1/7. Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: a case-study.methadone is used increasingly as a second-line opioid in the management of cancer pain refractory to conventional opioids. Recent case studies suggest that its use as an analgesic could be extended to non-cancer pain, especially neuropathic pain. The present case study reports, for the first time, the efficacy of methadone in a burn patient experiencing neuropathic pain in his healed wounds. The patient sustained extensive (55% total body surface area) chemical burns and developed chronic burning sensations, particularly in the lower limbs where skin grafting had been performed. Conventional pharmacotherapies against neuropathic pain were attempted to control pain for over 5 years. The agents used included long- and short-acting opioids, amitriptyline, clonazepam, and gabapentin, but they all failed to relieve the pain. When methadone (5 mg every 12 h) was introduced, it significantly alleviated the patient's pain within a few days of administration. The patient has now been taking methadone (15 mg every 12 h) for 10 months and reports that the opioid caused 70% pain relief and a 55% amelioration in his quality of life. Although these results are based on a case report, they suggest that a switch to methadone might be useful in some burn patients who have developed chronic neuropathic pain unrelieved by conventional pharmacotherapies. methadone, however, needs to be titrated with vigilance and thus should be administered by a physician experienced with its use in the treatment of chronic pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Pharmacologic management part 1: better-studied neuropathic pain diseases.Neuropathic pain impacts millions of people in the united states and around the world. patients experience one of many symptoms, such as pain, paresthesia, dysesthesia, hyperalgesia, and allodynia, for many years because of unavailable or inadequate treatment. One of the major challenges in treating patients with neuropathic pain syndromes is a lack of consensus concerning the appropriate first-line treatment options for conditions associated with neuropathic pain, including postherpetic neuralgia, diabetic peripheral neuropathy, and trigeminal neuralgia. This review summarizes the published results of randomized trials involving treatment for neuropathic pain conditions. anticonvulsants, such as gabapentin, carbamazepine, and lamotrigine, and tricyclic antidepressants, including amitriptyline and desipramine, have demonstrated efficacy in relieving pain associated with postherpetic neuralgia, diabetic peripheral neuropathy, and trigeminal neuralgia, in several studies. However, the lack of head-to-head comparison studies of these agents limits the conclusions that can be reached. Clinicians who must make decisions regarding the care of individual patients may find some guidance from the number of randomized trials with a positive outcome for each agent. Using quality-of-life study outcomes, treatment strategies must encompass the impact of therapeutic agents on the comorbid conditions of sleep disturbance and mood and anxiety disorders associated with neuropathic pain. Looking to the future, emerging therapies, such as pregabalin and newer N-methyl-D-aspartate-receptor blockers, may provide physicians and patients with new treatment options for more effective relief of pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. The therapeutic potential of botulinum toxin.BACKGROUND: Botulinum toxin type A (BTX-A; commercial preparation BOTOX) is most well known for its effect on muscle contraction because of the BTX binding to the presynaptic nerve terminal, inhibiting the release of acetylcholine (ACH). The therapeutic benefit of BTX-A, however, can also be isolated to pain relief alone, suggesting that BTX-A also works through additional modes of action. OBJECTIVE: This article provides insight by an experienced physician into four different case reports. Each case demonstrates the therapeutic potential of BTX-A and the possibility of a different mechanism of action for BTX other than the inhibition of ACH release. RESULTS: Four patients, each with different symptoms such as relapsing-remitting multiple sclerosis, postherpetic neuralgia, peripheral neuropathy, and severe tingling caused by herniation of cervical vertebrae at the level of C8, were treated with BOTOX, and their symptoms were alleviated. CONCLUSIONS: The BTX-A mechanism providing pain relief is hypothesized to be something other than muscle relaxation by inhibiting the release of ACH at the neuromuscular juncture, such as inhibition of the release of substance p or the blocking of autonomic pathways, etc. This article is intended to continue to keep physicians using this substance for dermatologic indications aware of the potential unsuspected effects.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/7. 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 = 1keywords = physician (Clic here for more details about this article) |
5/7. Anterior cervical pain syndromes.The paucity of clinical findings in patients with glossopharyngeal neuralgia, superior laryngeal neuralgia, styloid process syndrome, hyoid syndrome, or carotidynia presents an enigma to the patient and the physician. Manifest symptoms appear extraneous or incongruous unless the essential element is identified. Common to all these syndromes is the radiation of pain over the neck and face, starting from the anterior cervical area of the neck. Case histories of seven patients are presented. The rationale of underlying pathophysiologic mechanisms is discussed and supported by relevant recent basic pain research, and conceptual speculations are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Early treatment of herpes zoster.Although varicella virus vaccine may eventually decrease the incidence of herpes zoster, the disease will continue to plague patients and physicians for at least the next several decades. Recognition of shingles early in its vesicular stage is important, since that is when antiviral treatment is effective. Moreover, a variety of agents are now available for symptomatic relief of postherpetic neuralgia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Comparison of two patients with similar facial pain complaints of dental and non-dental etiologies.The medical and lay communities have become more aware of the role of dentistry in the diagnosis and management of facial pain disorders. In some cases, the patient or physician may presume that a facial pain complaint is of odontogenic origin and seek the opinion of a dental practitioner. While the majority of facial pain complaints may be due to dental pathologies, some may also be due to non-dental causes. The diagnostic acumen of the dentist must include a basic understanding of non-dental causes for facial pain as well as those related to dentistry. The following case reports may serve to underscore this observation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |