg, herpes zoster), cranial imaging studies should be undertaken to look for structural abnormalities such as neoplasm, granulomatous disease, demyelinating disease, or vascular malformations. Management of both common and rare cranial neuralgias is often challenging and is best guided by the most recent available evidence.
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Inguinal pain after groin hernia repair is a challenging issue. About 50 % of postherniorrhaphy pain allegedly is neuropathic, treatment of which is cumbersome given the limited efficacy of current therapeutic modalities. Possibly a clear protocol assessing the type of pain and treating it accordingly could improve its treatment. ⋯ In the present study, we implemented a diagnostic workup for patients with postherniorrhaphy inguinal pain to select those with neuropathic pain. Eighty-three percent of the patients with neuropathic groin pain obtained significant improvement of their pain scores after our protocolled treatment. The effect was achieved by nerve infiltrations and in some cases by an implanted PNS when the former was unsuccessful.
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Neuropathic pain in people with cancer (part 2): pharmacological and non-pharmacological management.
The aim of this paper is to provide an overview of the management of neuropathic pain associated with cancer and to provide helpful clinical advice for nurses working with patients who may have neuropathic pain. While cancer pain is a mixed-mechanism pain, this article will focus only on neuropathic pain management. The impact of neuropathic pain on patients' quality of life is great and while many patients recover from their cancer, a significant number continue to suffer from a neuropathic pain syndrome. ⋯ Specific drugs for neuropathic pain may be effective for some patients, but not all; therefore, ongoing and comprehensive assessment and management are required. Furthermore, these patients may require trials of several drugs before they find one that works for them. It is important for nurses to understand neuropathic pain, its manifestation, impact on quality of life and management when nursing patients with neuropathic pain associated with cancer.
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Nicotinic receptors in the central nervous system (nAChRs) are known to play important roles in pain processing and modulate behavioral responses to analgesic drugs, including nicotine. The presence of the α5-neuronal nicotinic accessory subunit in the nicotinic receptor complex is increasingly understood to modulate reward and aversive states, addiction, and possibly pathological pain. In the current study, using α5-knockout (KO) mice and subunit-specific antibodies, we assess the role of α5-containing neuronal nicotinic receptors in neuropathic pain and in the analgesic response to nicotine. ⋯ Nevertheless, thermal analgesic response to nicotine was marginally reduced in CCI α5-KO mice at 4 days after CCI, but not at later timepoints or after PSNL. Interestingly, upon daily intermittent nicotine injections in unoperated mice, WT animals developed tolerance to nicotine-induced analgesia to a larger extent than α5-KO mice. Our results suggest that α5-containing nAChRs mediate analgesic tolerance to nicotine but do not play a major role in neuropathic pain.