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Ruiz M, Porta-Etessam J, Garcia-Ptacek S, de la Cruz C, Cuadrado ML, Guerrero AL. Auriculotemporal Neuralgia: Eight New Cases Report. Pain Med 2016; 17:1744-8. [PMID: 26921888 DOI: 10.1093/pm/pnw016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Auriculotemporal neuralgia (ATN) is an infrequent syndrome consisting in strictly unilateral pain in the temporal region associated with nerve tenderness, which can be successfully treated with anesthetic blockade. We analysed clinical characteristics and treatment response in a series of eight patients. METHODS Series of consecutive patients diagnosed with ATN at Headache Clinics of two university hospitals in Spain. Data on demographic and pain characteristics, as well as response to treatment are presented. RESULTS Eight patients (seven women). Mean age at onset was 52.8 ± 14.3 years. Pain was strictly unilateral (left-sided in five cases, right-sided in three), and triggered by pressing the preauricular area. Four patients presented background pain, mostly dull in quality, with an intensity of 5.75 ± 1.2 on the verbal analogical scale (VAS). In six, burning exacerbations occurred, ranging from 2 seconds to 30 minutes, with intensity 7.3 ± 1.5 on VAS. Complete relief was achieved with gabapentin in three cases, anaesthetic blockade in three and spontaneously in two. CONCLUSION ATN is uncommon in headache units. Gabapentin is a good alternative therapeutic option to anesthetic blockade.
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Affiliation(s)
- M Ruiz
- *Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Spain
| | - J Porta-Etessam
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - S Garcia-Ptacek
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain; Department of Geriatrics, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - C de la Cruz
- *Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Spain
| | - M L Cuadrado
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - A L Guerrero
- *Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Spain;
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Abstract
PURPOSE The pterygospinous ligament extends from the posterior free margin of the lateral pterygoid plate till the spine of the sphenoid. The ligament may ossify partly or completely leading to the formation of the pterygospinous bar. A complete ossification of the ligament results in the formation of the foramen of Civinini. Presence of the complete or incomplete pterygospinous bar may lead to a difficulty in passing the needle during anaesthesia for the trigeminal neuralgia or the bar may also compress the mandibular nerve and its branches to cause lingual numbness, pain and speech impairment. METHOD Presence of the complete or incomplete pterygospinous bar and the foramen of Civinini were studied in 55 dried adult skulls and 20 sphenoid bones. RESULTS Partial or complete ossification of the pterygospinous ligament was seen in 17.33 % skulls. One skull showed the presence of bilateral complete pterygospinous bar while another skull had the unilateral complete pterygospinous bar on right side. Two skulls and one sphenoid had bilateral incomplete pterygospinous bar while seven skulls and one sphenoid bone had unilateral incomplete pterygospinous bar. In three cases, the bar was passing just below the foramen ovale. CONCLUSION The pterygospinous bar when present medial to the foramen ovale may not have much clinical significance but when the bar is present just below the foramen ovale, it may cause a compression of the mandibular nerve and its branches and may also obstruct the passage for the transoval approach to the neighbouring regions.
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Affiliation(s)
- Neeru Goyal
- Department of Anatomy, Christian Medical College, Ludhiana, India.
| | - Anjali Jain
- Department of Anatomy, Christian Medical College, Ludhiana, India
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203
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Ozkan D, Akkaya T, Yildiz S, Comert A. Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain. Anaesthesist 2016; 65:134-6. [PMID: 26811947 DOI: 10.1007/s00101-015-0133-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
Chronic pelvic pain is a condition that can be caused by pudendal neuralgia, interstitial cystitis, piriformis syndrome and neuropathy of the ilioinguinal, iliohypogastric and genitofemoral nerves. Based on three case reports this article discusses the clinical effectiveness of pulsed high-frequency radiofrequency (PRF) treatment applied to the pudendal nerve under ultrasound guidance in medicinally treated patients with chronic pelvic pain.
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Abstract
Neuropathic pain (NP) arises from injuries or diseases affecting the somatosensory component of the nervous system at any level of the peripheral or central nervous system. NP is diagnosed based on common neurologic signs and symptoms. NP is best treated with a combination of multiple therapeutic approaches, and treatments include conservative, complementary, medical, interventional, and surgical treatment modalities. Goals of treatment are the same as in pain management and include improvement in pain control and in coping skills as well as restoration of functional status. Most patients with NP benefit most from an individualized, multimodal approach that emphasizes both pain and function.
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Affiliation(s)
- Robert Carter Wellford Jones
- Center for Pain Medicine, Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9444 Medical Center Drive, MC 7651, La Jolla, CA 92093, USA
| | - Erin Lawson
- Center for Pain Medicine, Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9444 Medical Center Drive, MC 7651, La Jolla, CA 92093, USA; Lexington Brain and Spine Institute, 811 West Main Street, Suite 201, Lexington, SC 29072, USA
| | - Miroslav Backonja
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53706, USA.
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205
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Bindra A, Bithal P, Sokhal N, Arora A. Pain relief can be painful. Indian J Palliat Care 2015; 21:355-7. [PMID: 26600706 PMCID: PMC4617045 DOI: 10.4103/0973-1075.164913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mandibular nerve block is periodically used procedure used to treat neuralgic pain in the distribution of trigeminal nerve. It is a commonly performed block in outpatient settings at our institute. We present a case of an elderly edentulous patient with trigeminal neuralgia who suffered recurrent temporomandibular joint (TMJ) dislocation following mandibular nerve block. The patient presented with complaints of severe pain, inability to close mouth, and eat food since 2 days. Anterior closed reduction of TMJ resulted in reduction of joint and immediate pain relief. However, the maneuver failed due to recurrent dislocation of the joint. A Barton dressing was applied to prevent another dislocation. This was followed by autologous blood injection into the joint. This case focuses on the preponderance of clinical evaluation and accentuates the need for additional forethought to be taken during pain procedures, particularly in the geriatric population.
