Other Neuropathic Facial Pains

Other Neuropathic Facial Pains

Although the following pains share common mechanisms with those discussed previously, it is appropriate to list them separately, because they possess some unique cha racteristics. Postherpetic neuralgia. Postherpetlc neuralgia (PH:-‘;)i~ a potential sequelae of herpes zoster infection. Shingles, or herpes zoster, may occur at any stage in a person’s life. Herpes zoster is the clinical manifestation of the reactivation of a lifelong latent infection with varicella zoster virus, usually contracted af~i:’r an episode of chick-npcx n early Iife. Herpes zoster occurs more commonly in later  ift’ and in  patients, Each year in the t ‘nited States shingles strikes  develop PHN. Varicella zoster virus tends to be reactlvated ‘only once in a lifetime, with the incidence of second  attacks being less than S’Yu. PHN occurs after reactivationof the virus, which can lay dormant in the ganglia of a peripheral nerve. Most commonly this is a thoracic nerve but approximately 10% to lS% of the time the trigemina. . nerve is involved, with the VI dermatome affected ic approximately_ 80% of cases. When reactivated, the virus tavels along the nerve and is expressed in that nerve’
cutaneous dermatome . For a thoracic nerve, for examplethe patient ‘develops a unilateral patch of vesicular eruption closely outlining the classical dermatome for tha nerve ..In the ophthalmic division of the trigeminal nerve the VI dermatome is outlined by rash. In the V2 or V3
distribution, both intraoral and cutaneous expression is commonly seen. The acute phase is quite painful but subsides  within approximately 2 to S weeks, However, a subset of patients develops a deafferentation pain that, as discussed previously, can ~’~n:peripheral, central, or mixed  features. The painis [} pically burning, aching, or shocklike(consistent with a pain caused by a neuropathic condition), Treatment is undertaken with anticonvulsants or the tricyclic or other antidepressants, Tramadol, a mild
opiold with mild an idepressant effects, can be a useful adjunct. Local injection of painful sites, sympathetic block, or both is sometimes of value. \fost importantly  .preventive treatment of PH:\ with antivlrals. analgesics,
and frequently corticosteroids very early after rash presentation
can significantly reduce the expression of PHS, A related condition, Ramsay Hunt Syndrome, is a herpes

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Summary  The three classification systems discussed so far are used in conjunction to determine the difficulty

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