Seven consecutive patients with multiple sclerosis and trigeminal neuralgia were investigated with MRI to determine the occurrence of a lesion which would account for the patients' pain. Two patients had bilateral symptoms. In the patients with unilateral trigeminal neuralgia vascular compression of the nerve by an artery at the root entry zone on the symptomatic side was confirmed in three patients and an epidermoid tumour distorting the nerve on the symptomatic side was identified in one patient. A demyelinating plaque was identified in only one patient, affecting the trigeminal nerve at the root entry zone at the pons. In those with bilateral symptoms neurovascular compression was identified on both sides in one patient and on one side only in the remanng patient. Microvascular decompression cured the pain in two patients with neurovascular compression. The variable aetiology of trigeminal neuralgia is stressed even in patients with coexistent neurological conditions such as multiple sclerosis, which can cause trigeminal neuralgia independent of other causes. (7 Neurol Neurosurg Psychiatry 1995;59:253-259)
SummaryEleven patients with established postherpetic neuralgia, unresponsive to antidepressant therapy, entered this single-blind, placebo-controlled study to assess the effectiveness of epidural morphine in the control of the pain of postherpetic neuralgia. Two patients obtained a reduction in pain of greater than 50% following morphine 0 . 5 m g . The duration of this pain relief was 36h in one patient and 72 h in the other. Repeated doses, however, were ineffective in one patient and resulted in intolerable side effects in the other. The other six patients who received morphine developed opioid-related side effects without pain relief. Three patients did not receive morphine as they gained signiJicant, long-lasting pain relief from placebo. Two retained that benejit for more than 6 months. Epidural morphine is more likely to produce side effects than pain relief when administered to patients with postherpetic neuralgia.
Eleven patients with established postherpetic neuralgia, unresponsive to antidepressant therapy, entered this single-blind, placebo-controlled study to assess the effectiveness of epidural morphine in the control of the pain of postherpetic neuralgia. Two patients obtained a reduction in pain of greater than 50% following morphine 0 . 5 m g . The duration of this pain relief was 36h in one patient and 72 h in the other. Repeated doses, however, were ineffective in one patient and resulted in intolerable side effects in the other. The other six patients who received morphine developed opioid-related side effects without pain relief. Three patients did not receive morphine as they gained signiJicant, long-lasting pain relief from placebo. Two retained that benejit for more than 6 months. Epidural morphine is more likely to produce side effects than pain relief when administered to patients with postherpetic neuralgia.
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