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Affiliation(s)
- Ashish Bindra
- Department of Neuroanesthesiology, All Institute of Medical Sciences, New Delhi, India
| | - Parmod Bithal
- Department of Neuroanesthesiology, All Institute of Medical Sciences, New Delhi, India
| | - Navdeep Sokhal
- Department of Neuroanesthesiology, All Institute of Medical Sciences, New Delhi, India
| | - Ankit Arora
- Department of Oral and Maxillofacial Surgery, All Institute of Medical Sciences, New Delhi, India
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206
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Lee JB, Byun JH, Choi IS, Kim Y, Lee JS. The Effect of Pulsed Radiofrequency Applied to the Peripheral Nerve in Chronic Constriction Injury Rat Model. Ann Rehabil Med 2015; 39:667-75. [PMID: 26605164 PMCID: PMC4654073 DOI: 10.5535/arm.2015.39.5.667] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/29/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate the effect of pulsed radiofrequency (PRF) applied proximal to the injured peripheral nerve on the expression of tumor necrosis factor-α (TNF-α) in a neuropathic pain rat model. METHODS Nineteen male Sprague-Dawley rats were used in the study. All rats underwent chronic constriction injury (CCI) procedure. After 7 days of CCI, withdrawal frequency of affected hind paw to mechanical stimuli and withdrawal latency of affected hind paw to heat stimulus were measured. They were randomly divided into two groups: group A, CCI group (n=9) and group B, CCI treated with PRF group (n=10). Rats of group B underwent PRF procedure on the sciatic nerve. Withdrawal frequency and withdrawal latency were measured at 12 hours, and 7 days after PRF. Immunohistochemistry and Western blot analysis were performed using a TNF-α antibody. RESULTS Before PRF, withdrawal frequency and withdrawal latency were not different in both groups. After PRF, withdrawal frequency decreased and withdrawal latency prolonged over time in group B. There was significant interaction between time and group for each withdrawal frequency and withdrawal latency. Group B showed decreased TNF-α immunoreactivity of the spinal cord and sciatic nerve at 7 days. CONCLUSION PRF applied proximal to the peripheral nerve injury is potentially helpful for the reduction of neuropathic pain by neuromodulation of inflammatory markers.
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Affiliation(s)
- Jun-Beom Lee
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Jeong-Hyun Byun
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - In-Sung Choi
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Young Kim
- Department of Pathology, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Shin Lee
- Department of Pathology, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea
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Park C, Lee YW, Yoon DM, Kim DW, Nam DJ, Kim DH. Cross-cultural Adaptation and Linguistic Validation of the Korean Version of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. J Korean Med Sci 2015; 30:1334-9. [PMID: 26339176 PMCID: PMC4553683 DOI: 10.3346/jkms.2015.30.9.1334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/28/2015] [Indexed: 11/20/2022] Open
Abstract
Distinction between neuropathic pain and nociceptive pain helps facilitate appropriate management of pain; however, diagnosis of neuropathic pain remains a challenge. The aim of this study was to develop a Korean version of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and assess its reliability and validity. The translation and cross-cultural adaptation of the original LANSS pain scale into Korean was established according to the published guidelines. The Korean version of the LANSS pain scale was applied to a total of 213 patients who were expertly diagnosed with neuropathic (n = 113) or nociceptive pain (n = 100). The Korean version of the scale had good reliability (Cronbach's α coefficient = 0.815, Guttman split-half coefficient = 0.800). The area under the receiver operating characteristic curve was 0.928 with a 95% confidence interval of 0.885-0.959 (P < 0.001), suggesting good discriminate value. With a cut-off score ≥ 12, sensitivity was 72.6%, specificity was 98.0%, and the positive and negative predictive values were 98% and 76%, respectively. The Korean version of the LANSS pain scale is a useful, reliable, and valid instrument for screening neuropathic pain from nociceptive pain.
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Affiliation(s)
- Cholhee Park
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Youn-Woo Lee
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Mi Yoon
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do Wan Kim
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University, Suwon, Korea
| | - Da Jeong Nam
- Department of Anesthesiology and Pain Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Do-Hyeong Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Kim YJ, Byun JH, Choi IS. Effect of Exercise on µ-Opioid Receptor Expression in the Rostral Ventromedial Medulla in Neuropathic Pain Rat Model. Ann Rehabil Med 2015; 39:331-9. [PMID: 26161338 PMCID: PMC4496503 DOI: 10.5535/arm.2015.39.3.331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/10/2014] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the effects of aerobic exercise on neuropathic pain and verify whether regular treadmill exercise alters opioid receptor expression in the rostral ventral medulla (RVM) in a neuropathic pain rat model. Methods Thirty-two male Sprague-Dawley rats were used in the study. All rats were divided into 3 groups, i.e., group A, sham group (n=10); group B, chronic constriction injury (CCI) group (n=11); and group C, CCI+exercise group (n=11). Regular treadmill exercise was performed for 30 minutes a day, 5 days a week, for 4 weeks at the speed of 8 m/min for 5 minutes, 11 m/min for 5 minutes, and 22 m/min for 20 minutes. Withdrawal threshold and withdrawal latency were measured before and after the regular exercise program. Immunohistochemistry and Western blots analyses were performed using antibodies against µ-opioid receptor (MOR). Results Body weight of group C was the lowest among all groups. Withdrawal thresholds and withdrawal latencies were increased with time in groups B and C. There were significant differences of withdrawal thresholds between group B and group C at 1st, 2nd, 3rd, and 4th weeks after exercise. There were significant differences of withdrawal latencies between group B and group C at 3rd and 4th weeks after exercise. MOR expression of group C was significantly decreased, as compared to that of group B in the RVM and spinal cord. Conclusion In neuropathic pain, exercise induced analgesia could be mediated by desensitization of central MOR by endogenous opioids, leading to the shift of RVM circuitry balance to pain inhibition.
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Affiliation(s)
- Young-Jin Kim
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Center for Aging and Geriatrics, and Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong-Hyun Byun
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Center for Aging and Geriatrics, and Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - In-Sung Choi
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Center for Aging and Geriatrics, and Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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209
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Kim WS, Park JT, Lee YB, Park WY. Atlantoaxial Chordoma in Two Patients with Occipital Neuralgia and Cervicalgia. J Lifestyle Med 2015; 4:104-8. [PMID: 26064862 PMCID: PMC4391017 DOI: 10.15280/jlm.2014.4.2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022] Open
Abstract
Chordoma arises from cellular remnants of the notochord. It is the most common primary malignancy of the spine in adults. Approximately 50% of chordomas arise from the sacrococcygeal area with other areas of the spine giving rise to another 15% of chordomas. Following complete resection, patients can expect a 5-year survival rate of 85%. Chordoma has a recurrence rate of 40%, which leads to a less favorable prognosis. Here, we report two cases of chordoma presenting with occipital neuralgia and cervicalgia. The first patient presented with a C1-C2 chordoma. He rejected surgical intervention and ultimately died of respiratory failure. The second patient had an atlantoaxial chordoma and underwent surgery because of continued occipital neuralgia and cervicalgia despite nerve block. This patient has remained symptom-free since his operation. The presented cases show that the patients' willingness to participate in treatment can lead to appropriate and aggressive management of cancer pain, resulting in better outcomes in cancer treatment.
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Affiliation(s)
- Won Seop Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Taek Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Bok Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woo Young Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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210
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Bastian ZJ, Bastian RW. The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients. PeerJ 2015; 3:e816. [PMID: 25780768 PMCID: PMC4358635 DOI: 10.7717/peerj.816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/13/2015] [Indexed: 01/02/2023] Open
Abstract
Objective. This study sought to: (1) quantify response rate and efficacy of amitriptyline, desipramine, and gabapentin in treating sensory neuropathic cough; and (2) describe an efficient treatment protocol. Study Design. This study is a retrospective case series. Methods. Persons diagnosed with sensory neuropathic cough during a one-year period were potential study candidates. To bolster the diagnosis credibility, only persons who had been treated elsewhere for gastroesophageal reflux disease, asthma, and allergy with no reduction of cough were included. Upon diagnosis of sensory neuropathic cough, each person was treated with either amitriptyline, desipramine, or gabapentin, titrating the dose upward to desired benefit or the dose limit. If the benefit was insufficient, another of the medications was used next, using a similar dose escalation strategy. Data points included patient demographics, initial and final medication, final dose, and degree of improvement. Results. 32 patients met the diagnostic and inclusion criteria and had a complete data set. 94% (30 of 32) of the patients responded to at least one of the medications. The 32 patients undertook a total of 45 single-medication trials. Patients reported symptom relief during 78% (14 of 18) of amitriptyline trials, 73% (11 of 15) of desipramine trials, and 83% (10 of 12) of gabapentin trials. At final dosage, symptom reduction averaged 77% on amitriptyline, 73% on desipramine, and 69% on gabapentin. Conclusion. Amitriptyline, desipramine, and gabapentin appear to vary in their effectiveness for individual cases of sensory neuropathic cough; across a whole cohort, symptom relief was similar in frequency and degree on any of the three medications. More evidence is needed to demonstrate more convincingly the effectiveness of these medications, but this data set suggests that each of these three medications deserves consideration in the codified treatment protocol presented here.
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Affiliation(s)
- Zachary J Bastian
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina , Chapel Hill, NC , USA
| | - Robert W Bastian
- Bastian Voice Institute , Downers Grove, IL , USA ; Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center , Maywood, IL , USA
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211
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Amutio Gutiérrez S, Soto-González M. Effectiveness of gamma knife treatment in patients affected by idiopathic recurrent trigeminal neuralgia. Neurologia 2014; 31:482-90. [PMID: 25172395 DOI: 10.1016/j.nrl.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Gamma Knife Surgery (GNS) is one of the many techniques used to treat the idiopathic form of trigeminal neuralgia (TN). The aim of this review is to analyse the effectiveness of treatment with GNS in patients affected by recurrent TN. DEVELOPMENT a literature search conducted using MEDLINE, CINAHL, and Scopus in January of 2013 yielded 125 results. After applying the inclusion and exclusion criteria, we selected16 articles evaluating the effectiveness of GNS for reducing symptoms in patients with recurrent TN. Assessment criteria were degree of pain, time to pain relief, pain maintenance, and disease recurrence after the procedure. CONCLUSIONS GNS is considered a non-invasive, safe, and effective treatment for patients with idiopathic TN refractory to medication and surgery. It is currently considered the most advanced means of treating this disease.
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212
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Cheong C, Lee TJ. Prevalence and healthcare utilization of herpes zoster and postherpetic neuralgia in South Korea: disparity among patients with different immune statuses. Epidemiol Health 2014; 36:e2014012. [PMID: 25119454 PMCID: PMC4153010 DOI: 10.4178/epih/e2014012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/24/2014] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Despite the clinical and epidemiological importance of herpes zoster (HZ) and postherpetic neuralgia (PHN), their disease and economic burden related to immune status has not been studied in South Korea. Our aim was to calculate the prevalence and rate of healthcare utilization related to HZ and PHN among Korean patients stratified by immune status. METHODS This retrospective study used the Health Insurance Review and Assessment Service National Patients Sample (HIRA K-NPS) database, which includes all medical claims from January to December 2009 on a representative sample of the Korean population. HZ and PHN patients aged ≥ 50 years were categorized into three groups by immune status: severely immunocompromised group, moderately compromised group, and non-compromised group. The prevalence, disease-related healthcare utilization, and medical costs were compared across the three groups. RESULTS We estimated that there were 312,136 HZ patients and 48,461 PHN patients ≥ 50 years in South Korea. The prevalence of HZ and PHN was 18.54 and 2.88 per 1,000 persons, respectively, and increased with deteriorating immune status. The number of outpatient visits and hospitalization rate among HZ patients were highest in the severely immunocompromised group (4.38% and 7.52%, respectively) and lowest in the non-compromised group (3.82% and 4.08%, respectively). The average medical cost per patient in the severe group was the highest (240 US dollars) and that of the non-compromised group was the lowest (161 US dollars). No parameters were significantly different among patients with PHN by immunity. CONCLUSIONS HZ patients with severe immunodeficiency had a higher prevalence of HZ, more outpatient visits and hospitalizations, longer hospitalizations, and higher medical costs than their counterparts did. Efforts should be made to reduce the HZ-related burden of severely immunocompromised patients.
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Affiliation(s)
- Chelim Cheong
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Tae-Jin Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
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213
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Lee SJ, Seo AJ, Park BS, Jo HW, Huh Y. Neuropathic pain model of peripheral neuropathies mediated by mutations of glycyl-tRNA synthetase. J Korean Med Sci 2014; 29:1138-44. [PMID: 25120326 PMCID: PMC4129208 DOI: 10.3346/jkms.2014.29.8.1138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/24/2014] [Indexed: 12/18/2022] Open
Abstract
Charcot-Marie-Tooth disease (CMT) is the most common inherited motor and sensory neuropathy. Previous studies have found that, according to CMT patients, neuropathic pain is an occasional symptom of CMT. However, neuropathic pain is not considered to be a significant symptom associated with CMT and, as a result, no studies have investigated the pathophysiology underlying neuropathic pain in this disorder. Thus, the first animal model of neuropathic pain was developed by our laboratory using an adenovirus vector system to study neuropathic pain in CMT. To this end, glycyl-tRNA synthetase (GARS) fusion proteins with a FLAG-tag (wild type [WT], L129P and G240R mutants) were expressed in spinal cord and dorsal root ganglion (DRG) neurons using adenovirus vectors. It is known that GARS mutants induce GARS axonopathies, including CMT type 2D (CMT2D) and distal spinal muscular atrophy type V (dSMA-V). Additionally, the morphological phenotypes of neuropathic pain in this animal model of GARS-induced pain were assessed using several possible markers of pain (Iba1, pERK1/2) or a marker of injured neurons (ATF3). These results suggest that this animal model of CMT using an adenovirus may provide information regarding CMT as well as a useful strategy for the treatment of neuropathic pain.
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Affiliation(s)
- Seo Jin Lee
- Department of Anatomy and Neurobiology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ah Jung Seo
- Department of Anatomy and Neurobiology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Byung Sun Park
- Department of Anatomy and Neurobiology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Jo
- Department of Anatomy and Neurobiology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Youngbuhm Huh
- Department of Anatomy and Neurobiology, School of Medicine, Kyung Hee University, Seoul, Korea
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214
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Abstract
Objective To characterize neuropathic pain in patients with spinal cord injury (SCI) according to classification used in the study by Baron et al. (Baron classification), a classification of neuropathic pain based on the mechanism. To also compare the patterns of neuropathic pain in SCI patients with those in patients with other etiologies and to determine the differences in patterns of neuropathic pain between the etiologies. Methods This was a descriptive cross-sectional study. We used the Baron classification to investigate the characteristics of neuropathic pain in SCI. Sixty-one SCI patients with neuropathic pain (The Leeds assessment of neuropathic symptoms and signs score ≥12) were enrolled in this study between November 2012 and August 2013, after excluding patients <20 of age, patients with visual analog scale (VAS) score <3, pregnant patients, and patients with systemic disease or pain other than neuropathic pain. Results The most common pain characteristic was pricking pain followed by electrical pain and numbness. The mean VAS score of at-level neuropathic pain was 7.51 and that of below-level neuropathic pain was 6.83. All of the patients suffered from rest pain, but 18 (54.6%) patients with at-level neuropathic pain and 20 (50.0%) patients with below-level neuropathic pain suffered from evoked pain. There was no significant difference in between at-level and below-level neuropathic pains. Conclusion The result was quite different from the characteristics of post-herpetic neuralgia, but it was similar to the characteristics of diabetic neuropathy as shown in the study by Baron et al., which means that sensory nerve deafferentation may be the most common pathophysiologic mechanism of neuropathic pain after SCI. Since in our study, we included short and discrete symptoms and signs based on diverse mechanisms, our results could be helpful for determining further evaluation and treatment.
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Affiliation(s)
- Joon Young Jang
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung Hoon Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Huang B, Yao M, Feng Z, Guo J, Zereshki A, Leong M, Qian X. CT-guided percutaneous infrazygomatic radiofrequency neurolysis through foramen rotundum to treat V2 trigeminal neuralgia. Pain Med 2014; 15:1418-28. [PMID: 24716880 DOI: 10.1111/pme.12440] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Percutaneous radiofrequency thermocoagulation or neurolysis of Gasserian ganglion through foramen ovale (FO) is the classical approach to treat trigeminal neuralgia (TN). However, it has been technically challenging when individual trigeminal sub-branch nerve block is desired through this approach. We have thus developed a novel computed tomograph-guided technique to block the V2 trigeminal nerve through foramen rotundum (FR). With this technique, we have conducted a study of 27 patients with isolated V2 TN. We hypothesize that this new technique will have comparable clinical outcome with the conventional FO approach. DESIGN Prospective study. SETTING Academic hospitals. SUBJECTS Twenty-seven patients with isolated classical V2 TN were enrolled and divided into FO group (N = 12) and FR group (N = 15). METHODS Numeric Rating Scale (NRS) scores for facial pain, at pretreatment, immediate postoperative, postoperative 1 day, and 1, 6, and 12 months were recorded. The primary clinical outcome (successful pain relief with 50% or more reduction in NRS) and secondary adverse clinical outcome (hematoma, facial numbness, masticatory weakness, and corneal involvement) were compared and analyzed. RESULTS Both groups have good immediate and sustained pain relief. However, when compared with the FO group, the FR group is associated with shorter procedural time (29.2 ± 9.3 vs 45.4 ± 22.13 minutes, P < 0.05), has less nonspecific block in V1 and V3 dermatomes, and has fewer adverse outcomes including masticatory weakness (0/15 vs 5/12) and corneal perforation (0/12 vs 1/15). CONCLUSIONS We have developed a novel technique to selectively block the V2 trigeminal nerve at FR. This novel FR approach may be a good alternative to the classical FO approach when an isolated V2 branch block is desired.
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Affiliation(s)
- Bing Huang
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang, China
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216
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Suhrabi Z, Taghinejad H. A comparative study on the efficacy of Ibuprofen and celecoxib on the intensity of perineal pain following episiotomy: a randomized clinical trial. Iran Red Crescent Med J 2013; 15:e9980. [PMID: 24693414 PMCID: PMC3955529 DOI: 10.5812/ircmj.9980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/02/2013] [Accepted: 04/27/2013] [Indexed: 11/25/2022]
Abstract
Background: Pain is a worldwide problem that often originates from disease process, and diagnostic and treatment procedures such as surgical operations. Objectives: This trial was performed to compare the effectiveness of two analgesics for the management of perineal pain caused by episiotomy. Materials and Methods: A total of 170 nulliparous women who gave birth vaginally with episiotomy between March 2009 and November 2010 were randomly assigned to receive either ibuprofen or celecoxib which were given orally every 6 or 12 hours, respectively. Pain levels were measured before the intervention, and at 1, 2, 4, 8 and 12 hours after providing the first dose on a 10-cm visual analogue scale. Results: The results showed that the two groups had no significant differences regarding demographic characteristics, maternal, neonatal, and post-delivery factors, and mean premedication pain severity. Means of pain severity were different between the two groups as patients in the celecoxib group had lower means than the other group at 1,2,4,8 and 12 hours (4.01 ± 1.8 vs. 4.46 ± 1.9, 3.17 ± 1.9 vs. 3.79 ± 1.7, 2.89 ± 1.3 vs. 2.96 ± 1.5, 2.19 ± 1.8 vs. 2.55 ± 1.4, and 1.98 ± 1.1 vs. 2.45 ± 1.2, respectively) after administration of analgesics. Conclusions: Patients who received celecoxib had lower VAS in comparison with others. Although these differences were not significant, as celecoxib has longer half-life, fewer upper GI symptoms, and is better tolerated based on the previous studies, and this study is in favor of using it.
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Affiliation(s)
- Zainab Suhrabi
- Department of Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Hamid Taghinejad
- Department of Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding Author: Hamid Taghinejad, Department of Nursing, Ilam University of Medical Sciences, Ilam, IR Iran, Tel: +98-9183423104, Fax: +98-8412227134, E-mail:
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217
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Aleman M, Rhodes D, Williams DC, Guedes A, Madigan JE. Sensory evoked potentials of the trigeminal nerve for the diagnosis of idiopathic headshaking in a horse. J Vet Intern Med 2013; 28:250-3. [PMID: 24428325 PMCID: PMC4895556 DOI: 10.1111/jvim.12237] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 08/29/2013] [Accepted: 09/19/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- M Aleman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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218
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Aleman M, Williams DC, Brosnan RJ, Nieto JE, Pickles KJ, Berger J, Lecouteur RA, Holliday TA, Madigan JE. Sensory nerve conduction and somatosensory evoked potentials of the trigeminal nerve in horses with idiopathic headshaking. J Vet Intern Med 2013; 27:1571-80. [PMID: 24107198 DOI: 10.1111/jvim.12191] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/20/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Idiopathic headshaking (HSK) in horses is a distressing disorder in which the etiology and pathophysiology are unknown. HYPOTHESIS Differences in sensory function of the trigeminal nerve exist between healthy and affected horses. ANIMALS Six healthy mature geldings and 6 mature geldings with idiopathic HSK. METHODS Prospective study. Sensory nerve action and somatosensory evoked potentials studies were performed. The stimulus site comprised the gingival mucosa dorsal to the maxillary canine. A pair of recording electrodes was placed along the sensory pathway of the trigeminal complex at the infraorbital nerve (R1), maxillary nerve (R2), spinal tract of trigeminal (R3), and somatosensory cortex (R4). Sensory nerve action potential latency (ms), amplitude (μV), duration (ms), area under the curve (μVms), and conduction velocity (m/s) were calculated. RESULTS Threshold for activation of the infraorbital branch of the trigeminal nerve was significantly different between 5 affected (≤ 5 mA) and 6 control horses (≥ 10 mA). After initiation of an action potential, there were no differences in all parameters measured and no differences between left and right sides. A horse with seasonal HSK tested during a time of no clinical manifestations showed a threshold for activation similar to control horses. CONCLUSIONS AND CLINICAL IMPORTANCE This study confirms involvement of the trigeminal nerve hyperexcitability in the pathophysiology of disease. Further, results might support a functional rather than a structural alteration in the sensory pathway of the trigeminal complex that can be seasonal. The horse could serve as a natural animal model for humans with idiopathic trigeminal neuralgia.
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Affiliation(s)
- M Aleman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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219
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Rayment C, Hjermstad MJ, Aass N, Kaasa S, Caraceni A, Strasser F, Heitzer E, Fainsinger R, Bennett MI. Neuropathic cancer pain: prevalence, severity, analgesics and impact from the European Palliative Care Research Collaborative-Computerised Symptom Assessment study. Palliat Med 2013; 27:714-21. [PMID: 23175513 DOI: 10.1177/0269216312464408] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropathic pain causes greater pain intensity and worse quality of life than nociceptive pain. There are no published data that confirm this in the cancer population. AIM We hypothesised that patients with neuropathic cancer pain had more intense pain, experienced greater suffering and were treated with more analgesics than those with nociceptive cancer pain, and a neuropathic pain screening tool, painDETECT, would perform as well in those with cancer pain as is reported in those with non-cancer pain. DESIGN The data were obtained from an international cross-sectional observational study. SETTING/PARTICIPANTS A total of 1051 patients from inpatients and outpatients, with incurable cancer completed a computerised assessment on symptoms, function and quality of life. In all, 17 centres within eight countries participated. Medical data were recorded by physicians. Pain type was a clinical diagnosis recorded on the Edmonton Classification System for Cancer Pain. RESULTS Of the patients, 670 had pain: 534 with nociceptive pain, 113 with neuropathic pain and 23 were unclassified. Patients with neuropathic cancer pain were significantly more likely to be receiving oncological treatment, strong opioids and adjuvant analgesia and have a reduced performance status. They reported worse physical, cognitive and social function. Sensitivity and specificity of painDETECT for identifying neuropathic cancer pain was less accurate than when used in non-cancer populations. CONCLUSIONS Neuropathic cancer pain is associated with a negative impact on daily living and greater analgesic requirements than nociceptive cancer pain. Validated assessment methods are needed to enable early identification of neuropathic cancer pain, leading to more appropriate treatment and reduced burden on patients.
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Affiliation(s)
- Clare Rayment
- Academic Unit of Palliative Care, St Gemma's Hospice, Leeds, UK.
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220
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Weitzman D, Shavit O, Stein M, Cohen R, Chodick G, Shalev V. A population based study of the epidemiology of Herpes Zoster and its complications. J Infect 2013; 67:463-9. [PMID: 23872209 DOI: 10.1016/j.jinf.2013.06.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/13/2013] [Accepted: 06/19/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the incidence of Herpes Zoster (HZ) and its complications in the Israeli general population and specifically in immune-compromised individuals, and to identify risk factors for developing HZ and post-herpetic neuralgia (PHN). METHODS A retrospective database search for newly diagnosed cases of HZ and of PHN during 2006-2010 was conducted using the comprehensive longitudinal database of Maccabi Health Services. Cox-proportional hazards models were used to assess associations between risk factors and HZ and PHN. RESULTS During 2006-2010 there were 28,977 newly diagnosed cases of HZ and 1508 newly diagnosed cases of PHN. Incidence density rate of HZ was 3.46 per 1000 person-years in the total population and 12.8 per 1000 person-years in immune-compromised patients. HZ and PHN incidence increased sharply with age. 12.4% and 3.1% of elderly HZ patients (≥ 65 years) developed PHN or ophthalmic complications, respectively. In multivariable analyses, HZ and PHN were associated with female sex, higher socioeconomic status, diabetes mellitus, cancer history, and HIV treatment. CONCLUSIONS Extrapolating to the entire Israeli population, we estimate over 24,000 new cases of HZ and 1250 new cases of PHN each year. Cost-effectiveness analysis should be performed to determine the threshold age for vaccination against HZ.
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Affiliation(s)
- Dahlia Weitzman
- Maccabi Healthcare Services, Medical Division, Tel Aviv, Israel.
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221
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Abstract
Herpes zoster and post-herpetic neuralgia deteriorate the quality of life because of severe pain and complications, and cause considerable social and economic burden of disease. In 2012, herpes zoster vaccine was released in Korea. The efficacy of herpes zoster vaccine is known to be 51.3-66.5% among the aged over 60 and 69.8-72.4% among adults between 50 and 59. It is also known that preventive efficacy is maintained for at least 5 years. Although there can be local reactions such as redness, pain and swelling at the site of injection and systemic reaction such as headache and eruption after herpes zoster vaccination, most of the adverse reactions are minor and disappear within days by themselves. As it is a live vaccine, persons with severe immune-suppression and pregnant women should not be vaccinated with the vaccine. Currently, Korean Society of Infectious Diseases recommended for the aged over 60 to be vaccinated with herpes zoster vaccine by subcutaneous route. In this article, clinical aspects and burden of disease of herpes zoster, efficacy and effects of herpes zoster vaccine, and herpes zoster vaccine recommendation by Korean Society of Infectious Diseases are discussed.
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Affiliation(s)
- Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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222
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Jendrzejewski F, Peltier J, Havet E, Page C, Foulon P, Gondry J, Le Gars D. [The conflict between obturator nerve and ovary: a cadaveric and radioanatomic study]. Morphologie 2013; 97:54-8. [PMID: 23796698 DOI: 10.1016/j.morpho.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to describe the anatomical relationships between the ovary and the obturator nerve in its intrapelvic portion. Seven embalmed cadavers were dissected; 20 MRIs were then analyzed. The main distance between the lateral pole of the ovary and the obturator nerve was 29 mm. The authors describe various etiologies responsible for obturator neuralgia. An underdiagnosed cause is gonadal hypertrophy.
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Affiliation(s)
- F Jendrzejewski
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, université de Picardie Jules-Verne, rue des Louvels, 80036 Amiens cedex 1, France.
