Acute herpetic neuralgia and postherpetic neuralgia in the head and neck: response to gabapentin in five cases.

BACKGROUND AND OBJECTIVES: The clinical presentations and pharmacologic management of three patients with acute herpetic neuralgia (AHN) and two patients with postherpetic neuralgia (PHN), confined to the head and neck region, are described. METHODS: Two patients had pain in the ophthalmic division of the trigeminal nerve, two had pain confined to the C2-C4 dermatomes, and one patient had C2 pain with radiating and referred pain to the second and third divisions of the trigeminal nerve. RESULTS: Gabapentin, an anticonvulsant drug, was effective in treating these patients, including the two cases of AHN. All patients reported complete pain relief after titration with gabapentin up to 1,800 mg/d. The patients noted a dose-dependent decrease in pain almost immediately after starting gabapentin. Specifically, reduction in the frequency and intensity of allodynia, burning pain, shooting pain, and throbbing pain were noted. None of the patients experienced side effects from the drug. CONCLUSIONS: In view of the results in these patients, blinded, controlled studies are needed to determine the efficacy of gabapentin for treating AHN and PHN.

The relationship between depression and pain language in cancer and chronic non-cancer pain patients.

The present study investigated the relationship between depression and pain description among cancer and chronic non-cancer pain patients in a large outpatient sample. Participants consisted of 312 patients (158 men and 154 women) attending a pain management clinic at a comprehensive cancer institute. Sixty-one percent of the patients (190/312) were experiencing pain related to cancer and 39% (122/312) were experiencing chronic nonmalignant pain. Multivariate analyses of covariance were used to assess differences in the sensory and affective indices of the McGill Pain Questionnaire (MPQ) associated with depression and type of pain. Current pain intensity was the covariate. The results indicated that the MPQ affective and sensory intensity scales did not significantly differ among patients with cancer and chronic non-cancer pain. There were also no significant differences in the percentage of affective and sensory pain descriptors chosen by these patients. However, depression significantly influenced MPQ pain description. Depressed patients with pain scored higher on the affective pain intensity dimension of the MPQ than non-depressed patients with pain (P < 0.001). Depressed patients also chose more affective pain descriptors than non-depressed patients (P < 0.001). Chi-square analyses revealed that depressed and non-depressed pain patients made significantly different choices on four of the five MPQ affective adjective lists. There were no differences in the sensory pain index or the percentage of sensory pain descriptors based on depression. These findings are discussed in terms of their clinical implications and their relationship to the existing literature.

Adaptation to metastatic cancer pain, regional/local cancer pain and non-cancer pain: role of psychological and behavioral factors.

The present study compared the adaptation of cancer pain patients and chronic non-cancer pain patients. Differences between samples of cancer pain patients with and without metastatic disease were also examined. Cancer pain patients reported comparable levels of pain severity to non-cancer chronic pain patients; however, pain due to cancer was associated with higher levels of perceived disability (t(250) = 2.97, P < 0.004) and lower degree of activity (t(286) = 2.45, P < 0.04). The patients with cancer pain, particularly those with metastatic disease, reported significantly higher levels of support and solicitous behaviors from significant others, compared to non-cancer chronic pain patients. The majority of the cancer patients, both with (81%) and without (84%) metastatic disease as well as non-cancer chronic pain patients (85%), could be classified into one of three psychosocial subgroups that had been previously identified with non-cancer chronic pain patients: 'dysfunctional' (high levels of pain, perceived interference, affective distress and low levels of perceived control and activity), 'interpersonally distressed' (high levels of affective distress, negative responses from significant others and low levels of perceived support) and 'adaptive copers' (low levels of interference and affective distress, high levels of perceived control and activity). The distribution of the profiles was significantly different across groups (chi2(4) = 12.79, P < 0.02). However, within each profile. the response patterns were highly comparable across groups. Thus, contrary to the suggestions of some authors, cancer pain and non-cancer chronic pain patients share many features in common. Furthermore, the heterogeneity of psychosocial adaptation to pain within each patient group suggests the importance of psychological assessment in determining the pain management plan.

Experience with gabapentin for neuropathic pain in the head and neck: report of ten cases.

BACKGROUND AND OBJECTIVES: Gabapentin is an oral antiepileptic agent with an unknown mechanism of action. Recent case reports have suggested that gabapentin may be effective in the treatment of a variety of neuropathic pain states. This report presents baseline and follow-up data on ten patients who were treated with gabapentin when other pharmacologic interventions failed to relieve their neuropathic pain. METHODS: Ten patients referred for treatment of unrelieved neuropathic pain in the head and neck region were included in this study. Baseline and follow-up information included measures of pain intensity and pain quality. All of the patients were started on 300 mg gabapentin three times per day, though daily doses of up to 2400 mg were required for pain relief. RESULTS: Eight of the ten patients had no neuropathic pain on follow-up, whereas the remaining 2 patients reported only partial relief at follow-up. None of the patients complained of side effects. Gabapentin was effective in alleviating steady burning pain as well as lancinating pain and allodynia. CONCLUSIONS: The results suggest that gabapentin may be effective in the management of some cases of neuropathic pain in the head and neck. However, controlled, double-blind longitudinal studies are needed to evaluate this possibility.

Maintenance and decline of the suppression of infanticide in mother rats.

Virgin female rats kill foster neonates, whereas newly parturient mothers do not. We demonstrated previously that this tendency to kill is suppressed shortly prepartum, presumably by physiological factors. In this study, we show that a) suppression of infanticide is maintained through the first two weeks of lactation; b) the mothers that do not kill foster neonates are not necessarily the same mothers that respond maternally toward older foster pups, and those that kill neonates are not necessarily the same ones that are nonmaternal to older pups, the two behaviors being somewhat independent; and c) some virgins can be induced to be noninfanticides by prolonged exposure to young, but only under special testing conditions not required by actual mothers, which are nonkillers of foster young. This suggests that the maintenance of the suppression of infanticide in mothers owes something to the special circumstances of lactation other than continued exposure to young.

Renal cell carcinoma presenting as a primary parotid gland tumor.

A 62-year-old Caucasian man presented with a slow-growing 3 by 3 cm. mass in the left preauricular region. The pathologist's report on the surgical specimen favored a diagnosis of acinic cell carcinoma but recommended evaluation of the patient for possible metastatic renal cell carcinoma. A subsequent intravenous pyelogram and arteriogram revealed the presence of a mass in the right kidney. The lesion proved to be a renal cell carcinoma which was microscopically indistinguishable from the parotid tumor.

An exophytic soft tissue mass of the buccal mucosa.

A case is presented in which electron microscopy proved invaluable in determining the nature of a clinically innocuous lesion of the buccal mucosa. The clinical, histologic and ultrastructural features of the neoplasm identified are reviewed in the light of previous literature.

Benign nerve sheath myxoma: light and electron microscopic features of two cases.

Two new cases of the rare benign nerve sheath myxoma (NSM) are presented. The light microscopic findings are compared with previously reported cases. In addition, the ultrastructural features of three constitutent cell types are described. The lesion is confirmed as a neural sheath neoplasm, and its similarities to other myxomas are discussed.