Postthoractomy syndrome (PTS) is a multifactorial dis ease process which has never been adequately de scribed. This, in turn, has led to a discrepancy in the literature concerning the signs and symptoms which constitute PTS and what are the most efficacious treat ment modalities that should be used. The most impor tant fact before instituting therapy for PTS, is that recurrent disease must be ruled out. Once this is done, a stepped-treatment regimen can be instituted. Postherpetic neuralgia (PHN) is a disease state which afflicts 10% to 15% of patients who become infected with herpes zoster. At this time, there appears to be no definitive treatment regimen for PHN. However, there are various treatment modalities which can signifi cantly decrease the pain associated with the disease. There seem to be many promising agents undergoing scientific trials, so that a definitive treatment for PHN may soon be available.
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References
1.
Merskey H.: Post-thoracotomy pain syndrome (XVII-14) Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms prepared by the International Association for the Study of Pain, subcommittee on Taxonomy. Pain Suppl 3:S138, 1986.
2.
Jackson K.: Postthoracotomy pain syndromes, in Gravlee and Rauck (eds): Pain Management in Cardiovascular Surgery, Philadelphia, PA , Lippincott, 1993, pp 201-212
3.
Bachiocco V. , Morselli-Labate AM, Rusticali AG, et al: Intensity, latency and duration of post-thoracotomy pain: Relationship to personality traits. FuncNeurol5:321-322, 1990
4.
Dajczman E., Gordon A., Keisman H., et al: Long-term post-thoracotomy pain. Chest99:270-274, 1991
5.
Kanner RM, Martini N., Foley KM: Nature and incidence of post-thoracotomy pain. Proc Am Soc Clin Oncol Abstr1:C-590, 1982
6.
Ferrer-Brechner T.: Practical management of pain, in Raj P (ed): Rationale Management of Cancer Related Pain. Philadelphia, PA, Mosby-Year Book, 1986, pp 312-328
7.
Tanelian DL, Brose WG: Neuropathic pain can be relieved by drugs that are use-dependent sodium channel blockers: Lidocaine, carbamazepine and mexiletine. Anesthesiology74:949-951, 1991
8.
Carlsson CA, Persson K., Pelletieri L.: Painful scars after thoracic and abdominal surgery. Acta Chir Scand151:309-311,1985
9.
Defalque RJ, Bromley Jjo: Poststernotomy neuralgia: A new pain syndrome. Anesth Analg69:81-82, 1989
10.
Vecht CJ, VanderBrand HJ, Wajer Ojm: Post-axillary dissection pain in breast cancer due to a lesion of the intercostal brachial nerve. Pain38:171-176, 1989
11.
Johansson A. , Hao J., Sjolund B.: Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anaesthesiol Scand34:335-338, 1990
12.
Bennett GJ: The role of the sympathetic nervous system in painful peripheral neuropathy . Pain45:221-223, 1991 (editorial)
13.
Glynn CJ, Lloyd JW, Barnard Cjw: Cryoanalgesia in the management of pain after thoracotomy. Thorax35:325-327,1980
14.
Mainwand MO , Makey AR, Rees A.: Cryoanalgesia after thoracotomy: Improvement of technique and review of 600 cases. J Thorac Cardiovasc Surg92:291-295, 1986
15.
Johannesen N., Madsen G., Ahlburg P.: Neurological sequelae after cryoanalgesia for thoracotomy pain relief. Ann Chir Gynaecol79:108-109, 1990
16.
Miguel R., Hubbell D.: Does the postoperative pain relieving technique affect the incidence of postthoracotomy pain syndrome?Anesthesiology75:A763, 1991 (abstr)
17.
Watson Cpn, Evans RJ, Watt VR: The post-mastectomy pain syndrome and the effect of topical capsaicin . Pain38:177-186, 1989
18.
Fusco BM, Alessandri M.: Analgesic effect of capsaicin in idiopathic trigeminal neuralgia. Anesth Analg74:375-377, 1992
19.
Kavanagh BP , Katz J., Sandler AN: Pain control after thoracic surgery: A review of current techniques. Anesthesiology81:737-759, 1994
20.
Katz J., Jackson M., Kavanagh BP, Sandler AN: Acute pain after thoracic surgery predicts long-term post-thoracotomy pain . Clin J Pain12:50-55, 1996
21.
Ragozzino MW , Meltron LJ, Kurland LT, et al: Population based study of herpes zoster and its sequelae. Medicine (Baltimore ) 61:310-316, 1982
22.
De Moragas JM, Kierland RR: The outcome of patients with herpes zoster . Arch Dermatol75:193-196, 1957
23.
Rogers RS III, Tindall JP: Geriatric herpes zoster. Am Geriat Soc19:495-504, 1971
24.
Molin L.: Aspects of the natural history of herpes zoster. A follow-up investigation of outpatient material. Acta Derm Venereol49:569-583, 1969
25.
Hope-Simpson RE: Postherpetic neuralgia. JR Coll Gen Pract25:571-575, 1975
26.
Johnson RW: The future predictors, prevention, and therapy in postherpetic neuralgia . Neurology45:S70-72, 1995 (suppl 8)
27.
