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1.
Lasers Med Sci ; 39(1): 23, 2024 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-38191831

RESUMO

Orthognathic surgery involves invasive and major surgical procedures commonly used to correct maxillofacial deformities. Bilateral sagittal split ramus osteotomy (BSSO) is often used to treat dentofacial anomalies related to the mandible, but it can result in various complications, the most common of which is inferior alveolar nerve damage. Nerve damage-induced paresthesia of the lower lip significantly affects patient comfort. Medical treatments such as steroids and vitamin B, low-level laser therapy (LLLT), and platelet-rich fibrin (PRF) can be used as supportive therapies for nerve regeneration after damage. This study aimed to investigate the effectiveness of two different types of lasers in treating lower lip paresthesia after BSSO. This clinical trial was a controlled, single-center, prospective, single-blind, randomized study. Thirty patients were included in the study and randomly assigned to three groups: Group I (laser GRR, n = 10) received transcutaneous and transmucosal GRR laser treatment, Group II (Epic10 laser, n = 10) received transmucosal and transcutaneous Epic10 laser treatment, and Group III (vitamin B, n = 10) received B-complex vitamin tablets orally once a day. Two-point and brush tests were performed six times at specific intervals, and a visual analog scale was used to evaluate pain and sensitivity. Both vitamin B and laser therapies accelerated nerve regeneration. The contribution of the laser groups to the healing rate was better than that of the vitamin B group. Although there was no statistically significant difference between the two laser groups, clinical observations indicated better results in the GRR laser group.


Assuntos
Lábio , Parestesia , Humanos , Lábio/cirurgia , Parestesia/etiologia , Parestesia/terapia , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Estudos Prospectivos , Método Simples-Cego , Lasers , Vitaminas
2.
J Pain ; 24(12): 2319-2339, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37473903

RESUMO

Refractory persistent spinal pain syndrome after surgery (PSPS-T2) can be successfully addressed by spinal cord stimulation (SCS). While conventional stimulation generates paresthesia, recent systems enable the delivery of paresthesia-free stimulation. Studies have claimed non-inferiority/superiority of selected paresthesia-free stimulation compared with paresthesia-based stimulation, but the comparative efficacy between different waveforms still needs to be determined in a given patient. We designed a randomized controlled 3-month crossover trial to compare pain relief of paresthesia-based stimulation versus high frequency versus burst in 28 PSPS-T2 patients implanted with multiwave SCS systems. Our secondary objectives were to determine the efficacy of these 3 waveforms on pain surface, quality of life, functional capacity, psychological distress, and validated composite multidimensional clinical response index to provide holistic comparisons at 3-, 6-, 9-, and 15-month post-randomization. The preferred stimulation modality was documented during the follow-up periods. No difference between the waveforms was observed in this study (P = .08). SCS led to significant pain relief, quality of life improvement, improvement of multidimensional clinical response index, and of all other clinical outcomes at all follow-up visits. Forty-four percent of the patients chose to keep the paresthesia-based stimulation modality after the 15-month follow-up period. By giving the possibility to switch and/or to combine several waveforms, the overall rate of SCS responders further increased with 25%. In this study, high frequency or burst do not appear superior to paresthesia-based stimulation, wherefore paresthesia-based stimulation should still be considered as a valid option. However, combining paresthesia-based stimulation with paresthesia-free stimulation, through personalized multiwave therapy, might significantly improve SCS responses. PERSPECTIVE: This article assesses clinical SCS efficacy on pain relief, by comparing paresthesia-based stimulation and paresthesia-free stimulation (including high frequency and burst) modalities in patient presenting with PSPS-T2. Switching and/or combining waveforms contribute to increasing the global SCS responders rate.


