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WHAT'S
NEW -- November 1998
Treatment
to Alleviate Pain of Chronic Shingles
A novel treatment for postherpetic neuralgia has been shown
to alleviate the pain of chronic shingles in a majority of
sufferers. A TOPICAL LIDOCAINE PATCH has been studied in the
United States at the University of Washington School of Medicine
and University of California San Francisco School of Medicine.
The patches are applied directly to the painful region on
a daily basis where they work directly on the damaged nerves
underlying the painful skin. A significant advantage to these
patches is that no significant amount of lidocaine enters
the bloodstream. Patients have been using the patches successfully
for up to 5 years. The TOPICAL LIDOCAINE PATCH is manufactured
by Hind Health Care, Inc. (San Jose, California) and is pending
FDA approval.
 
Pain
Treatment -- Efficacy of Homeopathic Arnica 30X
A well-controlled study assessed the efficacy of HOMEOPATHIC
ARNICA 30X for the treatment of muscle soreness pain associated
with long-distance running. The placebo controlled drug trial
was completed by 400 runners. The study concluded that this
homeopathic remedy was ineffective and not better than placebo.
Vickers et al. Clin J Pain 1998;14:227-231
Health
Care Professionals: Articles on Understanding Pain
A recent article in the journal "Neurology" described
the pathological study of muscles, nerves, and blood vessels
from limbs of persons with severe chronic Complex Regional
Pain Syndrome (Reflex Sympathetic Dystrophy). The results
of this small study demonstrated consistent changes in the
muscles which appeared to be due to ischemia (not enough oxygen),
similar to changes seen in some patients with diabetes. To
the investigators' surprise, no consistent changes were seen
in these patients' peripheral nerves. While very interesting,
this study needs to be put in proper perspective. First, these
patients were not typical CRPS patients, but rather had severe
refractory disease--which is not common. Second, while the
investigators looked closely for "structural abnormalities",
i.e., changes that can be seen by microscopy, they did not
evaluate changes in neurochemicals, abnormal connections made
between nerves, nor alterations in the central nervous system
(spinal cord and brain).
Van der Laan et al. Neurology 1998;51:20-25
A very interesting and thought-provoking article was recently
published by pain psychiatrist and philosopher, Mark Sullivan,
MD, Ph.D. In his article "The Problem of Pain in the
Clinicopathological Method", he points out that the vast
majority of symptoms that bring patients to a doctor does
not result in a "tissue diagnosis." In other words,
in only one in five patients is a doctor able to make a definite
diagnosis, even after the doctor completes a medical history,
performs a physical examination, and obtains the results of
laboratory testing. Yet doctors are still trained, as Dr.
Sullivan states, "to be search-and-destroy engines for
disease." When assessing and assisting a person in pain,
the physician must not rely only on currently available methods
to "find the source of the pain" before treatment
is offered. The physician must not divide pain into "organic"
and "nonorganic." The physician must be a scientist
but not forget the art of healing. This poignant and well-written
article is a must for physician and patient alike.
Sullivan M. Clinical Journal of Pain 1998;14:201
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