1/9. Pharmacologic management part 2: lesser-studied neuropathic pain diseases.This second part of a review of the pharmacologic management of neuropathic pain diseases describes the current treatment options for three lesser-studied neuropathic syndromes: Central poststroke pain, spinal cord injury, and complex regional pain syndrome II. diagnosis can be difficult in patients with these syndromes, because the pain experienced is much greater and of a different type than would normally be expected following a stroke or injury to the spinal cord or a peripheral nerve. Even when an accurate and timely diagnosis is made, treatment options are limited and frequently suboptimal. However, the results of published trials do support the use of anticonvulsants and/or tricyclic antidepressants as first-line pharmacotherapy in these three neuropathic pain syndromes. To maximize treatment outcomes, future research must: Continue to more fully elucidate the relationship between the signs and symptoms of pain and the underlying pathophysiology; Delineate the natural history of central poststroke pain, spinal cord injury, and complex regional pain syndrome; Identify patient-related factors that may indicate an increased risk of developing neuropathic pain following stroke or nerve injury; Investigate emerging treatments that target underlying pain mechanisms.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/9. The management of malignant psoas syndrome: case reports and literature review.Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. We review the relevant clinical features and the subsequent multidisciplinary pain management in relation to four new cases of malignant involvement of the psoas muscle, and the 23 case reports in the literature. We propose that MPS comprises a continuum of symptoms and signs related to the degree of anatomical destruction with associated inflammatory reaction and muscle spasm, and also the degree of lumbosacral plexopathy causing neuropathic pain. A protocol is presented for the management of the complex pain issues of MPS directed at likely mechanisms. The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
3/9. Ziconotide infusion for severe chronic pain: case series of patients with neuropathic pain.Ziconotide intrathecal infusion was recently approved by the united states food and drug administration for the treatment of intractable severe chronic pain. patients with neuropathic pain make up a significant population among those who experience chronic pain for which there are less than optimal pharmacotherapeutic options. Published clinical trials provide a global view of ziconotide efficacy and safety. A subset of patients in clinical trials obtained complete pain relief, a remarkable finding given the history of drug treatment for neuropathic pain. To provide more information regarding those who respond to ziconotide therapy, we discuss three patients with neuropathic pain who received ziconotide infusion. Two patients with longstanding neuropathic pain, one with complex regional pain syndrome (formerly known as reflex sympathetic dystrophy) of the leg and one with lumbar radiculitis, achieved temporary but complete pain relief from single 5- and 10-microg epidural test doses. In the third case, a patient with longstanding bilateral leg and foot neuropathic pain from acquired immunodeficiency syndrome and antiretroviral drug therapy achieved considerable pain relief from a long-term continuous intrathecal infusion. The patients who received a single dose had mild central nervous system adverse effects such as sedation, somnolence, nausea, headache, and lightheadedness. The patient who received the intrathecal infusion experienced mild-to-severe adverse effects depending on the rate of infusion; these effects included sedation, confusion, memory impairment, slurred speech, and double vision. This patient could sense impending adverse effects and made rate adjustments or suspended infusion to avert untoward symptoms. In all three cases, patients achieved considerable pain relief that was long-lasting and persisted well after dose administration or suspension of infusion.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
4/9. Peripheral nerve field stimulation in chronic abdominal pain.INTRODUCTION: spinal cord stimulation (SCS) has become an accepted therapeutic modality for the treatment of intractable pain syndromes, primarily used today in the settings of failed back surgery syndrome, neuropathic back and limb pain. The use of spinal cord stimulators for peripheral nerve field electrostimulation is becoming increasingly recognized as a safe, effective alternative for chronic pain conditions that are refractory to medical management and do not respond to traditional dorsal column stimulation. Advances in technology have allowed for minimally invasive percutaneous placement of multipolar leads with complex programmable systems to provide patient- controlled relief of pain in precisely targeted regions. With these improvements in hardware, the use of Peripheral Nerve Field Stimulation (PNFS) appears to have an untapped potential for providing patients with pain relief for a wider range of underlying conditions than was previously believed possible. We present three cases, each with a different etiology of chronic abdominal pain: one with inguinal neuralgia, one with chronic pancreatitis, and one with pain following liver transplant. Each patient was refractory to conventional medical approaches. For all three patients, PNFS provided significant relief from pain, enabling patients to decrease or discontinue their opioid medications and to enjoy significant improvement in their quality of life. We conclude that PNFS is a safe, effective and minimally invasive treatment that may be used successfully for a wide variety of indications including chronic abdominal pain.