Assuntos
Dor Crônica , Dor Intratável , Estimulação da Medula Espinal , Humanos , Estimulação da Medula Espinal/métodos , Estudos Cross-Over , Parestesia/etiologia , Parestesia/terapia , Estudos Prospectivos , Qualidade de Vida , Medição da Dor , Resultado do Tratamento , Medula Espinal
3.
J Am Acad Dermatol ; 89(6): 1192-1200, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37517675

RESUMO

Dysesthesia is an abnormal sensation in the skin that occurs in the absence of any extraordinary stimulus or other primary cutaneous disorders, excluding any delusions or tactile hallucinations. Clinicians have characterized dysesthesias to include sensations such as burning, tingling, pruritus, allodynia, hyperesthesia, or anesthesia. The etiology and pathogenesis of various generalized dysesthesias is largely unknown, though many dysesthesias have been associated with systemic pathologies including malignancy, infection, autoimmune disorders, and neuropathies. Dermatologists are often the first-line clinicians for patients presenting with such cutaneous findings, thus it is crucial for these physicians to be able to methodically work-up generalized dysesthesias to build a working differential diagnosis, follow up with key labs and/or imaging, and offer patients evidence-based treatment to relieve their symptoms. This broad literature review is an attempt to centralize key studies, cases, and series to help guide dermatologists in their assessment and evaluation of complaints of abnormal cutaneous sensations.


Assuntos
Doenças do Sistema Nervoso Periférico , Dermatopatias , Humanos , Parestesia/diagnóstico , Parestesia/etiologia , Parestesia/terapia , Pele , Prurido/diagnóstico , Prurido/etiologia , Prurido/terapia , Doenças do Sistema Nervoso Periférico/complicações , Dermatopatias/complicações
4.
Artigo em Inglês | MEDLINE | ID: mdl-36945765

RESUMO

Trigeminal trophic syndrome (TTS) is an uncommon and relatively unknown cause of facial ulceration that occurs after damage to the trigeminal nerve. It characteristically involves non-healing facial ulceration(s) with accompanying anesthesia, paresthesia, and dysesthesia along the distribution of a trigeminal dermatome. The ulcerations are believed to be self-induced in response to paresthesia. The disease is most common in middle-aged women, manifesting as a unilateral crescent-shaped ulceration on the ala nasi, with sparing of the nasal tip. The diagnosis is clinical and mostly based on exclusion of other possible causes of facial ulcerations, with emphasis on neoplasms, infection-associated vasculitis, and factitial disorders. There are no specific histological or laboratory signs. There is no standard treatment protocol; however, a number of different successful strategies have been reported, including pharmaceutical and surgical interventions, transcutaneous nerve stimulation, and simple occlusion dressings. Due to the self-inflicted nature of this disorder, the cornerstone of management is patient education with behavioral modification. Here, we report a case of TTS following herpes zoster ophthalmicus and review the current literature on this subject.


Assuntos
Úlcera Cutânea , Pessoa de Meia-Idade , Humanos , Feminino , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/etiologia , Úlcera Cutânea/terapia , Face , Parestesia/complicações , Parestesia/diagnóstico , Parestesia/terapia , Síndrome , Nariz
5.
Neuromodulation ; 26(8): 1680-1688, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36369082

RESUMO

OBJECTIVE: Novel deep brain stimulation (DBS) systems allow directional and short-pulse stimulation to potentially improve symptoms and reduce side effects. The aim of this study was to investigate the effect of short-pulse and directional stimulation, in addition to a combination of both, in the ventral intermediate thalamus (VIM)/posterior subthalamic area (PSA) on tremor and stimulation-induced side effects in patients with essential tremor. MATERIALS AND METHODS: We recruited 11 patients with essential tremor and VIM/PSA-DBS. Tremor severity (Fahn-Tolosa-Marin), ataxia (International Cooperative Ataxia Rating Scale), and paresthesia (visual analog scale) were assessed with conventional omnidirectional and directional stimulation with pulse width of 60 µs and 30 µs. RESULTS: All stimulation conditions reduced tremor. The best directional stimulation with 60 µs reduced more tremor than did most other stimulation settings. The best directional stimulation, regardless of pulse width, effectively reduced stimulation-induced ataxia compared with the conventional stimulation (ring 60 µs) or worst directional stimulation with 60 µs. All new stimulation modes reduced occurrence of paresthesia, but only the best directional stimulation with 30 µs attenuated paresthesia compared with the conventional stimulation (ring 60 µs) or worst directional stimulation with 60 µs. The best directional stimulation with 30 µs reduced tremor, ataxia, and paresthesia compared with conventional stimulation in most patients. Correlation analyses indicated that more anterior stimulation sites are associated with stronger ataxia reduction with directional 30 µs than with conventional 60 µs stimulation. CONCLUSION: Directional and short-pulse stimulation, and a combination of both, revealed beneficial effects on stimulation-induced adverse effects.


