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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case is described in which trigeminal neuralgia was controlled primarily by a programme of mandibular relaxation. The symptoms and the success of the management were consistent with the hypothesis that trigeminal neuralgia is caused by chronic compression of the trigeminal nerve and surrounding tissues in the vicinity of the temporomandibular joint. The triggering of attacks appears to be a result of stimulation of individual pain receptors associated with neurons in which transmission thresholds have been reduced by cumulative nerve damage. Extracranial and systemic trigger factors, of cervical and abdominal origin, are described. The conservative management involved mandibular relaxation, avoidance of flatulence and constipation, occasional use of an acrylic occlusal splint, and when necessary, use of Dilantin in prescribed amounts.
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PMID:Trigeminal neuralgia: induced remission without surgery, and observations on its aetiology. 93 71

The treatment of tic douloureux was dramatically altered in 1962 with the demonstration that carbamazepine (Tegretol(R)) alone or in combination with diphenylhydantoin sodium (Dilantin(R)) was effective in controlling the painful paroxysms. However, 30 percent of the patients so treated have not been successfully managed and some type of surgical therapy is required to control their pain. A wide variety of surgical alternatives are available but they all trade a sensory deficit for pain relief and have a significant risk of morbidity and mortality. Experience with percutaneous radiofrequency trigeminal gangliolysis has indicated that this new technique is capable of producing lasting relief of tic douloureux in as many as 95 percent of the patients. To date there have been no deaths from this procedure and a very low incidence of minor complications. It achieves this high success rate at the expense of only partial sensory deficits restricted to a circumscribed area of the face. No other surgical alternative carries such a high long-term success rate with a low complication rate. We believe that percutaneous radiofrequency trigeminal gangliolysis has become the surgical treatment of choice for tic douloureux.
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PMID:Percutaneous radiofrequency trigeminal gangliolysis in the treatment of tic douloureux. 127 35

The safety and efficacy of administering individualized phenytoin sodium loading doses by intravenous infusion were studied on 40 occasions in 37 adult patients having seizures. Doses were calculated based on an average volume of distribution (0.75 L/kg) and desired plasma phenytoin concentration. Total and free phenytoin concentrations were determined before and after the infusion. Phenytoin sodium doses of 225-1300 mg were administered by intravenous infusion at a rate of 40 mg/min after dilution in 0.9% sodium chloride injection to concentrations ranging from 4.5 to 13.5 mg/mL. Infusion rates were reduced if adverse effects occurred. The dosing method accurately achieved desired phenytoin concentrations (predicted mean +/- S.D. concentration, 18.3 +/- 1.6 micrograms/mL; observed mean concentration, 17.4 +/- 2.5 micrograms/mL). Postinfusion concentrations of free phenytoin ranged from 0.8 to 3.6 micrograms/mL (mean +/- S.D., 1.7 +/- 0.6 micrograms/mL). Of 21 patients evaluated for efficacy, 16 responded. A total of 45% of patients experienced pain at the infusion site, which diminished when the infusion rate was reduced. No serious cardiovascular or neurological toxicities occurred. The intravenous infusion method of administration is safe and effective and is useful for rapid achievement of therapeutic phenytoin concentrations in the emergency room setting.
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PMID:Efficacy of individualized phenytoin sodium loading doses administered by intravenous infusion. 335 18

Dilantin had been shown to reduce the post-tetanic potentiation (PTP). The aim of the present study was to study the role of the PTP in the long-term memory. Dilantin in a dose of 16 and 32 mg/kg did not effect the realization of defensive reflexes to a conditioned stimulus (CS, light flashes) in alert non-immobilized rabbits. A week disinhibition of movements in response to the combination of the light flashes with continuous illumination (conditioned inhibition, CI) took place. Similarity of responses to CS and its combined action with the pain reinforcement did not change in most of the neurons under study and was enhanced in some of them. Distinction between responses of most neurons to CS and CI did not disappear but in some of them became less expressed. The data obtained imply that PTP does not play a decisive role in the long-term memory storage.
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PMID:[The effect of dilantin on the neuronal reactions of the visual cortex and on the behavior of rabbits during learning]. 817 4

Glossopharyngeal neuralgia with syncope, secondary to a malignant tumor in the neck, is an extremely rare condition. Dysman, et al more recently described a case in 1980. In this case, it was initially difficult to confirm the proper diagnosis since recurrent tumor was not able to be detected either clinically or radiographically. The patient was initially treated as syncope due to hypotension and bradycardia, but pacemaker therapy failed to control the cardiovascular abnormality. The administration of Dilantin, however, seems to improve the neuralgic pain and syncope. Due to a poor prognosis from the neck tumor recurrence, and patient refusal of further therapy, no surgical control of symptoms was attempted in this patient. This report is presented to make otolaryngologists aware of this condition.
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PMID:Glossopharyngeal neuralgia and syncope secondary to neck malignancy. 844 96

Cancer patients suffer multiple symptoms and require numerous drug therapies. Parenteral administration of multiple medications from a single container can simplify drug regimens for patient self-administration. This simplification reduces drug preparation costs and risk of infection. Therapeutic options are limited by the lack of published information on the compatibility of opioids and adjuvant drugs. We report the results of a study evaluating the physical compatibility of injectable opioids with selected drugs for pain and symptom management. Fentanyl citrate, hydromorphone hydrochloride, methadone hydrochloride, and morphine sulfate solutions were physically compatible with 14 of 15 supportive care drugs tested through visual examination using a high intensity light beam and through measured examination using a turbidimeter over a range of times up to 48 hr. Phenytoin sodium was the only drug found to be incompatible with all opioid solutions tested. This compatibility information will assist clinicians in selecting the most efficient, safe, and cost-effective supportive care drug regimen.
J Pain Symptom Manage 1996 Sep
PMID:Combined administration of opioids with selected drugs to manage pain and other cancer symptoms: initial safety screening for compatibility. 880 80

Older generation antiepileptic drugs like Phenobarbital (Luminal), carbamazepine (Tegretol), phenytoin (Dilantin), and valproic acid (Depakote) have several shortcomings such as suboptimal response rates, significant adverse effects, several drug interactions, and a narrow therapeutic index. New antiepileptic drugs have been developed in the last decade to overcome some of these problems. These newer generation antiepileptics like felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), tiagabine (Gabitril), topiramate (Topamax), and zonisamide (Zonegran) have better tolerability profiles, low interaction potential, and significantly less enzyme inducing or inhibiting properties. As the use of antiepileptic drugs has expanded to include treatment of neuropathic pain, newer side effects have been reported. In addition to the common side effects of antiepileptic drugs, like dizziness, drowsiness, and mental slowing; other side effects like weight gain, metabolic acidosis, nephrolithiasis, angle closure glaucoma, skin rash, hepatotoxicity, colitis, and movement and behavioral disorders, to name a few, have been brought to our attention. This review is an attempt to highlight the features and incidences of some of these side effects.
Pain Pract 2004 Sep
PMID:Side effects of antiepileptics--a review. 1717 1