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Journal of neuropathic pain & symptom palliation最新文献

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Surgical Treatment of Neuropathic Pain 神经性疼痛的外科治疗
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/MED/9780190298357.003.0008
Jianguo Cheng, Wenbao Wang
{"title":"Surgical Treatment of Neuropathic Pain","authors":"Jianguo Cheng, Wenbao Wang","doi":"10.1093/MED/9780190298357.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780190298357.003.0008","url":null,"abstract":"Surgical treatment of intractable neuropathic pain has evolved significantly during the past few decades. Early treatments focus on neuroablation of the pain pathways. Although these techniques still have a role in specific indications, they have largely fallen out of favor due to causing irreversible destructive damage to the brain and/or spinal cord. Spinal cord stimulation, peripheral nerve stimulation, and intrathecal drug delivery system using programmable pump have become more popular treatment options for patients who do not respond to pharmaceutical and interventional procedures. These methods have reasonable safety profiles and can be efficacious and cost-effective, especially for patients with failed back surgical syndrome and complex regional pain syndrome. Deep brain stimulation and motor cortex stimulation are options for central pain. Microvascular decompression surgery and Gamma Knife radiosurgery are excellent options in selected patients with refractory trigeminal neuralgia or glossopharyngeal neuralgia.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"288 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77895253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessment and Diagnosis of Neuropathic Pain 神经性疼痛的评估与诊断
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0004
Erik C Hustak
{"title":"Assessment and Diagnosis of Neuropathic Pain","authors":"Erik C Hustak","doi":"10.1093/med/9780190298357.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0004","url":null,"abstract":"The assessment and diagnosis of neuropathic pain are essential in understanding the complex mechanisms responsible for this syndrome. Furthermore, there is a tremendous need for more effective, targeted strategies for delivering pain medicine. Unfortunately, the diagnosis and treatment of neuropathic pain can be challenging. A standardized approach leading to an accurate diagnosis must be consistently communicated among clinicians and researchers, and the diagnostician needs to differentiate neuropathic pain from other pain phenotypes. Several validated tools and questionnaires have been designed specifically for this purpose and are discussed in depth in this chapter. The clinician must utilize the history and physical exam and consider ordering pertinent confirmatory tests to support the neuropathic pain diagnosis. A critical understanding of this work is needed in order to promote progress in our ability to define potential treatment targets to alleviate suffering in our patients.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84365080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Immune-Related Neuropathy 几种神经病变
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0018
W. Braddy
{"title":"Immune-Related Neuropathy","authors":"W. Braddy","doi":"10.1093/med/9780190298357.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0018","url":null,"abstract":"There are many causes of neuropathic pain, as this book illustrates in great detail. The closer we look into these causes, the more researchers are discovering how the immune system contributes to chronic pain. This chapter reviews the most commonly accepted immune-related causes of painful peripheral neuropathy. These fall into four main categories: viral, vasculitis, autoimmune, and paraneoplastic. The review borrows from the texts, journals, and wisdom of colleagues in internal medicine, neurology, and oncology. Despite the fact that these are uncommon subjects for most pain clinicians, they do present in pain clinics. The mechanisms of these related conditions, such as Guillain-Barré syndrome, hepatitis, Sjogren syndrome, and multiple sclerosis, and their treatments have bearing on understanding immune-related causes of painful peripheral neuropathy.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86747818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cervical Radiculopathy 颈神经根病
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0026
Sam Samuel, Eduardo E Icaza
{"title":"Cervical Radiculopathy","authors":"Sam Samuel, Eduardo E Icaza","doi":"10.1093/med/9780190298357.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0026","url":null,"abstract":"This chapter discusses cervical radiculopathy, a common, painful condition from cervical root compression, irritation, or both. A thorough history and physical exam can often help in diagnosing the affected nerve root, without the need for reflexive imaging. A series of provocative tests can aid in the differential diagnosis. Most cases will be resolved with conservative management within several weeks of symptoms onset. Evidence-based conservative management includes physical therapy and oral NSAIDs. If symptoms indicate myelopathic changes or are refractory to 6 to 8 weeks of conservative management, advanced imaging such as MRI should be considered. Patients with imaging evidence of a compressive etiology and refractory to conservative therapy should have a surgical consultation. Either an MRI or CT should be obtained before surgical decompression. Both interventional and surgical treatments have had positive outcomes in the short term, but long-term outcomes appear comparable to those with conservative therapies. It is recommended that conservative treatment strategies be used for 6–8 weeks before pursuing procedural or surgical intervention.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82610322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Entrapment Syndromes 诱捕综合症