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223
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Parker JP, Javaher SP, Jackson FK, Carter GT. Considerations for neuropathic pain conditions in life care planning. Phys Med Rehabil Clin N Am 2013; 24:507-20. [PMID: 23910488 DOI: 10.1016/j.pmr.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Significant progress has been made in assessing and managing neuropathic pain. Newer, more effective treatments with minimal side effects are available. Despite advances in treatments, neuropathic pain remains a multifaceted phenomenon that can be difficult to alleviate. Diagnosis, mechanisms of injury, and treatment recommendations are critical components of life care plans for patients with neuropathic pain. A clear understanding of the underlying issues and careful coordination with neurologists and other treatment providers are key to providing optimal life care plans. Understanding that pain treatments vary over time and by individual patient is integral to comprehensive life care planning.
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Affiliation(s)
- Judith P Parker
- OSC Vocational Systems, Inc, Bothell, 10132 Northeast 185th Street, WA 98011, USA.
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224
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Quraishi MB, Khalil Q, Tivakaran V. Successful implanted pacemaker for an extreme inhibitory reflex syncope evoked by post herpetic trigeminal neuralgia. J Cardiol Cases 2013; 7:e173-5. [PMID: 30533156 DOI: 10.1016/j.jccase.2013.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/17/2013] [Accepted: 02/20/2013] [Indexed: 11/22/2022] Open
Abstract
Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Numerous causes of syncope have been described. Vasovagal syncope is the most common with a number of precipitants. We report a case of post herpetic trigeminal neuralgia leading to neurocardiogenic syncope. These episodes were preceded by severe stabbing left frontal headaches followed by significant sinus bradycardia, asystole, and syncope requiring pacemaker implantation. To our knowledge only one previous case of post herpetic trigeminal neuralgia leading to syncope has been reported. <Learning objective: Neuralgia-associated syncope is a rare phenomenon. Failing to recognize and treat appropriately may be associated with recurring episodes of syncope with significant lifestyle limitations. Although post herpetic neuralgia is treatable, one should be prepared to insert a pacemaker if treatment fails to control symptoms that progress to cardioinhibitory syncope.>.
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225
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Khoshmohabat H, Panahi F, Alvandi AA, Mehrvarz S, Mohebi HA, Shams Koushki E. Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy. Trauma Mon 2012; 17:323-8. [PMID: 24350117 PMCID: PMC3860626 DOI: 10.5812/traumamon.6581] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/28/2012] [Accepted: 08/15/2012] [Indexed: 11/16/2022] Open
Abstract
Background Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time. Objectives The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method. Materials and Methods In this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis. Results All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery). Conclusions Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.
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Affiliation(s)
- Hadi Khoshmohabat
- Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences,, Tehran, IR Iran
| | - Farzad Panahi
- Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences,, Tehran, IR Iran
- Corresponding author: Farzad Panahi, Trauma Research Center, Bagiyatallah University of Medical Sciences, Molasadra st, Tehran, IR Iran. Tel.: +98-2188053766, Fax: +98-2188053766, E-mail:
| | - Ali Akbar Alvandi
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Shaban Mehrvarz
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hasan Ali Mohebi
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ehsan Shams Koushki
- Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences,, Tehran, IR Iran
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Becker D, Amirlak B. Beyond Beauty: Onobotulinumtoxin A (BOTOX®) and the Management of Migraine Headaches. Anesth Pain Med 2012; 2:5-11. [PMID: 24223326 PMCID: PMC3821109 DOI: 10.5812/aapm.6286] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 05/14/2012] [Accepted: 05/20/2012] [Indexed: 12/20/2022] Open
Abstract
Based on the conducted anatomic studies at our institutions as well as clinical experience with migraine surgery, we have refined our onobotulinumtoxin A (BOTOX®) injection techniques. Pain management physicians are in unique position to be able to not only treat migraine patient, but also to be able to collaborate with neurologists and peripheral nerve surgeons in identifying the migraine trigger sites prior to surgical deactivation. The constellation of migraine symptoms that aid in identifying the migraine trigger sites, the potential pathophysiology of each trigger site, the effective methods of botulinumtoxin and nerve block injection for diagnostic and treatment purposes, as well as the pitfalls and potential complications, will be addressed and discussed in this paper.
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Affiliation(s)
- Devra Becker
- Department of Plastic and Reconstructive Surgery, Case Western University, Cleveland, USA
| | - Bardia Amirlak
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, USA
- Corresponding author: Bardia Amirlak, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, 1801 In wood Road, Dallas, Texas 75390-9132, USA. Tel: +1-214645.5560, Fax: +1-2146453148, E-mail:
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227
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Mohajjel Nayebi A, Sharifi H, Ramadzani M, Rezazadeh H. Effect of acute and chronic administration of carbamazepine on Cisplatin-induced hyperalgesia in rats. Jundishapur J Nat Pharm Prod 2012; 7:27-30. [PMID: 24624148 PMCID: PMC3941866 DOI: 10.17795/jjnpp-3559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/15/2011] [Accepted: 12/30/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cisplatin is an effective antineoplastic drug used extensively in the treatment of malignancies. It induces painful peripheral neuropathy at high doses. OBJECTIVES The aim of this study was to investigate the effect of carbamazepine (CBZ) on cisplatin-induced peripheral neuropathic pain by using the tail-flick test. MATERIALS AND METHODS The study was performed using male Wistar rats weighing 180-200 g. Neuropathic pain was induced by intraperitoneal (IP) administration of cisplatin (5 mg/kg). The effect of oral (PO) CBZ administration (5, 10, and 15 mg/kg) on cisplatin-induced pain was assessed using the tail-flick test. RESULTS Our results showed that cisplatin (5 mg/kg, IP) induced egregious pain (P < 0.01) on day 15. Acute administration of CBZ (5, 10, and 15 mg/kg, PO) caused significant (P < 0.05) increase in tail-flick time latency in a dose-dependent manner, in comparison with that observed in the control group. Furthermore, chronic administration of CBZ (5, 10, and 15 mg/kg, PO) increased (P < 0.05) the pain threshold on days 5 and 10. The analgesic effect of morphine (5 mg/kg, IP) was greater than that after acute CBZ administration (5, 10, and 15 mg/kg, PO). CONCLUSIONS Our results showed that both acute and chronic CBZ administration attenuated cisplatin-induced pain. We suggest that CBZ can be used clinically for alleviating cisplatin-induced neuropathic pain in cancer patients, without any limitations such as tolerance to analgesic effect.