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
5/9. T2-ganglionectomy via limited costotransversectomy for minor causalgia.T2-ganglionectomy via limited costotransversectomy is a safe and effective method to produce sympathetic denervation of the upper extremity. It provides prompt and lasting relief of the complex array of symptoms associated with minor causalgia. Four patients with minor causalgia treated by this procedure are presented. All patients were seen by multiple physicians before a correct diagnosis was made. Pain and trophic changes resolved in all cases. No instances of Horner's syndrome or pneumothorax were encountered. Preoperative response to temporary stellate ganglion block is essential to both diagnosis and treatment. Consideration of early surgical intervention should be given in cases involving significant disability. A fundamental problem surrounding the appropriate management of minor causalgia has been and continues to be accurate recognition of the diagnosis.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
6/9. Posterior femoral cutaneous neuralgia.A middle-aged male developed a right posterior femoral cutaneous neuralgia that persisted for 10 years without any associated neurologic, electrophysiologic, or radiologic findings. Five years after onset, surgical exploration of the subgluteal area identified a venous malformation surrounding the nerve. The syndrome appears unique and exemplifies all major aspects of the sensory distribution of the nerve complex.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
7/9. The cessation of cervical nerve root pain following modified SMAS rhytidectomy.The cessation of cervical nerve root pain following modified SMAS rhytidectomy is reported. CAT scans and radiographs demonstrating substantial changes in the intervertebral relationships are documented. No previous report exists demonstrating the biomechanical response to platysma muscle surgery. The potential for alterations in the cervical spine either positive, as in this case, or perhaps negative with exacerbation or creation of symptoms not existing prior to surgery, is presented. The complex biomechanical influence of the procedure indicates that further study and appreciation of the biomechanical changes are necessary to thoroughly understand the ramifications of the SMAS rhytidectomy.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
8/9. Tic convulsif, the combination of geniculate neuralgia and hemifacial spasm relieved by vascular decompression.A patient had combined otalgia and intractable unilateral facial spasm, relieved by microsurgical vascular decompression of the seventh and eighth cranial nerve complex in the cerebellopontine angle without section of the intermediate nerve. A dolicho-ectatic anterior inferior cerebellar artery compressed the seventh and eighth cranial nerves complex, suggesting that vascular compression of the intermediate nerve or of the sensory portion of the facial nerve may cause geniculate neuralgia. "Tic convulsif" seems to be a combination of geniculate neuralgia and hemifacial spasm. This combination could be due to vascular compression of the sensory and motor components of the facial nerve at their junction with the brainstem.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/9. Chronic neuropathic pain and its control by drugs.The medical treatment and some currently known aspects of the aetiology of five neurogenic pain states are discussed. Neurogenic pain can be described as pain resulting from noninflammatory dysfunction of the peripheral or central nervous system without nociceptor stimulation or trauma. The enormity of the field has limited this review to post-herpetic neuralgia, complex regional pain syndromes, phantom pain, trigeminal neuralgia and diabetic neuralgia. Evidence suggests that many neurogenic pain states are not effectively controlled. This may be due in part to a lack of understanding of the aetiology of these conditions and to the lack of high quality studies evaluating existing treatments. A compact review of the literature is presented with some treatment options and possible future directions. Where appropriate surgical management and physical therapy have been discussed; however, a thorough appraisal of nondrug treatments was not the main priority of this review.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |