[The effectiveness of the percutaneous discectomy in the treatment of pain secondary to disc herniation]. / Discectomía percutánea para tratamiento del dolor radicular.

BACKGROUND: Percutaneous discectomy has shown to be useful for relief the radicular pain due to a disk hernia, which is a common condition in the general population. The objective was to evaluate the efficacy of percutaneous discectomy in radicular pain caused by disk hernia. METHODS: A descriptive study was done. The records of percutaneous discectomy patients from a two years period were analyzed including those who had a pain intensity scored by a Analog Visual Scale (VAS), those with daily taken analgesics, before and after the procedure were registered. Dose in milligrams (mg) of analgesic intake were converted to equivalent dosages for 24 hours oral morphine. Pain intensity and medication take before and after the procedure were compared. RESULTS: VAS average previous to the procedure was 6.29 and after it descended to 2.86. The mean of medication intake before discectomy was 30.32 mg and after the procedure was 12.75 mg. DISCUSSION: We found pain improvement in a high percentage of patients reflected by a decrease in VAS and the medication needed.

[Algological treatment of trigeminal neuralgia. Experience of 15 years]. / Tratamiento algológico de neuralgia del trigémino. Experiencia de 15 años.

BACKGROUND: We present the experience in the treatment of trigeminal neuralgia (TN) during 15 years in one institute, evaluating epidemiological variables and clinical presentation, and comparing the results obtained with different treatments available. METHODS: A retrospective, descriptive study was carried out by reviewing cases diagnosed by the Neurology Service, such as TN, and treated by the Pain Medicine and Palliative Care Unit of the Insituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubíran," from January 1, 1998 to December 31, 2003. Age, sex, type of neuralgia, anatomical site affected and intensity of pain were evaluated by means of the Analogue Visual Scale (AVS). The following treatments were evaluated (pharmacologic, surgical, and blockade of Gasser ganglion). Descriptive statistics, linear regression and bivariate correlation were used (statistical package SPSS). RESULTS: Fifty two cases were studied with a female predominance (2:1). Average age was 60 years. Clinical presentation most frequently was typical neuralgia (51.9%), right predominance (59.6%) and affected branch V2 (50%). In 88%, pharmacological treatment was used. The reduction of pain was 74% in all cases, with r-.765 for the pharmacological treatment, r-.715 in the blockade of the Gasser ganglion, and r-.901 for surgical treatment (p < 0.01). CONCLUSIONS: In the experience of the INCMNSZ, treatment of choice in most cases of TN is pharmacological, with surgical treatment useful in cases where vascular alterations were identified.

[Complex regional pain syndrome. Current status]. / Síndrome doloroso regional complejo. Estado actual.

Complex regional pain syndrome (CRPS) is a disorder or group of disorders that develop as a consequence of previous trauma with or without evident nerve injury. The syndrome is characterized by presence of spontaneous pain, hyperalgesia and allodynia, sensitive changes, blood flow changes, sweating, and trophic changes. The disease is characterized by symptoms of acute inflammatory states as well as by chronic neuropathic changes. Pain is associated with changes generated by the autonomic nervous system. Spinal neurons can increase their sensitivity to these autonomic changes. At a supraspinal level, reorganization of somatosensorial cortex is seen. Creation of diagnostic criteria has been difficult due to the plentiful symptoms of CRSP. Sympathetic blockade with phentolamine is the most commonly approved examination to diagnose sympathetic maintained pain. Several strategies have been used for treatment of CRPS, but with none of these has sufficient evidence of treatment effectiveness been afforded.