Assuntos
Estimulação Encefálica Profunda , Tremor Essencial , Humanos , Tremor Essencial/terapia , Tremor/terapia , Estimulação Encefálica Profunda/efeitos adversos , Parestesia/etiologia , Parestesia/terapia , Tálamo/fisiologia , Ataxia/etiologia , Resultado do Tratamento
6.
Neuromodulation ; 25(1): 85-93, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35041591

RESUMO

OBJECTIVES: Spinal cord stimulation (SCS) is an effective therapy for chronic intractable pain. Conventional SCS involves electrode placement based on intraoperative paresthesia mapping; however, newer paradigms like burst may allow for anatomic placement of leads. Here, for the first time, we report the one-year safety and efficacy of burst SCS delivered using a lead placed with conventional, paresthesia mapping, or anatomic placement approach in subjects with chronic low back pain (CLBP). MATERIALS AND METHODS: Subjects with CLBP were implanted with two leads. The first lead was placed to cross the T8/T9 disc and active contacts for this lead were chosen through paresthesia mapping. The second lead was placed at the T9/T10 spinal anatomic landmark. Subjects initially underwent a four-week, double-blinded, crossover trial with a two-week testing period with burst SCS delivered through each lead in a random order. At the end of trial period, subjects expressed their preference for one of the two leads. Subsequently, subjects received burst SCS with the preferred lead and were followed up at 3, 6, and 12 months. Pain intensity (visual analog scale), quality-of-life (EuroQol-5D instrument), and disability (Oswestry Disability Index) were evaluated at baseline and follow-up. RESULTS: Forty-three subjects successfully completed the trial. Twenty-one preferred the paresthesia mapping lead and 21 preferred the anatomic placement lead. Anatomic placement lead was activated in one subject who had no preference. The pain scores (for back and leg) significantly improved from baseline for both lead placement groups at all follow-up time points, with no significant between-group differences. CONCLUSIONS: This study demonstrated that equivalent clinical benefits could be achieved with burst SCS using either paresthesia mapping or anatomic landmark-based approaches for lead placement. Nonparesthesia-based approaches, such as anatomic landmark-based lead placement investigated here, have the potential to simplify implantation of SCS and improve current surgical practice.


Assuntos
Estimulação da Medula Espinal , Estudos Cross-Over , Método Duplo-Cego , Humanos , Parestesia/etiologia , Parestesia/terapia , Estudos Prospectivos , Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
7.
Clin Exp Dermatol ; 47(1): 3-8, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34137059

RESUMO

Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well-defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high-potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12.