Mazur M., Dolin R.: Herpes zoster at the NIH: A 20 year experience. Am J Med65:738-744, 1978
28.
Rifkind D.: The activation of varicella zoster virus infection by immunosuppressive therapy . J Lab Clin Med68:463-474, 1966
29.
Feld R., WK, De EvansBoer G: Herpes zoster in patients with small cell carcinoma of the lung receiving combined modality treatment. Ann Inter Med69:881-885, 1980
30.
Schimpff S. , Serpick A., Stoler B., et al: Varicella zoster infections in patients with cancer. Ann Inter Med76:241-254, 1972
31.
Burgoon CF, Burgoon JS, Baldridge GD: The natural history of herpes zoster. JAMA164:265-269, 1957
32.
Weis O., Swiratanakul K., Weintraub M.: Treatment of postherpetic neuralgia and acute herpetic pain with amitriptyline and prophenazine. S Afr Med J62:274-275, 1982
33.
Boon R., Griffin D.: Efficacy of famciclovir in the treatment of herpes zoster: Reduction of pain associated with zoster. Neurology45:576-577, 1995 (12 suppl 8).
34.
Hope-Simpson RE: The nature of herpes zoster: A long term study and a new hypothesis. Proc R Soc Med58:9-20, 1965
35.
Ragozzino MW , Meltron LJ, Kurland LT, et al: Risk of cancer after herpes zoster: A population based study. N Engl J Med307:393-397, 1982
36.
Niv D., Lang E., Wolman I.: Postherpetic neuralgia: What do we know and where are we heading? Pain Digest8:73-79, 1998
37.
Eaglestein WH, Katz R., Brown JA: The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. JAMA211:1681-1683, 1970
38.
Riopelle JM , Naraghi M., Grush KP: Chronic neuralgia incidence following local anesthetic for herpes zoster therapy. Arch Dermatol120:747-750, 1984
39.
Noordenbos W.: Problems pertaining to the transmission of nerve impulses which give rise to pain. Pain ( Amsterdam) 1:4-10,1959
40.
Melzac R., Wall PD: Pain mechanisms: A new theory. Science1950:971-979, 1965
41.
Choi B., Rowbotham MC: Effect of adrenergic receptor activation on postherpetic neuralgia pain and sensory disturbances. Pain69:55-63, 1997
42.
Baron R., Saguer M.: Mechanical allodynia in postherpetic neuralgia. Evidence for central mechanisms depending on nociceptive C-fiber degeneration. Neurology45:S63-65, 1995 (suppl)
43.
Watson Cpn, Evan RJ, Reed K., et al: Amitriptyline vs. placebo in postherpetic neuralgia. Neurology32:671-673, 1982
44.
Max MB, Schafer SC, Culnane M., et al: Amitriptyline, but not lorazepam, relieves postherpetic neuralgia . Neurology38:1427-1432, 1988
45.
Swerdlow M. : Anticonvulsant drugs and chronic pain. Clin Neuropharmacol7:51-82, 1982
46.
Niv D., Ben-Ari S., Rappaport A., et al: Postherpetic neuralgia-clinical experience with a conservative treatment. Clin J Pain5:295-300, 1989
47.
Sokolowski P.: Capsaicin in pain therapy. Wiad Lek47:527-532, 1994
48.
Litman SJ, Vitkun SA, Poppers RJ: Use of EMLA cream in the treatment of postherpetic neuralgia. J Clin Anesth8:54-57, 1996
49.
Rowbotham MC , Davies PS, Verkempinck C., et al: Lidocaine patch: Double-blind controlled study of a new treatment method for postherpetic neuralgia . Pain65:39-44,1996
50.
De Benedittis G., Lorenzetti A.: Topical aspirin/diethyl ether mixture versus indomethacin and diclofenac/ diethyl ether mixtures for acute herpetic neuralgia and postherpetic neuralgia: A double-blind, crossover, placebo controlled study. Pain65:45-51, 1996
51.
Jessell TM, Iverson LL, Cuello AC: Capsaicin-induced depletion of substance P from primary sensory neurons . Brain Res152:132-188, 1978
52.
Watson N., Evans RJ, Watt VR, et al: Postherpetic neuralgia and topical capsaicin. Pain33:333-340, 1988
53.
Stow PJ, Glynn CJ, Minor B.: EMLA cream in the treatment of post herpetic neuralgia. Efficacy and pharmacokinetic profile. Pain39:301-305, 1989
54.
Rowbotham MC , Davies PC, Fields HL: Topical lidocaine gel relieves postherpetic neuralgia. Ann Neurol37:246-253, 1995
55.
Eide K., Stubhaug A., Oye I., et al: Continuous subcutaneous administration of the NMDA receptor antagonist ketamine in treatment of postherpetic neuralgia. Pain61:221-228,1995
56.
Eide K., Jorum E., Stubhaug A., et al: Relief of postherpetic neuralgia with the NMDA receptor antagonist ketamine: A double-blind, crossover comparison with morphine and placebo. Pain58:347-354, 1994
57.
Saiki M., Kondo A., Kinuta Y., et al: Treatment of intractable postherpetic neuralgia and blepharospasm: Intra-neural injection of adriamycin. No Shinkei Geka23:125-130, 1995
