Neuralgias

The acetylcholinesterase inhibitor tacrine (64) was approved for the treatment of mild-to-moderate SDAT in the United States in 1993 followed by several other countries. The acetylcholinesterase inhibitor galanthamine (65), which has long been in clinical use in Austria for the treatment of indications such as facial neuralgia and residual poliomyelitis paralysis, has also been approved for use in... 

USP XXII specifies that sodium iodide contains 99—101.5% Nal, calculated on an anhydrous basis (4). It is used iaterchangeably with potassium iodide as a therapeutic agent, except where sodium ion is contraindicated (see Potassium compounds). Intravenous sodium iodide formulations have been used for a variety of diseases, from thyroid deficiency to neuralgia (see Thyroid and antithyroid preparations). However, these solutions are no longer listed ia the XFXUII (4), iadicatiag that their therapeutic value has not been satisfactorily demonstrated. 

Thyrotoxicosis Pheochromocytoma Myotonic dystrophy Trigeminal neuralgia... 

GlaserMA. 1931. Treatment of trigeminal neuralgia with trichloroethylene. JAMA 96 916-920. 

Neuropathic pain is defined as spontaneous pain and hypersensitivity to pain associated with damage to or pathologic changes in the peripheral nervous system as in painful diabetic peripheral neuropathy (DPN), acquired immunodeficiency syndrome (AIDS), polyneuropathy, post-herpetic neuralgia (PHN) or pain originating in the central nervous system (CNS), that which occurs with spinal cord injury, multiple sclerosis, and stroke. Functional pain, a relatively newer concept, is pain sensitivity due to an abnormal processing or function of the central nervous system in response to normal stimuli. Several conditions considered to have this abnormal sensitivity or hyperresponsiveness include fibromyalgia and irritable bowel syndrome. 

DPN, diabetic peripheral neuropathy PHN, post-herpetic neuralgia TCA, tricyclic antidepressant. 

Owing to the lag time between initiation and effect, capsaicin is not used for treatment of acute pain from injury. Instead, topical capsaicin is used for chronic pain from musculoskeletal and neuropathic disorders. Capsaicin preparations have been studied in the treatment of pain from diabetic neuropathy, osteoarthritis, rheumatoid arthritis, postherpetic neuralgia, and other disorders.48 It is often used as an adjuvant to systemic analgesics in these chronic pain conditions. 

Later in life, approximately 15% of the population will develop herpes zoster. Herpes zoster is the reactivation of latent varicella zoster virus in the sensory ganglia. Approximately 20% of persons with herpes zoster will develop post-herpetic neuralgia, which is a painful debilitating condition that can persist for months after resolution of the herpes zoster rash. 

Neuralgia Pain that extends along the course of one or more nerves. 

Trigeminal neuralgia A disorder of the fifth cranial (trigeminal) nerve characterized by excruciating paroxysms of pain in the face. 

There have been many sporadic reports that lipo-PGEj is effective in fulminant hepatitis, neuralgia associated with herpes zoster, multiple spinal canal stenosis, cerebral infarction, myocardial infarction, chronic renal failure, and bed sores as well as for its registered indications. 

Elderberries, which ripen in September and October, are relished by many varieties of birds. As an herb used by people, they are somewhat laxative and diuretic. They have been used for centuries in the treatment of rheumatism, neuralgia, facial tics and epilepsy. 

Antirheumatic. Elder flower and vinegar fomentations can be used topically for painful joints, muscle soreness and stiffness. Elderberry juice is an ancient remedy to help neuralgia, rheumatism, gout and sciatica. Parts used flowers, berries, leaves. 

Chronic Bronchitis Chronic Gastritis Gastroenteritis Chronic Hepatitis Neuritis, Neuralgia Sciatica... 

An excellent example for an enzymatic resolution process is reported for production of Pregabalin. This drug was approved by the US Food and Drug Administration (FDA) in 2004 against neurophatic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia. Several different routes have been developed based on asymmetric hydrogenation, crystallization and biocatalytic resolutions [16-20]. The most powerful and currently applied process is based on a lipase resolution, shown in Figure 14.3. This process is one of the very few... 

Neuropathic and functional pain is often described in terms of chronic pain. Neuropathic pain (e.g., postherpetic neuralgia, diabetic neuropathy) is a result of nerve damage, but functional pain (e.g., fibromyalgia, irritable bowel syndrome, tension-type headache) refers to abnormal operation of the nervous system. Pain circuits may rewire themselves and produce spontaneous nerve stimulation. 

Special situations of sudden-onset/sudden-resolution pain, especially along a nerve track, or neuralgias, may require an adjunct of an anticonvulsant and/or tricyclic antidepressant. 

As the last example suggests, the publicity given the uric acid theory also set off an epidemic of self-diagnosis by the public. "Indeed," a Chicago physician complained, "among the laity it is the almost universal belief that a joint pain, myalgia, neuritis, neuralgia, etc. are due to uric acid-----How... 

A clinical study of 21 females and 21 males used to determine the efficacy of using aspirin dissolved in chloroform which was then applied topically to patients infected with herpes zoster and post-therapeutic neuralgia with painful skin lesions has been reported. When an aspirin/chloroform combination (approximately 43.3 mg/mL) was applied, the only reported side-effect was an occasional burning sensation on the skin as the chloroform evaporated from the skin surface however, the possible impact on other major body organs (liver, kidney, etc.) was not investigated (King 1993). 

King RB. 1993. Topical aspirin in chloroform and the relief of pain due to herpes zoster and postherpetic neuralgia. Arch Neurol 50 1046-1053. 

Trigeminal neuralgia 100 mg bid titrate to 400 mg bid. Macrolide antibiotics elevate carbamazepine level. 

Neuroanatomically both the locus coeruleus and the raphe nuclei project to the spinal cord where they gate sensory pathways from the skeletomuscular areas. As there is evidence that both noradrenaline and 5-HT are dysfunctional in depression, it is perhaps not surprising to find that the pain threshold is often reduced in patients with depression. Conversely, different types of antidepressants have been shown to have an antinociceptive effect in both rodent models of neuropathic pain, and clinically in fibromyalgia, chronic fatigue syndrome, postherpetic neuralgia and diabetic neuropathy. In general, it would appear that the dual action antidepressants (such as the TCAs and SNRIs) are more effective than the SSRIs. 

Largactil is a proprietary preparation of chlorpromazine, an aliphatic antipsychotic with marked sedation and moderate antimuscarinic and extrapyramidal side-effects. Serenace is a proprietary preparation of haloperidol, a butyrophenone antipsychotic with marked extrapyramidal side-effects, moderate sedation but not very likely to cause hypotension. Tegretol is a proprietary preparation of carbamazepine, an anti-epileptic drug indicated in partial and secondary generalised tonic-clonic seizures, primary generalised tonic-clonic seizures, trigeminal neuralgia and in the prophylaxis of bipolar disorder unresponsive to lithium. 

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