Assuntos
Neurodermatite/diagnóstico , Neurodermatite/terapia , Parestesia/diagnóstico , Parestesia/terapia , Couro Cabeludo , Humanos
8.
Photobiomodul Photomed Laser Surg ; 39(12): 774-781, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34878933

RESUMO

Objective: This randomized clinical trial evaluated the sensitive return of the lower alveolar nerve (LAN) using two photobiomodulation therapy (PBMT) techniques, after the extraction of lower third molars or implant surgery. Materials and methods: Sixty participants with sensory impairment of LAN were randomly divided into three groups (n = 20): group C-systemic medication (control-ETNA®, 01 capsule, 8/8 h, 30 days); group laser therapy (LT) (808 nm, 100 mW, 40 sec/point, 4 J/point, intra/extraoral, irradiation following nerve path); group laser acupuncture (LA) (same parameters as the LT group, applied at six acupuncture points on the affected side (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). The following evaluations were performed, at predetermined times: general perception of paresthesia, thermal perception, vibratory mechanical perception, two-point discrimination, pain perception, and tactile perception. Data were analyzed by two-way analysis of variance (ANOVA), followed by the Tukey, except for the two-point discrimination, which was analyzed using the chi-square test. Results: In general and thermal perception, both PBMTs had better results than control; regarding cold perception, only the LT group was statistically superior to control. LA presented inferior results of neural regeneration for tests of perception of pain and tactile at the lip, and of tactile perception at the chin. In the other tests, there was no statistical difference among the groups. Conclusions: LT and the conventional drug treatment had the same effectiveness and both were superior to LA for the treatment of paresthesia of the LAN after oral surgeries.


Assuntos
Terapia por Acupuntura , Terapia a Laser , Terapia com Luz de Baixa Intensidade , Humanos , Dente Serotino/cirurgia , Parestesia/etiologia , Parestesia/terapia
9.
Medisan ; 25(4)2021. ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1340214

RESUMO

Se describe el caso clínico de un paciente de 36 años de edad, quien acudió a la consulta de Ortopedia y Traumatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, con un alambrón oxidado, encarnado en la cara palmar de la muñeca derecha, con parestesias en la zona de inervación del nervio mediano. La radiografía reveló que dentro de las estructuras de la muñeca había 10 cm del alambrón, con la porción distal doblada en forma de gancho, por lo cual se le realizó intervención quirúrgica de urgencia. Se utilizó anestesia regional, sedación e isquemia y se extrajo el cuerpo extraño en sentido contrario a la curvatura que presentaba. Luego de pasar el efecto anestésico persistían las parestesias en el pulpejo del índice, que desaparecieron completamente a los 4 meses del accidente. Se incorporó a sus labores habituales a los 2 meses de operado.


The case report of a 36 years patient is described. He went to the Orthopedics and Traumatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, with a rusty big wire, ingrowing in the right wrist palmar face, with paresthesias in the innervation area of the median nerve. The x-ray revealed that inside the wrist structures there was 10 cm of the big wire, with the distal portion bent in hook form, reason why an emergency surgical intervention was carried out. Regional anesthesia, sedation and ischemia were used and the strange body was removed in sense contrary to the bend that presented. After the anesthetic effect eased the paresthesias of the index finger tip persisted that disappeared completely 4 months after the accident. He went back to his usual works 2 months after the operation.


Assuntos
Parestesia/terapia , Corpos Estranhos , Nervo Mediano/lesões , Acidentes de Trabalho , Nervo Mediano/cirurgia
10.
Neuromodulation ; 23(5): 613-619, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32166842

RESUMO

INTRODUCTION: In this prospective, multicenter, double-blinded, randomized, crossover study, we compared the therapeutic efficacy of burst SCS delivered using a lead implanted with the paresthesia mapping approach to a lead implanted with an anatomic placement approach. MATERIALS AND METHODS: Subjects with chronic low back pain were implanted with two leads, one using paresthesia-mapping approach (PM) and the second using anatomical placement procedure (AP). Stimulation contacts were chosen using the standard intraoperative paresthesia-testing procedure for the paresthesia-mapped lead or an activated bipole overlapping the T9-T10 junction for the anatomical lead. Amplitude for either lead was selected such that no sensory percepts were generated. Subjects were assessed at baseline and after a trial period during which they tested each lead for two weeks in random order. Eligible subjects had the option to receive permanent implants using their preferred AP or PM approach at end-of-trial. RESULTS: Of the 53 subjects who completed both trial periods, 43 (81.1%) experienced at least 50% back pain relief with at least one lead. Nearly half of these (20; 46.5%) were profound responders who experienced at least 80% back pain relief with either leads. Primary and secondary outcomes, at the end of trial, showed significant improvements for both AP and PM leads from baseline yet were not significantly different from each other. DISCUSSION: The trial results of this study suggest that similar clinical outcomes can be achieved in burst SCS when performing lead placement either using paresthesia mapping or anatomical placement with imaging references.


