Neuropathic pain--recent trends in management.

Injury to central or peripheral nervous system causes neuropathic pain. Initially it affects the sensory nerves, then the motor nerves. In crush or traumatic injuries the sensory or motor nerves are affected simultaneously and the symptoms develop simultaneously. Spontaneous pain, abnormal evoked pains and paroxysmal evoked pain are the pesenting symptoms. Types of neuropathies are: Peripheral nerve lesion, spinal or ganglionic lesion and spinal cord lesion. Diabetic neuropathy, postherpetic neuralgia and painful polyneuropathy are the types which should be looked meticulously. The treatment modality can be subdivided into pharmacological pain management and interventional pain management. The following groups of drugs can be used either singularly or in combination in pharmacological pain management: Analgesics, anticonvulsants, antidepressants and miscellaneous group. Interventional pain management can be done by: Neural blockade, electric stimulation and implantable devices.

Choroidal metastases as a presenting sign after 24 years of a primary breast cancer.

A case of relapsing breast carcinoma presenting with acute visual loss secondary to choroidal metastases is described. Relapse occurred 24 years after surgery and radiotherapy for primary lesion and spared the loco-regional area. Such a long remission period is unusual.