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Saturday, 30 November 2013

Neuralgia - The Symptoms and |Risk Factors

Neuralgia is defined as a condition of a sudden and heavy attacks of pain that follows the path of a nerve or nerves as a result of a change in neurological structure or function due to irritation or damage to the nerves without stimulating pain receptor (nociceptor) cells. the disease affects about 2%–3% of the population.

I. Symptoms
1. In the study to evaluate the symptoms of neuralgia effect on the patient with postherpetic neuralgia (PHN), scientists at Policy Analysis Inc, showed that only about one half had taken prescription medication for shingles pain during the prior week; dosages were typically low. Mean average, worst, least, and current pain caused by shingles (0- to 10-point scale) was 4.6 (+/-2.1), 6.0 (+/-2.4), 2.9 (+/-2.3), and 4.0 (+/-2.7), respectively. Mean pain interference with general activity, mood, relations with other people, sleep, and enjoyment of life (0- to 10-point scale) was 3.7 (+/-3.1), 4.3 (+/-2.9), 3.0 (+/-2.8), 3.8 (+/-2.9), and 4.5 (+/-3.1), respectively. The mean EQ-5D health index score was 0.61; respondents rated their overall health as 65.7 (+/-21.1) on a 100-point scale. PHN causes substantial pain, dysfunction, and poor health-related quality of life in older persons, many of whom might be suboptimally treated(a).

2. Mechanical allodynia and cold hyperalgesia(13) 

Risk factors
1. Age, sex and migraine
In the study conducted by  University of Rochester School of Medicine and Dentistry showed that Univariate and multivariate analyses indicated that older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity made independent contributions to identifying which patients developed PHN. Patients with subacute herpetic neuralgia who did not develop PHN were significantly younger and had less severe acute pain than postherpetic neuralgia (PHN) patients but were significantly more likely to have severe and widespread rash than patients without persisting pain.(14). Other indicated that indicate that patients with migraine(M) should also be screened for symptoms of occipital neuralgia (ON), as there may be similarities in presentation. The clinical implications of distinguishing ON + M and isolated ON include differences in treatment regimen, avoidance of inappropriate use of medical resources, and differences in long-term outcomes.(15)

2. Immunity
In a report of 821 cases of herpes zoster that met all eligibility criteria, indicated that the prevalence of postherpetic neuralgia (PHN) more than 30 days after onset of zoster was 8.0% (95% confidence interval [CI], 6.3%-10.1%) and 4.5% (95% CI, 3.2%-6.2%) after 60 days. Compared with patients younger than 50 years, individuals aged 50 years or older had a 14.7-fold higher prevalence (95% CI, 6.8-32.0) 30 days and a 27.4-fold higher prevalence (95% CI, 8.8-85.4) 60 days after developing zoster. Prodromal sensory symptoms and certain conditions associated with compromised immunity were also associated with PHN. Systemic corticosteroids before zoster and treatment of zoster with acyclovir or corticosteroids did not significantly affect the prevalence of PHN.(16)

3. Nutrient deficiency
In the study to compare the nutritional status of PHN patients with that of healthy controls, and then to identify risk factors for PHN using multivariate multiple logistic regressions, conducted by Chi Mei Medical Center,, Dr. Chen JY and the medical team showed that lower concentrations of circulating nutrients, namely vitamin C, ionised Ca or Zn, are probably a risk factor in Taiwanese patients with PHN.(17)

4. Etc.
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/15943957
(13) http://www.ncbi.nlm.nih.gov/pubmed/20055264 
(14) http://www.ncbi.nlm.nih.gov/pubmed/15136679
(15) http://www.ncbi.nlm.nih.gov/pubmed/21198572  
(16) http://www.ncbi.nlm.nih.gov/pubmed/9183233 
(17) http://www.ncbi.nlm.nih.gov/pubmed/21473799