Assuntos
Neuroestimuladores Implantáveis , Parestesia , Estimulação da Medula Espinal , Adulto , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Parestesia/etiologia , Parestesia/terapia , Estudos Prospectivos , Medula Espinal , Resultado do Tratamento
11.
Spine (Phila Pa 1976) ; 45(6): E342-E345, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30028777

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: Since this is the first ever case of a male patient with Klippel-Feil syndrome (KFS) with anterior cervical meningomyelocele and syringomyelia. All four previously reported cases were female patients. This makes this case unique. SUMMARY OF BACKGROUND DATA: KFS with auxiliary anterior cervical meningomyelocele is a rare entity. To the best of our knowledge so far only four cases are reported. METHODS: A 22-year-old male patient was presented to neurology outpatient department with 2-year history of left hand paresthesia and progressive weakness. The diagnostic evaluation showed KFS with auxiliary anterior cervical meningomyelocele and thoracic syringomyelia. RESULTS: Patient was sent to neurosurgery department for intervention. After discussing the possible risks and complications of intervention he opted for conservative therapy and declined the surgery. CONCLUSION: The paucity of data is the key reason for any recommended protocol for management of such patients but the available literature recommends neurosurgical intervention in symptomatic patients. LEVEL OF EVIDENCE: 5.


Assuntos
Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/diagnóstico por imagem , Meningomielocele/complicações , Meningomielocele/diagnóstico por imagem , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Tratamento Conservador/métodos , Humanos , Síndrome de Klippel-Feil/terapia , Masculino , Meningomielocele/terapia , Parestesia/diagnóstico por imagem , Parestesia/etiologia , Parestesia/terapia , Siringomielia/terapia , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
13.
Medicine (Baltimore) ; 98(48): e17756, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770194

RESUMO

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) generates an uncomfortable postoperative period accompanied by pain, edema, and paresthesia. There are few studies on the effect of photobiomodulation (PBM) after SARME and it was not possible to find studies on the efficacy of light emitted by diode (LED) after this type of intervention. The main objective of the study will be to evaluate the efficacy of PBM with LED in the control of pain, facial edema, paresthesia, and bone repair after SARME. METHODS: A randomized, double-blind, placebo-controlled clinical trial involving 72 participants aged from 18 to 45 years, who search the Department of Buccomaxillofacial Surgery and Traumatology of Mandaqui Hospital Complex, will be conducted. Immediately after surgeries, the participant will be inserted into the placebo or LED group. In the LED group, the participants will receive PBM with an extraoral device (660 and 850 nm with 6 J per point) and an intraoral device (660 nm with 2 J per point) and in the control group the person in charge of the application will simulate the irradiation with the devices kept off. The applications will be in the immediate postoperative period, 1, 2, 7, 14, 30, 60, 90, and 120 days after the end of the surgeries, when the evaluations will also be performed. Facial measurements, extra and intraoral sensitivity, pain and bone repair will be evaluated. Secondarily, data regarding the occurrence of headache; otalgia; nausea; bruising; nasolacrimation; epistaxis; dysphagia; systemic and superficial temperature in the operated region; use of analgesics and anti-inflammatories; anxiety and impact of oral health on the participants' quality of life will be computed. DISCUSSION: Since PBM has shown positive effects on postoperative complications of other types of oral surgery and also has a positive effect on bone repair after maxillary disjunction, surgically assisted or not, it seems clear the need to evaluate its performance regarding pain, edema, and paresthesia after these surgeries. TRIAL REGISTRATION: This protocol was registered in Clinical Trials platform (https://clinicaltrials.gov/) with the number NCT03814525, first published and last updated on January 24, 2019.


Assuntos
Edema/terapia , Terapia com Luz de Baixa Intensidade/métodos , Doenças Maxilares/terapia , Dor Pós-Operatória/terapia , Técnica de Expansão Palatina/efeitos adversos , Parestesia/terapia , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Regeneração Óssea , Método Duplo-Cego , Edema/etiologia , Feminino , Humanos , Masculino , Maxila/cirurgia , Doenças Maxilares/etiologia , Pessoa de Meia-Idade , Parestesia/etiologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
14.
Am J Phys Med Rehabil ; 97(12): 929-932, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30439740

RESUMO

Notalgia paresthetica is a rarely reported T2-T6 sensory neuropathy whose etiology and treatment are not fully established. Although it is believed to be common in dermatological practice, it remains underrecognized, underdiagnosed, and therefore underreported. This case-report provides a physical medicine and rehabilitation perspective on notalgia paresthetica diagnosis and treatment. This article presents a case report of a 39-yr-old woman with pain, pruritus, and a hyperpigmented area in the right dorsal infra scapular region. The diagnosis of notalgia paresthetica was established. She was successfully treated with topical anesthetics, postural corrective exercises, scapular muscle strengthening, and pectoral muscle stretching. In this context, different treatment options were reviewed. A small set of pharmacological and nonpharmacological techniques were identified. Several of these modalities belong to the physical medicine and rehabilitation field of action.


Assuntos
Dor nas Costas/terapia , Terapia por Exercício , Parestesia/terapia , Adulto , Anestésicos Locais/uso terapêutico , Dor nas Costas/diagnóstico , Feminino , Humanos , Hiperpigmentação/etiologia , Lidocaína/uso terapêutico , Parestesia/diagnóstico , Prurido/etiologia , Prurido/terapia , Adesivo Transdérmico
15.
Orbit ; 37(1): 32-35, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28812959

RESUMO

Trigeminal trophic syndrome (TTS) is a condition whereby persistent facial ulceration presents consequent to central or peripheral insult to the trigeminal nerve. Lesions are created by repetitive self-inflicted manipulation and trauma of dysaesthetic skin within the trigeminal dermatome. We discuss four cases with aetiologies varied from presumed microvascular compromise to resection of cerebral meningioma, cerebrovascular accident, and herpes zoster ophthalmicus. We discuss the management of the under-recognised associated periocular skin ulcerations that result from physical manipulation of dysesthic skin and prove to be persistent and challenging to treat. Patient education and counselling are crucial in understanding and preventing the detrimental effect of physical manipulation of the skin. Occlusive dressings can reduce recurrent trauma. Topical lubricants, antibiotics, or autologous serum may be needed in cases with corneal involvement or exposure. Surgical interventions may be used, but frequently fail if the underlying neurological pathology and skin manipulation has not been adequately addressed. TTS should be suspected in persistent or recurrent facial ulceration with concomitant anaesthesia and paraesthesia in the trigeminal distribution, with alar nasi involvement being a key feature.


Assuntos
Doenças Palpebrais/diagnóstico , Doenças Orbitárias/diagnóstico , Parestesia/diagnóstico , Úlcera Cutânea/diagnóstico , Doenças do Nervo Trigêmeo/diagnóstico , Adulto , Idoso , Doenças Palpebrais/terapia , Face , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/terapia , Parestesia/terapia , Úlcera Cutânea/terapia , Doenças do Nervo Trigêmeo/terapia
16.
Neuromodulation ; 21(1): 10-18, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29105244

