Postherpetic Neuralgia
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Treating Herpes Zoster and Postherpetic Neuralgia
® VOVOLL XX I XXIII• NO 1• NO• JU 4N E• MAY2013 2015 Treating Herpes Zoster and Postherpetic Neuralgia Vol.ÊXXI,ÊIssueÊ1Ê JuneÊ2013 Editorialostherpetic Board neuralgia (PHN) but a minority of patients experience months and 15% had pain at 2 years in is the most frequent chronic pain (PHN) persisting for months, years, a Dutch study.6 In the landmark zoster Editor-in-Chief PsychosocialÊAspectsÊofÊChronicÊPelvicÊPain complication of herpes zoster or even a lifetime. vaccine study, which included almost JaneÊC.ÊBallantyne,ÊMD,ÊFRCA (shingles).1 Herpes zoster (HZ) Anesthesiology,ÊPainÊMedicine 40,000 people aged 60 years or older PUSA represents a reactivation of the vari- Epidemiology of HZ and PHN (of whom fewer than 1000 developed cella zoster virus (VZV), a ubiquitous, Pain is unwanted, is unfortunately common, and remains essential for survival (i.e., AdvisoryÊBoard HZ) and where PHN was defined as highly neurotropic, exclusively human Accordingevading toda ang recenter) and systematic facilitating medical diagnoses. This complex amalgamation of MichaelÊJ.ÊCousins,ÊMD,ÊDSC pain intensity of 3/10 or more, 30% of -herpesvirus. Primary infection causes review,sensati theon, incidence emotions, of a ndHZ t houghis 3–5 ts manifests itself as pain behavior. Pain is a moti- α PainÊMedicine,ÊPalliativeÊMedicine 1patients who developed HZ had PHN - Australia casesvati perng f1000actor person-years.for physician 3c Theonsu ltations and for emergency department visits and is varicella (chickenpox), after which VZV at 1 month, 12% at 3 months, and 5% age-specific incidence rates of HZ were becomes latent in sensory ganglia along at 6 months in the placebo group.7 Ac- similar across countries, with a steep the entire neuraxis. -
Sciatica and Chronic Pain
Sciatica and Chronic Pain Past, Present and Future Robert W. Baloh 123 Sciatica and Chronic Pain Robert W. Baloh Sciatica and Chronic Pain Past, Present and Future Robert W. Baloh, MD Department of Neurology University of California, Los Angeles Los Angeles, CA, USA ISBN 978-3-319-93903-2 ISBN 978-3-319-93904-9 (eBook) https://doi.org/10.1007/978-3-319-93904-9 Library of Congress Control Number: 2018952076 © Springer International Publishing AG, part of Springer Nature 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. -
ICD9 & ICD10 Neuromuscular Codes
ICD-9-CM and ICD-10-CM NEUROMUSCULAR DIAGNOSIS CODES ICD-9-CM ICD-10-CM Focal Neuropathy Mononeuropathy G56.00 Carpal tunnel syndrome, unspecified Carpal tunnel syndrome 354.00 G56.00 upper limb Other lesions of median nerve, Other median nerve lesion 354.10 G56.10 unspecified upper limb Lesion of ulnar nerve, unspecified Lesion of ulnar nerve 354.20 G56.20 upper limb Lesion of radial nerve, unspecified Lesion of radial nerve 354.30 G56.30 upper limb Lesion of sciatic nerve, unspecified Sciatic nerve lesion (Piriformis syndrome) 355.00 G57.00 lower limb Meralgia paresthetica, unspecified Meralgia paresthetica 355.10 G57.10 lower limb Lesion of lateral popiteal nerve, Peroneal nerve (lesion of lateral popiteal nerve) 355.30 G57.30 unspecified lower limb Tarsal tunnel syndrome, unspecified Tarsal tunnel syndrome 355.50 G57.50 lower limb Plexus Brachial plexus lesion 353.00 Brachial plexus disorders G54.0 Brachial neuralgia (or radiculitis NOS) 723.40 Radiculopathy, cervical region M54.12 Radiculopathy, cervicothoracic region M54.13 Thoracic outlet syndrome (Thoracic root Thoracic root disorders, not elsewhere 353.00 G54.3 lesions, not elsewhere classified) classified Lumbosacral plexus lesion 353.10 Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy 353.50 Neuralgic amyotrophy G54.5 Root Cervical radiculopathy (Intervertebral disc Cervical disc disorder with myelopathy, 722.71 M50.00 disorder with myelopathy, cervical region) unspecified cervical region Lumbosacral root lesions (Degeneration of Other intervertebral disc degeneration, -
