By Dr. J.D. Hoppenfeld MD
Fundamentals of soreness Medicine is an important advisor for any general practitioner looking to enhance the standard of ache remedies and sufferers’ comfort.
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- Numerous case examples and commonest remedies, suitable and acceptable to daily medical use
- Step-by-step guideline on office-based procedures
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Extra info for Fundamentals of Pain Medicine: How to Diagnose and Treat your Patients
2-1). The pain of trigeminal neuralgia is most common in the V2 and V3 branches of the trigeminal nerve. It is a sharp, electric pain that radiates deep into the cheek, lips, and tongue, typically on one side of the face. During an attack, any sensory stimuli, even a stream of fastmoving air, may exacerbate the pain. Theories about the cause of trigeminal neuralgia remain controversial. One prevailing theory is that a small blood vessel wrapped around the branches of the trigeminal nerve causes periodic compression, leading to aberrant nerve firing.
The facet joints that link the vertebral bodies posteriorly can hypertrophy, which leads to both central canal and foraminal stenosis (Fig. 2-19). B Figure 2-19 A (axial view): Facet hypertrophy decreasing both central canal and foraminal diameter on the left. The right foraminal diameter is minimally affected. B (oblique view): Facet hypertrophy. indd 28 06/03/14 9:26 PM ChapteR 2 ■ Neuropathic Pain 29 Central herniated disc Minimal decrease in foraminal diameter Figure 2-20 Centrally herniated disc decreasing central spinal canal diameter with minimal effect of foraminal diameter.
The symptoms can be constant or come and go. It is possible to make the pain worse by leaning forward, because this position may put more pressure on the nerve root by further herniating the disc against the nerve root. On examination, the course that the pain travels helps identify which nerve root is affected (Fig. 2-12). The Figure 2-12 Dermatome map. A dermatome is an area of skin that is mainly supplied by a single nerve. indd 24 06/03/14 9:26 PM ChapteR 2 ■ Neuropathic Pain 25 A B C longitudinal extent of the pain appears to be proportional to the amount of pressure exerted on the nerve root,7 thus the further down toward the toes the pain spreads along the nerve root, the more affected it is.