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0012
J. Eskander, Z. Malik, R. Shah
{"title":"Entrapment Syndromes","authors":"J. Eskander, Z. Malik, R. Shah","doi":"10.1093/med/9780190298357.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0012","url":null,"abstract":"Entrapment syndromes, also known as nerve compression or compression neuropathy, are caused by compression or pressure on the nerve. These nerves may become compressed within various joints and regions of tight anatomy that result in symptoms of pain, numbness, and tingling. Within these “tunnel” regions the nerve continues to cause neuropathic pain and chronically may present with weakness of the distal muscles. Typically, entrapment syndromes are caused by trauma, surgery, inflammation, anatomic abnormalities, or autoimmune diseases. One way of diagnosing entrapment syndromes is through nerve conduction studies such as an electromyelogram (EMG), in conjunction with radiologic imaging such as Magnetic Resonance Imaging (MRI’s). This chapter focuses on the common entrapment neuropathies with example cases and treatment choices.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80210164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Spinal Cord Infarction 脊髓梗死
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0022
R. Brewer, Sai K Munjampalli, Aliza Kumpinsky
{"title":"Spinal Cord Infarction","authors":"R. Brewer, Sai K Munjampalli, Aliza Kumpinsky","doi":"10.1093/med/9780190298357.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0022","url":null,"abstract":"This chapter discusses spinal cord infarctions, which are rare but with devastating consequences. It is associated with surgical procedures that compromise oxygen supply to the spinal cord, arteriosclerosis, embolism of the spinal cord circulation, or compression of blood vessels of the spinal cord. The most common of spinal neurovascular syndromes is the anterior spinal artery syndrome, caused by infarction in the anterior two-thirds of the cord. This syndrome spares the dorsal columns as the posterior one-third of the spinal cord is supplied by a pair of posterior spinal arteries. It is characterized by complete motor paralysis below the level of the lesion; loss of pain and temperature sensation with sparing of proprioception and vibratory sensation; and autonomic dysfunction, such as hypotension, sexual, and bowel and bladder dysfunction. MRI imaging, biochemical and immunological studies from cerebrospinal fluid and blood, and spinal angiography can be considered to confirm the diagnosis and delineate the cause. Treatments are directed at managing motor paralysis and spasticity, sensory dysfunction and pain, and autonomic dysfunction that includes neurogenic bladder and autonomic dysreflexia. Cervical and thoracic spinal cord injury affects respiratory muscles, causing pneumonia, in addition to autonomic dysreflexia. Preventive measures during abdominal aorta aneurysm surgery include neuromonitoring of the spinal cord, spinal fluid drainage, induced hypothermia, and use of pharmacological adjuncts such as intrathecal papaverine. Precautions in using particulate steroids for transforaminal epidural injection in pain management may help reduce the risk of articular embolism in the spinal cord or brainstem.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81204175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mechanisms of Neuropathic Pain 神经性疼痛的机制
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/MED/9780190298357.003.0003
Jianguo Cheng
{"title":"Mechanisms of Neuropathic Pain","authors":"Jianguo Cheng","doi":"10.1093/MED/9780190298357.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190298357.003.0003","url":null,"abstract":"Neuropathic pain arises as a direct consequence of a lesion or a disease affecting the somatosensory system. The mechanisms of neuropathic pain are often complex and difficult to study given the diversity of causes, pathology, and clinical presentation of various neuropathic pain conditions. Common mechanisms include peripheral and central sensitizations. Peripheral sensitization refers to increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields. Central sensitization refers to the augmented response of central signaling neurons. The mechanisms of peripheral and central sensitization are understood at the cellular and molecular levels. The processes of neuroplasticity involve activation of inflammatory cells, such as macrophages (and microglia in the central nervous system) and other immune cells, and release of inflammatory mediators, such as cytokines, chemokines, and a host of other mediators. Interactions of these mediators with specific receptors in the nociceptors or the spinal cord neurons may lead to phosphorylation or changes in expression of ion channels, receptors, transporters, and other effectors through specific signaling pathways. These events ultimately lead to changes in excitability, conductivity, and transmissibility of neurons in the pain processing pathways. Other factors may include disinhibition of interneurons, changes in descending inhibitory and excitatory pathways, and reorganization of the cortical areas and their interconnections.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86414355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Post-Traumatic Neuralgia 创伤后神经痛