Diagnosing and Treating Trigeminal Neuralgia in General Dentistry
general practice feature Chasing Pain Diagnosing and Treating Trigeminal Neuralgia in General Dentistry by Steven Olmos, DDS, DABCP, DABCDSM, DABDSM, DAAPM, FAAOP, FAACP, FICCMO, FADI, FIAO As dentists, we know quite a bit about tooth and gum pain, but when it comes to chronic facial pain and neuropathic pain, our dental school education leaves us unprepared. The objective of this article is to explain the differences between men and women with chronic orofacial pain and the relationship to proper functional breathing, using a case study as demonstration. 34 JANUARY 2016 // dentaltown.com general practice feature the United States, nearly half research published in Chest 2015 demonstrates that of all adults lived with chronic respiratory-effort-related arousal may be the most pain in 2011. Of 353,000 adults likely cause (nasal obstruction or mouth breath- 11 aged 18 years or older who were ing). Rising C02 (hypercapnia) in a patient with a surveyed by Gallup-Health- sleep-breathing disorder (including mouth breath- ways, 47 percent reported having at least one of ing) specifically stimulates the superficial masseter three types of chronic pain: neck or back pain, muscles to contract.12 knee or leg pain, or recurring pain.2 Identifying the structural area of obstruction A study published in The Journal of the Amer- (Four Points of Obstruction; Fig. 1) of the air- ican Dental Association October 2015 stated: way will insure the most effective treatment for a “One in six patients visiting a general dentist had sleep-breathing disorder and effectively reduce the experienced orofacial pain during the last year. -
Occipital Neuralgia: a Literature Review of Current Treatments from Traditional Medicine to CAM Treatments
Occipital Neuralgia: A Literature Review of Current Treatments from Traditional Medicine to CAM Treatments By Nikole Benavides Faculty Advisor: Dr. Patrick Montgomery Graduation: April 2011 1 Abstract Objective. This article provides an overview of the current and upcoming treatments for people who suffer from the signs and symptoms of greater occipital neuralgia. Types of treatments will be analyzed and discussed, varying from traditional Western medicine to treatments from complementary and alternative health care. Methods. A PubMed search was performed using the key words listed in this abstract. Results. Twenty-nine references were used in this literature review. The current literature reveals abundant peer reviewed research on medications used to treat this malady, but relatively little on the CAM approach. Conclusion. Occipital Neuralgia has become one of the more complicated headaches to diagnose. The symptoms often mimic those of other headaches and can occur post-trauma or due to other contributing factors. There are a variety of treatments that involve surgery or blocking of the greater occipital nerve. As people continue to seek more natural treatments, the need for alternative treatments is on the rise. Key Words. Occipital Neuralgia; Headache; Alternative Treatments; Acupuncture; Chiropractic; Nutrition 2 Introduction Occipital neuralgia is a type of headache that describes the irritation of the greater occipital nerve and the signs and symptoms associated with it. It is a difficult headache to diagnose due to the variety of signs and symptoms it presents with. It can be due to a post-traumatic event, degenerative changes, congenital anomalies, or other factors (10). The patterns of occipital neuralgia mimic those of other headaches. -
Update on Herpes Zoster: Treatment and Prevention of Shingles 27Th Annual Primary Health Care of Women Conference
UPDATE ON HERPES ZOSTER: TREATMENT AND PREVENTION OF SHINGLES 27TH ANNUAL PRIMARY HEALTH CARE OF WOMEN CONFERENCE DECEMBER 5, 2019 PAMELA G. ROCKWELL, DO, FAAFP ASSOCIATE PROFESSOR DEPARTMENT OF FAMILY MEDICINE UNIVERSITY OF MICHIGAN NO FINANCIAL DISCLOSURES • AAFP Liaison of the Advisory Committee on Immunization Practices (ACIP) • AAFP Liaison ACIP Hepatitis, Pediatric and Adult RSV, and General Recommendations Work Groups • MAFP Liaison MDHHS Immunizations Committee • Co-Chair Immunization Committee, University of Michigan GOALS AND OBJECTIVES • Review Varicella Zoster Virus infection • Review Herpes Zoster (Shingles) Disease & Epidemiology • Review Shingles Risk Factors & Complications • Learn How to Diagnose and Treat Shingles and Common Complications • Learn How to Best Prevent Shingles/Update on Vaccination VARICELLA ZOSTER VIRUS (VZV) • Human α-herpesvirus, present worldwide, highly infectious • Primary infection with VZV causes varicella (chicken pox) • CDC estimate: ~ 4 million cases annually prior to 1995 • Annual incidence15-16 cases per 1,000 U.S. population • High annual burden of disease with hospitalization • 100-150 deaths per year https://www.cdc.gov/chickenpox/about/index.html CHICKENPOX • Transmitted person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster (shingles), or aerosolized infected respiratory tract secretions CHICKENPOX • >95% of people born before 1980 in the U.S infected with wild-type VZV despite having no recall of disease* • VZV remains -
Occipital Neuralgia - Types of Headache/Migraine | American Migraine
Occipital Neuralgia - Types of Headache/Migraine | American Migraine ... http://www.americanmigrainefoundation.org/occipital-neuralgia/?print=y Occipital Neuralgia - Symptoms, Diagnosis, and Treatment Key Points: 1. Occipital neuralgia may be a cause of head pain originating in the occipital region (back of the head). 2. Pain is episodic, brief, severe, and shock-like. It originates from the occipital region and radiates along the course of the occipital nerves. 3. Attacks may be triggered by routine activities such as brushing the hair, moving the neck, or resting the head on a pillow. 4. Antiepileptic medications, tricyclic anti-depressants, and nerve blocks may be used for treatment. Introduction: Occipital neuralgia (ON) is a relatively rare primary headache disorder (primary headache disorders are not symptoms of or caused by another condition) affecting around 3.2/100,000 people per year.1 The term “neuralgia” refers to pain in the distribution of a nerve, in this case the occipital nerves. The greater, lesser, and third occipital nerves originate from the upper cervical nerve roots, course up the neck muscles, and exit near the base of the skull. These pure sensory nerves provide sensation to the back of the head, up to the top of the head, and behind the ears. The cause of ON is unknown; however, entrapment and irritation of the nerves have been proposed. Pain secondary to trauma such as whiplash injuries, inflammation, and compression of the occipital nerves by arteries or tumors have all been hypothesized, but no consensus has been reached. 1,2 ON may be provoked (triggered) simply by touching the affected region. -
Non-Live Recombinant Herpes Zoster Vaccine (SHINGRIX)
Rx Files: Q&A Summary www.RxFiles.ca - Updated May 2021 Originally prepared by: M Jin, PharmD Non-Live Recombinant Herpes Zoster Vaccine (SHINGRIX) P L Bottom Line… SHINGRIX is indicated for the prevention of herpes zoster (HZ or shingles) in adults age ≥ 50 SHINGRIX reduces the risk of shingles by 91% (ARR=3.1%, NNT=32) & postherpetic neuralgia (PHN) by ~90% (ARR=0.30%, NNT=333) in 3 yrs. NNT: Eg. for every 333 vaccinated with SHINGRIX, 10 shingle cases (age ≥ 50 years) and 1 PHN cases (age ≥50 years) were prevented over ~ 3 yrs. SHINGRIX demonstrated efficacy for prevention of shingles effective in all age groups 50-80+. ZOSTAVAX less effective with increasing age. SHINGRIX use in patients with a history of shingles has been studied {open-label, non-randomized trial (n=93 patients, age 50-89 yr) for 3 months}.ZOSTER-033 Vaccine can be given after shingles symptoms/rash resolved CDC or ≥1 yr CDN Cost ~ $ 300 for 2 doses given intramuscularly (IM) 2-6 months apart (can give up to 12 months apart if needed to increase compliance). (Refrigerate 2 to 8°C; Discard if frozen) (New Jan/2021 NIHB covers for those between 65 & 70 years of age) Canadian NACI’18 recommends SHINGRIX should be offered to individuals ≥50 yrs without contraindications including: -Individuals previously vaccinated with ZOSTAVAX or ZOSTAVAX II; Re-vaccinate with two doses of RZV at least one year after receiving ZOSTAVAX -Individuals with a previous episode of herpes zoster disease. Provide two doses of SHINGRIX at least one year after herpes zoster episodeexpert opinion -Immunocompromised individuals, may be considered on a case-by-case assessment of the benefits vs risks expert opinion ZOSTAVAX II may be considered for immunocompetent individuals ≥50 yrs without contraindications when SHINGRIX is contraindicated, unavailable or inaccessible. -
Neuropathic Orofacial Pain the Brochure Is Provided Compliments Of
Neuropathic_Pain_Brochure_Neuropathic_Pain_Brochure 6/9/2010 11:41 AM Page 1 Neuropathic orofacial paiN The brochure is provided compliments of This brochure in intended for informational purposes only and should be considered a replacement for a professional treatment for a health care professional. To locate knowledgeable and experienced expert in orofacial pain, contact: The American Academy of Orofacial Pain 174 S. New York Ave. POB 478 Oceanville, NJ 08231 P: 609-504-1311 E: [email protected] W: www.aaop.org To locate knowledgeable and experienced expert in Trigeminal Neuralgia, contact: Trigeminal Neuralgia Association 2801 SW Archer Road Gainesville, FL 32608 P: 352-376-9955 E: [email protected] W: www.tna-support.org Neuropathic_Pain_Brochure_Neuropathic_Pain_Brochure 6/9/2010 11:41 AM Page 3 coNteNts 1-Neuropathic orofacial paiN 4-GettiNG help/What to expect 6-commoN Neuropathic orofacial paiN DisorDers aND their treatmeNt 6 - triGem iNal NeuralGia 8 - pre-triGem iNal NeuralGia 9 - atypical oDoNtalGia (phaNtom tooth paiN) 10 - chroNic reGioNal paiN syNDrome 12 - iN coNclusioN Neuropathic_Pain_Brochure_Neuropathic_Pain_Brochure 6/9/2010 11:41 AM Page 4 Neuropathic orofacial paiN Of the many pains that can effect the head and neck, perhaps the most confusing and difficult to diagnose are a group of maladies called Neuropathic Orofacial Pain Disorders. These neuropathic pain disorders are often chronic and arise from the brain and nerves of the head, face and neck. If you have experienced the frustration of having a toothache or face pain and, after seeing many doctors, still don't know where the pain is coming from, Brain you may be suffering from a neuropathic pain Spinal Cord disorder. -
View Board (KMUH-IRB-EXEMPT- We Further Investigated Whether HF Is a Time- 20130059)
Wu et al. BMC Infectious Diseases (2015) 15:17 DOI 10.1186/s12879-015-0747-9 RESEARCH ARTICLE Open Access A nationwide population-based cohort study to identify the correlation between heart failure and the subsequent risk of herpes zoster Ping-Hsun Wu1,4, Yi-Ting Lin2, Chun-Yi Lin6, Ming-Yii Huang3, Wei-Chiao Chang5,7 and Wei-Pin Chang6* Abstract Background: The association between heart failure (HF) and herpes zoster has rarely been studied. We investigated the hypothesis that HF may increase the risk of herpes zoster in Taiwan using a nationwide Taiwanese population- based claims database. Method: Our study cohort consisted of patients who received a diagnosis of HF in 2001 ~ 2009 (N = 4785). For a comparison cohort, three age- and gender-matched control patients for every patient in the study cohort were selected using random sampling (N = 14,355). All subjects were tracked for 1 year from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 1-year herpes zoster-free survival rates. Results: The main finding of this study was that patients with HF seemed to be at an increased risk of developing herpes zoster. Of the total patients, 211 patients developed herpes zoster during the 1-year follow-up period, among whom 83 were HF patients and 128 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with HF was higher (AHR: 2.07; 95% confidence interval (CI): 1.54 ~ 2.78; p < 0.001) than that of the controls during the 1-year follow-up. -
Acute Low Back Pain
Acute low back pain Key reviewers: Mr Chris Hoffman, Orthopaedic Surgeon, Mana Orthopaedics, Wellington Dr John MacVicar, Medical Director, Southern Rehab, Christchurch Key concepts: ■ Acute low back pain is common and most patients will recover fully within three months ■ Serious causes are rare and can be excluded with careful history and examination ■ Radiological studies are not required for acute low back pain in the absence of red flags ■ An exact diagnosis is often not possible, nor needed for management ■ Patients’ beliefs and attitudes warrant as much attention as the anatomical and pathological aspects of their condition ■ Fear about pain is a major determinant of disability and possible chronicity ■ Management should include reassurance, education and helping the patient stay active ■ Adequate analgesia is important to allow the patient www.bpac.org.nz keyword: lowbackpain to stay active 6 | BPJ | Issue 21 Acute low back pain is common and often relapsing Red Flags: ▪ Trauma Low back pain is discomfort, muscle tension or stiffness ▪ Unrelenting pain, or pain worse at night localised to the area around the lumbar spine. Back pain (supine) may radiate to the groin, buttocks or legs as referred somatic pain and may be associated with lumbar radicular ▪ Age <20 years, or new back pain age >50 pain such as sciatica. years ▪ History of cancer In any given year approximately one third of adults will ▪ Systemic symptoms suffer from low back pain and one third of these will seek help from a health practitioner.1 Most people with low ▪ IV drug use back pain self-treat with over-the-counter medications and ▪ Immunosuppression or steroids lifestyle changes.2 ▪ Widespread or progressive neurological deficit Low back pain is described as acute if present for less than six weeks, sub-acute between six weeks and three Serious causes of acute low back pain are rare months, and chronic if it continues for longer than three and include:6 months. -
A Misdiagnosis of Atypical Trigeminal Neuralgia
RESIDENT & FELLOW SECTION Clinical Reasoning: A misdiagnosis of atypical trigeminal neuralgia Jaclyn R. Duvall, MD, and Carrie E. Robertson, MD Correspondence Dr. Robertson Neurology 2019;93:124-131. doi:10.1212/WNL.0000000000007790 ® [email protected] Section 1 A 47-year-old man presented with right-sided facial pain that started 2 years prior. He described the pain as extremely intense, stabbing along the right jaw, lasting 5–60 seconds. This pain was exacerbated by chewing, and to a lesser degree, by brushing his teeth. The pain was so intense that he avoided eating when possible, leading to a 20-pound weight loss. When he did eat, he would try to chew on the left side of his mouth. Around the onset of these symptoms, he also noticed a persistent numbness and burning extending from the right lower earlobe to the lateral angle of the jaw that was exacerbated by turning his head to the right. The patient was given a diagnosis of atypical trigeminal neuralgia (TN) and sent to our headache clinic for further management. Questions for consideration: 1. What features are typical and atypical for classical TN? 2. What is your differential diagnosis in this patient presenting with facial pain? GO TO SECTION 2 From the Department of Neurology, Headache Division, Mayo Clinic, Rochester, MN. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. 124 Copyright © 2019 American Academy of Neurology Copyright © 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.