1/25. Augmentative treatment of chronic deafferentation pain syndromes after peripheral nerve lesions.Deafferentation pain syndromes developing after peripheral nerve lesions are difficult to treat. According to the follow-up (mean: 39.5 months) of 6 patients suffering from causalgic pain we will present our method of augmentative therapy in chronic neuropathic pain caused by peripheral nerve lesions, i.e., peripheral nerve stimulation (PNS), spinal cord stimulation (SCS) and chronic intrathecal opioid infusion. None of the patients showed intraoperative or follow-up complications. Evaluated by visual analogue scales all patients reported a good to excellent pain relief (75-100%). (1) Regarding the favourable long-term results of PNS, this method should be considered in cases of mononeuropathic pain syndromes. (2) Neuropathic pain syndromes which are not assignable to a singular nerve lesion, can often be managed effectively by SCS. (3) In contrast to the widespread opinion, deafferentation pain syndromes of central or peripheral origin can be treated satisfactorily by intrathecal opiate administration.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/25. Abdominoinguinal pain syndrome treated by centrocentral anastomosis.During operations in the lower part of the abdomen injuries to nerves located here arise in 1-4,2 per cent; the most frequently iliohypogastric, ilioinguinal, genitofemoral and lateral femoral cutaneous nerves. These injuries to nerves are often very painful and till to day very difficult to treat. Clinical terminology of their injuries is variable and not strict. Therefore we suggest an all embracing term "abdominoinguinal pain syndrome". The authors present four case reports, in whom centrocentral anastomosis with use of both autologous interposed segment of nerve and also without it, achieved successful treatment of chronic pain. On the basis of this experience the authors prefer centrocentral anastomosis without autologous interposed segment of nerve, which is technicaly more simple.- - - - - - - - - - ranking = 0.625keywords = nerve (Clic here for more details about this article) |
3/25. Increased sodium channel SNS/PN3 immunoreactivity in a causalgic finger.The sodium channels SNS/PN3 and NaN/SNS2 are regulated by the neurotrophic factors-nerve growth factor (NGF) and glial-derived neurotrophic factor (GDNF), and may play an important role in the development of pain after nerve injury or inflammation. These key molecules have been studied in an amputated causalgic finger and control tissues by immunohistochemistry. There was a marked increase in the number and intensity of SNS/PN3-immunoreactive nerve terminals in the affected finger, while GDNF-immunoreactivity was not observed, in contrast to controls. No differences were observed for NGF, trk A, NT-3 or NaN/SNS2-immunoreactivity. While further studies are required, these findings suggest that accumulation of SNS/PN3 and/or loss of GDNF may contribute to pain in causalgia, and that selective blockers of SNS/PN3 and/or rhGDNF may provide effective novel treatments.- - - - - - - - - - ranking = 0.375keywords = nerve (Clic here for more details about this article) |
4/25. Complex regional pain syndrome after thromboendarterectomy: which type is it?The authors describe a complex regional pain syndrome (CRPS) and discuss its type according to the presence or absence of nerve injury. A patient underwent thromboendarterectomy of the right popliteal artery. Subsequently, right lower limb reflex sympathetic dystrophy developed, which was confirmed by scintigraphy and responded well to calcitonin treatment. Typing according to the new classification of CRPS type I or II with possible nerve injury is discussed, and a short review of the literature is included.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
5/25. Severe complex regional pain syndrome type II after radial artery harvesting.The radial artery is increasingly used as a coronary bypass graft. We report on a patient who developed a severe complex regional pain syndrome type II--also called causalgia--after radial artery harvesting. After an odyssey of diagnostic and presumed therapeutic procedures, she underwent surgical revision of the left forearm. Intraoperatively, a titanium clip in close neighborhood to the superficial radial nerve affecting the perineurium was found and removed, and more distally, a small neurinoma (3 by 4 mm) was resected. Despite presumed successful operation, symptoms did not improve. The patient presumably remains unable to use her left arm and hand.- - - - - - - - - - ranking = 0.125keywords = nerve (Clic here for more details about this article) |