RESUMO

BACKGROUND: Traditional spinal cord stimulation (SCS) requires that paresthesia overlaps chronic painful areas. However, the new paradigm high-frequency SCS (HF-SCS) does not rely on paresthesia. STUDY DESIGN: A review of preclinical and clinical studies regarding the use of paresthesia-free HF-SCS for various chronic pain states. METHODS: We reviewed available literatures on HF-SCS, including Nevro's paresthesia-free ultra high-frequency 10 kHz therapy (HF10-SCS). Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, and SCOPUS, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: The primary goal is to describe the present developing conceptions of preclinical mechanisms of HF-SCS and to review clinical efficacy on paresthesia-free HF10-SCS for various chronic pain states. RESULTS: HF10-SCS offers a novel pain reduction tool without paresthesia for failed back surgery syndrome and chronic axial back pain. Preclinical findings indicate that potential mechanisms of action for paresthesia-free HF-SCS differ from those of traditional SCS. CONCLUSIONS: To fully understand and utilize paresthesia-free HF-SCS, mechanistic study and translational research will be very important, with increasing collaboration between basic science and clinical communities to design better trials and optimize the therapy based on mechanistic findings from effective preclinical models and approaches. Future research in these vital areas may include preclinical and clinical components conducted in parallel to optimize the potential of this technology.


Assuntos
Dor Crônica/terapia , Terapia por Estimulação Elétrica/métodos , Parestesia/terapia , Estimulação da Medula Espinal/métodos , Animais , Humanos , Medição da Dor
17.
J Acupunct Meridian Stud ; 10(2): 131-134, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28483185

RESUMO

Paresthesia is defined as an alteration in local sensibility, associated with numbness, tingling, or unpleasant sensations caused by nerve lesions or irritation. It can be temporary or permanent. The treatment protocol for facial paresthesia is primarily based on the use of drugs and implant removal, which may not be completely effective or may require other risk exposure when there is no spontaneous regression. However, other therapeutic modalities such as acupuncture can be used. The aim of this study is to report a case of a patient with paresthesia of the inferior alveolar nerve and pain caused by an implant surgery performed 2 years earlier. The patient received acupuncture treatment during 4 months of weekly sessions. Six points were used: Large Intestine (LI4), Large Intestine (LI11), Stomach (ST36), Liver (LR3), Extra Head and Neck (E-HN-18), and Stomach (ST5). The visual analog scale was used before and after each session for the analysis of paresthesia and pain, together with assessment of the paresthesia by delimitation of the desensitized region of the skin and presented discomfort. Pain remission and reduction in the size of the paresthesia area occurred after four sessions.


Assuntos
Terapia por Acupuntura/métodos , Implantes Dentários/efeitos adversos , Parestesia/etiologia , Parestesia/terapia , Animais , Feminino , Humanos , Nervo Mandibular/fisiopatologia , Pessoa de Meia-Idade
18.
Spine (Phila Pa 1976) ; 42 Suppl 14: S80-S92, 2017 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-28368981

RESUMO

STUDY DESIGN: A review of literature. OBJECTIVE: The aim of this study was to define and explore the current evidence gaps in the use of spinal cord stimulation (SCS) for treating chronic spine conditions. SUMMARY OF BACKGROUND DATA: Although over the last 40 years SCS therapy has undergone significant technological advancements, evidence gaps still exist. METHODS: A literature review was conducted to define current evidence gaps for the use of SCS. Areas of focus included 1) treatment of cervical spine conditions, 2) treatment of lumbar spine conditions, 3) technological advancement and device selection, 4) appropriate patient selection, 5) the ability to curb pharmacological treatment, and 6) methods to prolong efficacy over time. New SCS strategies using advanced waveforms are explored. RESULTS: The efficacy, safety, and cost-effectiveness of traditional SCS for chronic pain conditions are well-established. Evidence gaps do exist. Recently, advancement in waveforms and programming parameters have allowed for paresthesia-reduced/free stimulation that in specific clinical areas may improve clinical outcomes. New waveforms such as 10-kHz high-frequency have resulted in an improvement in back coverage. To date, clinical efficacy data are more prevalent for the treatment of painful conditions originating from the lumbar spine in comparison to the cervical spine. CONCLUSION: Evidence gaps still exist that require appropriate study designs with long-term follow-up to better define and improve the use of this therapy for the treatment of chronic spine pain in both the cervical and lumbar regions. LEVEL OF EVIDENCE: N/A.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Medicina Baseada em Evidências/normas , Estimulação da Medula Espinal/normas , Doenças da Coluna Vertebral/terapia , Dor nas Costas/diagnóstico , Dor Crônica/diagnóstico , Medicina Baseada em Evidências/métodos , Humanos , Vértebras Lombares , Parestesia/diagnóstico , Parestesia/terapia , Seleção de Pacientes , Medula Espinal/fisiologia , Estimulação da Medula Espinal/métodos , Doenças da Coluna Vertebral/diagnóstico , Resultado do Tratamento
19.
Artigo em Chinês | MEDLINE | ID: mdl-29871282

