Spotlight on Neurosurgical management of chronic pain

Chronic pain encompasses a spectrum of clinical scenarios involving both peripheral and central pain syndromes. In this article, Dr. Richard Polin of George Washington University discusses the progression of understanding about the pathophysiology of pain, culminating in the gait theory hypothesis.He addresses pain from peripheral nerve injury, spinal cord injury, and brain injury and stroke and discusses the basic science behind the rationale for current management schemes and pain treatments (both pharmacological and surgical).

Also discussed is cervical spinal cord stimulation and the success (or lack thereof) of surgical treatment modalities for chronic pain.

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Spotlight on Carpal tunnel syndrome

Carpal tunnel syndrome is the most common entrapment neuropathy with a prevalence of about 270 per 100,000. The etiology is compression of the median nerve in the carpal tunnel. Clinical manifestations consist of intermittent pain, numbness, and tingling in the fingers that is dependent on the position of the hand and wrist and commonly associated with subjective weakness of grip. Diagnosis is made on the basis of clinical complaints and electrodiagnostic studies. Treatment is conservative or surgical depending on the severity of the symptoms. Data on carpal tunnel syndrome in pregnancy reveal that about half of the patients remain symptomatic at 6 months after delivery. Ultrasound has emerged as a useful and less invasive technique for evaluation of carpal tunnel syndrome. Endoscopic carpal tunnel release supposedly produces less scarring than open release but is more expensive and precludes visualization of the median nerve proper. Controversy continues about which surgical procedure is the best.

In this recently updated article, Dr. Mamatha Pasnoor of the University of Kansas Medical Center and Dr. Mazen Dimachkie, Director of the Neuromuscular Disease Section and the Electromyography Laboratory at the University of Kansas Medical Center discuss updates on diagnosis and management.

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Spotlight on Neuropathic pain: treatment

Treatment of neuropathic pain is an ongoing challenge for clinicians. In this article, Dr. Yi Pan and Dr. Florian P Thomas, both of St. Louis University, summarize pharmacological management based on published clinical trials. Not all medications mentioned in this article have been investigated in placebo-controlled, double-blind, randomized trials. The aim of this article is to provide a variety of updated information so clinicians can choose an optimal treatment for an individual patient.

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Spotlight on Neuropathic pain: treatment

Treatment of neuropathic pain is an ongoing challenge for clinicians. In this clinical summary, Dr. Yi Pan and Dr. Florian P Thomas of St. Louis University summarize pharmacological management based on published clinical trials. Not all medications mentioned in this summary have been investigated in placebo-controlled, double-blind, randomized trials. A new guideline for treating painful diabetic neuropathy was published in 2011. The aim of this summary is to provide a variety of updated information for clinicians to choose an optimal treatment for an individual patient.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Chronic pain


Neurologic pain management is now recognized as a subspecialty of neurology. The ideal management of a chronic pain patient is by a multidisciplinary approach, including disciplines such as internal medicine, neurology, anesthesia, nursing, psychology, pharmacy, rehabilitation medicine, physical therapy, etc. Studies of the molecular basis of pain have provided receptors as targets for analgesic drugs. Gene therapy may be used in the near future as a method of delivery of therapeutic proteins with analgesic effect to the site of action and, thus, avoiding some of the undesirable effects of drugs. Viral vectors, expressing proenkephalin can transduce neurons of the dorsal root ganglion, leading to release of enkephalin from nerve terminals in dorsal horn, and produce analgesic effect.

In this clinical summary, Dr. K K Jain focuses on the evaluation of chronic pain as a symptom and includes discussion of the mechanism, differential diagnosis, diagnostic workup, and general management.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.