Subject(s)
Catechol O-Methyltransferase/genetics , Genetic Predisposition to Disease , Pain/drug therapy , Pain/genetics , Polymorphism, Genetic , Analgesics/therapeutic use , Animals , Chronic Disease , Female , Forecasting , Humans , Male , Pain/physiopathology , Pain Measurement , Risk Assessment , Severity of Illness IndexABSTRACT
Postherpetic ophthalmic neuralgia is the final stage of a varicella zoster infection. Many years after chickenpox infection, patients can develop herpes zoster in one or more specific dermatomal regions. The ophthalmic branch of the trigeminal nerve and the thoracic nerves are most commonly affected. Younger patients are less prone to postherpetic neuralgia than the older. Patients with a depression in cell-mediated immunity are more susceptible to develop postherpetic pain. Postherpetic ophthalmic neuralgia is a neuropathic pain and can be treated by anticonvulsants and tricyclic antidepressants. Neurodestructive procedures are not recommended as they enhance destruction and neuropathic pain. Sympathetic nerve blocks can be helpful. Neurostimulation is the last therapeutic resort.
Subject(s)
Chickenpox/complications , Ophthalmic Nerve , Trigeminal Neuralgia/etiology , Anesthetics, Local/therapeutic use , Anticonvulsants/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Child , Humans , Middle Aged , Transcutaneous Electric Nerve Stimulation , Trigeminal Neuralgia/diagnosis , Trigeminal Neuralgia/therapyABSTRACT
This case report illustrates differences in analgesia quality and morphine consumption between an intrathecal infusion and the subcutaneous instillation of morphine in a cancer patient with hypernephroma. Superior analgesia was obtained with a 450 mg dose of subcutaneous morphine [i.e., visual analog scale (VAS) score 0/10] than with 10 mg intrathecal morphine/day administered at the thoracolumbar (twelfth dorsal vertebra) level (VAS score 2/10). If the instillation occurs at the lumbosacral level (between the last lumbar and the first sacral vertebra), a dosage of 70 mg morphine/day cannot induce the same pain relief as 450 mg subcutaneous morphine (VAS score 5/10 vs. 0/10). In some cancer patients, subcutaneous morphine offers superior pain control than intrathecal morphine.
Subject(s)
Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Carcinoma, Renal Cell/complications , Kidney Neoplasms/complications , Morphine/administration & dosage , Morphine/therapeutic use , Pain/drug therapy , Humans , Injections, Spinal , Injections, Subcutaneous , Male , Middle Aged , Pain/etiology , Pain MeasurementABSTRACT
OBJECTIVE: To demonstrate difficulties encountered in alleviating neuropathic pain in a terminally ill cancer patient, with the very tentative diagnosis of postherpetic neuralgia. SETTING: A multidisciplinary pain department in a university hospital. PATIENTS: A patient with Hodgkin's lymphoma and leiomyosarcoma in the liver developed an unusual manifestation of neuropathic pain. INTERVENTION: Oral drug treatment with morphine associated with amitriptyline, valproic acid, mexilitine, flufenazine, and methylprednisolone failed to suppress pain attacks. Only the subcutaneous instillation of lidocaine (2 mg/kg/h) could partially suppress pain. A dorsal root entry zone lesion intervention could only temporary stop the pain attacks. Infiltration and nervous stimulation techniques were not helpful. OUTCOME MEASURES: In determining pain control, the visual analog scale rating scale and the number of attacks per hour were considered. RESULTS: Only the subcutaneous administration of lignocaine could partially suppress pain. Because of the patient's poor hepatic circulation, variable lidocaine plasma concentrations were responsible for intolerable side effects. CONCLUSIONS: Subcutaneous lignocaine administration remains a useful method in treating neuropathic cancer pain. The poor metabolic condition of the patient can lead to deleterious high plasma levels. A dorsal root entry zone lesion could only temporarily stop the pain.