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0010
M. Anitescu, J. Frenkel, B. Silva
{"title":"Post-Traumatic Neuralgia","authors":"M. Anitescu, J. Frenkel, B. Silva","doi":"10.1093/med/9780190298357.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0010","url":null,"abstract":"Peripheral nerve damage is classified into three categories based on severity: neurapraxia, axonotmesis, and neurotmesis. Peripheral nerve damage is the second most common category of in anesthesia related complications. The “double-crush” phenomenon is a term used to describe preexisting neurological injury that limits the neurological reserve of affected nerves. The risk of clinical deficits from a subsequent nerve injury is increased with the double crush phenomenon. Noniatrogenic traumatic nerve injury is most common in young adult males. Management of post-traumatic neuralgia often involves consultation with pain medicine, neurology, and neurosurgery. This multidisciplinary approach has two central goals, restoring nerve function and minimizing chronic neuropathic pain. Pharmacotherapy and procedural therapies are the treatments for neuropathic pain. Pharmacological agents include secondary amine tricyclic antidepressants (e.g., nortriptyline, desipramine), calcium channel α‎-2-δ‎ ligand anticonvulsants (e.g., pregabalin, gabapentin), opioids, ketamine, and topical lidocaine. Procedural interventions may be indicated when pain remains refractory to multiple pharmacological therapies. Procedures include nerve blocks, ablation, and neurostimulation, designed to interfere with, interrupt, or modulate pain pathways.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79515372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phantom Pain
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0025
J. Devarajan, B. Minzter
{"title":"Phantom Pain","authors":"J. Devarajan, B. Minzter","doi":"10.1093/med/9780190298357.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0025","url":null,"abstract":"This chapter discusses phantom pain, defined as an unpleasant or painful sensation in the distribution of the lost or deafferentiated body part. It is more commonly reported in the limbs but also has been reported in other body parts such as the tongue, teeth, nose, breast, part of the gastrointestinal tract, and the penis. The incidence varies from 42.2% to 78.8%. Perception of non-painful sensations from the amputated body part is known as phantom sensation. The severity and frequency of attacks slowly decrease with time during the first 6 months, after which they remain constant. Patients with significant preoperative pain, stump pain, and infection are at increased risk of developing phantom pain. The mechanism of origin is not known; it is thought to be due to peripheral nerve damage, which contributes to neural sensitization at peripheral, spinal, and supraspinal levels. Both chemical mediators and psychological factors are involved. Phantom pain improves with time and responds to conservative medical management, mirror therapy, and psychological counseling. A small percentage of cases are resistant to treatment and may require invasive neuromodulatory treatment options such as spinal cord stimulation and peripheral nerve stimulation.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75827191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Occipital Neuralgia 枕神经痛
Journal of neuropathic pain & symptom palliation Pub Date : 2018-12-01 DOI: 10.1093/med/9780190298357.003.0033
A. Deroee, Jianguo Cheng
{"title":"Occipital Neuralgia","authors":"A. Deroee, Jianguo Cheng","doi":"10.1093/med/9780190298357.003.0033","DOIUrl":"https://doi.org/10.1093/med/9780190298357.003.0033","url":null,"abstract":"Occipital neuralgia is a primary headache disorder characterized by intermittent, sharp stabbing occipital pain. Diagnosis is made by history, clinical examination, and positive response to anesthetic block of the greater occipital nerve. Occipital neuralgia should be differentiated from cervicogenic headache, migraines, and other causes of headaches as some of them may manifest with similar symptoms, including occipital pain and allodynia, and may also respond to occipital nerve block. Conservative treatment with physical therapy and low-dose antiepileptics or tricyclic antidepressants can be effective. Refractory cases may respond to occipital nerve block, Botox injection, pulse radiofrequency, or occipital nerve stimulation.","PeriodicalId":87440,"journal":{"name":"Journal of neuropathic pain & symptom palliation","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75162847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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