RESUMO
Diabetic neuropathy is common in patients with diabetes mellitus, and 7.5% of diabetics experience pain from diabetic neuropathy. Complications of diabetes mellitus are more common where control of the disease is not optimal. By improving the control of the disease, both the neuropathy and the pain it can produce may be improved. The pain of diabetic neuropathy can frequently be controlled using analgesics, antidepressants, anticonvulsants, topical capsaicin, and neuromodulation, either alone or in any combination.
Assuntos
Analgésicos/administração & dosagem , Neuropatias Diabéticas/tratamento farmacológico , Neuralgia/tratamento farmacológico , Analgésicos/efeitos adversos , Ensaios Clínicos como Assunto , Neuropatias Diabéticas/diagnóstico , Humanos , Neuralgia/diagnóstico , Medição da Dor , Resultado do TratamentoRESUMO
A series of 26 patients with chronic pain were treated with percutaneous radiofrequency lesioning of the dorsal root ganglion. Ten patients had an excellent result, which persisted in 8 to the present time or death, and 5 had a good persistent result. A useful persisting result was therefore obtained in 13 patients with a further 2 patients having temporary benefit.
Assuntos
Eletrocoagulação/métodos , Gânglios Espinais/cirurgia , Dor Intratável/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/cirurgiaRESUMO
The treatment of 77 consecutive cases of post-herpetic neuralgia is reviewed. Stellate blockade proved helpful in 75% of patients with pain of less than 1 year's duration; 40% became virtually pain free. Drug treatment and electrical counterirritation methods gave improvement in 60% of cases but only 15% became pain free. Stellate block carried out after 1 year of pain proved helpful in only 44% of patients, and only 22% became pain free. Stellate blockade carried out within 1 year of the onset of symptoms would appear to be one of the treatments of choice for post-herpetic neuralgia. It would be of interest to see the results of a controlled randomised trial.
Assuntos
Analgésicos/uso terapêutico , Bloqueio Nervoso Autônomo , Terapia por Estimulação Elétrica , Herpes Zoster/complicações , Neuralgia/terapia , Gânglio Estrelado/efeitos dos fármacos , Adulto , Idoso , Amitriptilina/uso terapêutico , Carbamazepina/uso terapêutico , Terapia Combinada , Quimioterapia Combinada , Flufenazina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Neuralgia/tratamento farmacológico , Neuralgia/etiologiaRESUMO
Ninety patients with chronic venous ulceration were investigated to determine the extent of the incompetence of the venous valves. They were then treated by established surgical methods to control reflux. All wore fitted compression stockings and were regularly followed up. Forty-two patients had valvular incompetence confined to the perforating and superficial veins. All their ulcers healed and only one developed a minor recurrence during the three year follow-up. Nineteen patients had additional but limited incompetence of the deep veins; all their ulcers healed, but three developed a recurrence. Twenty-nine patients had extensive deep vein valvular incompetence including incompetence of the popliteal valve; in 12 of these patients either the ulcer failed to heal or the patient developed a recurrent ulcer within 18 months. Thirty-two other patients developed further venous reflux from the opening of new channels, including the perforating veins of the foot, and required sclerosants or local ligation. It was concluded that established surgical techniques, thoroughly performed, were very effective for the treatment of chronic venous ulceration provided the popliteal valves were competent. When the popliteal valves were incompetent the recurrence rate was unacceptably high and additional methods, including vein valve transplants, excision of the ulcer with skin grafting and lumbar sympathectomy, were considered. Nine of 11 patients who received a vein valve transplant had falls in their ambulant venous pressures, improvement in the nutrition of their skin and healing of their recurrent ulcers.