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Affiliation(s)
- Alireza Mohajjel Nayebi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran ; Department of Pharmacology and Toxicology, Fcaulty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hamdollah Sharifi
- Department of Pharmacology and Toxicology, Fcaulty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mohammad Ramadzani
- Department of Pharmacology and Toxicology, Fcaulty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hassan Rezazadeh
- Department of Pharmacology and Toxicology, Fcaulty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, IR Iran
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228
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Abstract
Background: Trigeminal neuralgia (TN) is neuropathic pain which can involve any part or side of the face. Objectives: The objectives of this study were to find the most common branch of trigeminal nerve affected and the most common side involved. Patients and Methods: This Cross sectional study was carried out on 100 patients of trigeminal neuralgia in one year time. The diagnosis was based on a detailed history, clinical examination and control of pain by carbamazepine being taken supplemented by radiographic investigations. The collected data was analysed by SPSS 16. Results: The age of the patients varied from 40 to 80 years with a mean age 54 years at the time of presentation. The males to females ratio was 1:2. The right side of the face was found to be involved in seventy patients (64 %) and left side in (36 %). No case presented with bilateral involvement. The Mandibular division was most commonly involved in this study (n = 55; 55%) and least was ophthalmic divisions (n = 6; 6%). Conclusions: This study demonstrated numerous clinical similarities of trigeminal neuralgia afflicting different populations. Right side was more involved along with mandibular division the most commonly affected. However studies needs to be done to know the exact reasons of involvement of the affected side and branches.
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Affiliation(s)
- Tanweer Hussain Bangash
- Employee Health Department, Peshawar, Khyber Pakhtoonkhwa, Pakistan
- Corresponding author: Tanweer Hussain Bangash, Employee Health Department, Govt. Khyber pakthoonkhwa, House-253, St/7, K/1, Phase-3, Hayatabad Township, Peshawar, Khyber Pakhtoonkhwa, Pakistan. Tel: +92-9157100336, Fax: +92-3339159458, E-mail:
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229
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Kim EH, Ryu DH, Hwang S. The expression of corticotropin-releasing factor and its receptors in the spinal cord and dorsal root ganglion in a rat model of neuropathic pain. Anat Cell Biol 2011; 44:60-8. [PMID: 21519550 PMCID: PMC3080009 DOI: 10.5115/acb.2011.44.1.60] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 02/28/2011] [Accepted: 03/14/2011] [Indexed: 01/15/2023] Open
Abstract
Corticotropin-releasing factor (CRF) is a peptide involved in the activation of the hypothalamic-pituitary-adrenal (HPA) axis. CRF is distributed not only along the HPA axis but also throughout pain-relevant anatomical sites. CRF elicits potent antinociception at the three main levels of pain transmissions: namely, the brain, spinal cord, and peripheral sensory neurons. The widespread distribution of CRF receptors 1 and 2 in the brain offers several targets wherein CRF could alter pain, some of which may be independent of the HPA axis. In this study, we assessed the expression of CRF and its receptors, CRF receptor type (CRFR)1 and CRFR2, in the spinal dorsal horn and dorsal root ganglion (DRG) in a rat model of neuropathic pain induced by spinal nerve injury (SNI). CRF was expressed in a few DRG neurons and primary afferent fibers in the dorsal horns of naїve rats, and the CRF-positive neurons in DRG and fibers in the spinal dorsal horn were found to have increased after SNI. CRFR1 was not expressed in DRG or the dorsal horn and CRFR2 was expressed weakly in the small neurons in DRG in the naїve rats. After SNI, CRFR1 was expressed in the activated microglia in the ipsilateral dorsal horn, and immunoreaction for CRFR2 was increased in the contralateral DRG following SNI. Consequently, it has been suggested that the increased expression of CRF and CRFR2 in DRG neurons and primary afferent fibers in dorsal horn, and CRFR1 in the activated microglia, may be involved in the mediation of stress responses as well as in microglial activation in the neuropathic pain state following SNI.
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Affiliation(s)
- Eun Hyun Kim
- Department of Anatomy and Cell Biology, College of Medicine, Hanyang University, Seoul, Korea
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Na SH, Kim TW, Oh SY, Kweon TD, Yoon KB, Yoon DM. Ultrasonic doppler flowmeter-guided occipital nerve block. Korean J Anesthesiol 2010; 59:394-7. [PMID: 21253376 PMCID: PMC3022132 DOI: 10.4097/kjae.2010.59.6.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/16/2010] [Accepted: 07/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Greater occipital nerve block is used in the treatment of headaches and neuralgia in the occipital area. We evaluated the efficacy of ultrasonic doppler flowmeter-guided occipital nerve block in patients experiencing headache in the occipital region in a randomized, prospective, placebo-controlled study. METHODS Twenty-six patients, aged 18 to 70, with headache in the occipital region, were included in the study. Patients received a greater occipital nerve block performed either under ultrasonic doppler flowmeter guidance using 1% lidocaine or the traditional method. Sensory examination findings in the occipital region were evaluated. RESULTS The complete block rate of greater occipital nerve blockade in the doppler group was significantly higher than in the control group respectively (76.9% vs. 30.8%, P < 0.05). Only one patient in the control group had a complication (minimal bleeding). CONCLUSIONS Ultrasonic doppler flowmeter-guided occipital nerve block may be a useful method for patients suffering headache in the occipital region.
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Affiliation(s)
- Se Hee Na
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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