Medications

The simple analgesics are easily chosen by the patient, if not the physician. They are inexpensive and easy to obtain. They include aspirin and acetaminophen. Aspirin appears to work by inhibiting the synthesis of prostaglandin by blocking the action of cyclo-oxygenase (COX), an enzyme that enables the conversion of arachidonic acid to prostaglandin to occur. Prostaglandins are synthesized from cellular membrane phospholipids after activation or injury, and sensitize pain receptors. Aspirin,...

Sympathetically Maintained Pain And Myofascial Pain Syndrome

From the two entities, sympathetically maintained pain and MPS, it is clinically possible, if not probable, that of the multitude of patients with soft-tissue injuries leading to MPS those who do not recover within a short period of time (one to three months) of appropriate physical therapy may have developed secondary sympathetically maintained pain. Research data indicate that some receptors in skin and skeletal muscle can be influenced by sympathetic activity. It appears that the sympathetic...

Smallfiber Neuropathy

Small-fiber neuropathy (SFN) is a common peripheral nerve disease, typically idio-pathic in etiology, which commonly presents in middle-aged and older people with burning pain in their feet and or symptoms of autonomic dysfunction (77,78,79). The disorder selectively involves small diameter myelinated and unmyelinated nerve fibers. Frequently, autoimmune disorders mechanisms are suspected but rarely found. SFN can be caused by disorders of metabolism (diabetes), chronic infections (such as...

Voltagegated Channels

Changed expression of the calcium, sodium, and potassium voltage-gated channels has been associated with neuropathic pain (69). There is good evidence for the importance of calcium channels in the pathogenesis of neuropathic pain (70,71). The voltage-gated calcium channels involve a single a subunit and structural homology with sodium channels accessory subunits to these channels are complex, with functional calcium channel complexes involving five proteins a1, a2, ft, S, and y (70). The two...

Limbically Augmented Pain Syndrome

The Rome brothers described a hypothesis that would tie the biopsychosocial aspects of the problem of chronic pain together in a way that would encompass all aspects of chronic soft-tissue pain and other forms of chronic pain in at least a subset of such patients 20 . The question of the relationship between depression and chronic pain has long been debated. It is known that nociceptive sensory information, after reaching the thalamus, goes to the limbic system where any emotional significance...

Central Poststroke Pain

Central post-stroke pain CPSP was originally thought to be thalamic pain, as described by Dejerine and Roussy 131 , although it was described even earlier in 1883 132 . Dejerine and Roussy 131 characterized their eponymous thalamic pain syndrome by including hemiplegia hemiataxia and hemiastereognosis difficulties with both superficial and deep sensation persistent, paroxysmal, typically intolerable pain and choreoathetoid movements. The reported incidence of CPSP varies widely from 2 133 to 8...