RESUMO

Objective:To investigate the therapeutic effect and potential reason for anxiety in pharyngeal paraesthesia in patients with different degrees of anxiety based on their characteristics.Method:All patients were divided into three groups according to self-rating anxiety scale(SAS),including group 1(mild anxiety),group 2(moderate anxiety)and group 3(severe anxiety).The characteristics,risk factors and prognosis in each group were compared and analyzed.Meanwhile,State-Trait Anxiety Inventory(STAI)was used to analyze anxiety state of all patients and healthy participates(Group 4).SPSS13.0 statistical software was used for data analysis. Result:The proportions of female patients(54.05%) who had anxiety symptom were higher than those of male patients(45.95%).The proportions of moderate anxiety in female patients were higher(P<0.01),but those of mild anxiety were lower(P<0.01) compared with male patients. There was no gender difference about the proportions of severe anxiety. The patients aged 40-59 years had the highest proportions of anxiety(60.14%)and a higher proportions of moderate and severe anxiety compared with the patients aged 18~39 years and over 60 years old(P<0.05).However, there was no significant difference in proportions of different degrees of anxiety between the patients aged 18-39 years and over 60 years old(P>0.05).The proportions of mild anxiety in patients with 5-10 years duration and those of moderate anxiety in patients with the course of less than 5 years were all the highest.However, no difference was found in proportions of severe anxiety among different courses(P>0.05).The proportions of moderate anxiety(except mild and severe anxiety) in patients with no fixed occupation and no senior middle school education were higher than those in patients with fixed occupation and senior middle school education or above(P<0.05).But there were no relationships between the degrees of anxiety and other general conditions of patients,including marital status and live condition. Among different degrees of anxiety,the proportions of patients who feared cancer were all the highest, followed by stress and mental stimulation factors.The proportions of patients who feared cancer and felt stress were higher in severe anxiety than those in mild and moderate anxiety.But there was no significant difference between any two groups in other related factors,including mental stimulation factors, obsessive-compulsive disorder(OCD) and family history of psychosis.Male and female patients with different degrees of anxiety compared with healthy controls respectively,had significant difference in state anxiety(SAI) scores(P<0.05),but showed no significant difference in trait anxiety(T-AI) scores(P>0.05). Both recovery rates and total effective rates of mild and moderate anxiety were higher than those of severe anxiety(P<0.01).However,there was no difference between mild and moderate anxiety whether in recovery rates or in total effective rates (P>0.05). Conclusion:Pharyngeal paraesthesia in patients with different degrees of anxiety has different clinical features and prognosis .The main cause of anxiety appears to be a long duration of treatment. No obvious anxiety potential was found in patients compared with normal people.


Assuntos
Ansiedade , Parestesia/psicologia , Doenças Faríngeas/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo , Parestesia/terapia , Inventário de Personalidade , Doenças Faríngeas/terapia , Fatores de Risco , Adulto Jovem
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