6/25. 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 = 0.25keywords = nerve (Clic here for more details about this article) |
7/25. amenorrhea in a patient after treatment with gabapentin for complex regional pain syndrome type II.A 35-year-old woman suffered a traumatic injury to her right sciatic nerve requiring nerve exploration and external neurolysis. Following the surgery, the patient developed complex regional pain syndrome (CRPS) type II and was treated with gabapentin for pain control. Three months after the initiation of gabapentin therapy (1800 mg/day), the patient reported complete cessation of her menses. Based on hormonal tests, her gynecologist concluded that her amenorrhea was secondary to gabapentin therapy. The patient was weaned off the gabapentin over 6 days with return of her menses 2 weeks later. I conclude that gabapentin has the potential to cause amenorrhea with return of menses occurring after discontinuation of the drug.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
8/25. A case of complex regional pain syndrome type II after transradial coronary intervention.The transradial approach for coronary catheterization is now a routine technique without serious complications at the puncture site. We report a case of complex regional pain syndrome type II (CRPS type II) in the hand after the transradial coronary intervention, which may alert medical personnel that the technique may cause serious regional pain with disability. A 61-year-old woman underwent coronary intervention via the right radial artery for the treatment of unstable angina. After the operation she complained of severe pain in the right hand, consistently felt along the median nerve distribution. The nerve conduction study suggested carpal tunnel syndrome. We made a diagnosis of CRPS type II, and the patient received stellate ganglion blockade, cervical epidural blockade, and administration of amitriptyline and loxoprofen. The symptoms gradually improved and her activities of daily living markedly improved. The median nerve appeared to be damaged by local compression and potential ischemia. Careful attention should be paid to avoid CRPS type II, associated with excess compression.- - - - - - - - - - ranking = 5.3130703736328keywords = median nerve, nerve, median (Clic here for more details about this article) |
9/25. Surgical relief of causalgia with an artificial nerve guide tube: Successful surgical treatment of causalgia (Complex Regional Pain Syndrome Type II) by in situ tissue engineering with a polyglycolic acid-collagen tube.Two patients with causalgia associated with allodynia and finger contracture were treated surgically with a bioresorbable nerve guide tube made from polygycolic acid and collagen: the injured segment of the digital nerve was resected and the resulting gap (25 and 36mm) was bridged with the tube. In both cases, a neuroma was found on the injured nerve and many sprouting branches were. After reconstruction, the causalgia and allodynia disappeared and movement of the fingers recovered during the following 6 months. Functional recovery was objectively identified for 1 year and 9 months. Both patients regained full use of their finger and were free of discomfort for up to 24 and 18 months, respectively. Since the first description of causalgia in 1864, there has been no definitive treatment for this intractable burning pain. Our experience shows that at least some types of causalgia can be resolved successfully by surgery.- - - - - - - - - - ranking = 0.875keywords = nerve (Clic here for more details about this article) |
10/25. Painful neuropathy with trigeminal nerve involvement in type 2 diabetes.After several years of treatment for type 2 diabetes mellitus, a 69-year-old Japanese man developed an acute painful neuropathy, characterized by bilateral causalgia and dysaesthesia in his cheeks and around his eyes, typically 30 min to 3 h after meals. As his glycaemic control deteriorated, his haemoglobin (Hb) A1c level gradually increased from 7 - 8% to 10.3% and his symptoms became more severe. The pain radiated out along the distribution of the ophthalmic and maxillary divisions of the trigeminal nerve. The patient was treated with insulin therapy and his HbA1c level decreased from 10.3% to 6.8% within 7 months. Five months after initiating insulin therapy, his symptoms showed a dramatic improvement. This was a very unusual case of bilateral acute painful neuropathy that involved the ophthalmic and maxillary divisions of the trigeminal nerve, and in which aggravation of the symptoms clearly related to poor glycaemic control.- - - - - - - - - - ranking = 0.75keywords = nerve (Clic here for more details about this article) |
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