Trigeminal neuralgia and endorphins

$259 TRIGEMINAL NEURALGIA AND ENDORPHINS. G. Salar, S. Mingrino + 316 S l i d e Department of Neurosurgery, University of Padua, Padua 35100 FriTheQtre16:00C J! Italy. Aim of i n v e s t i g a t i o n : Pathogenetic factors in trigeminal neuralgia (TN)are not already well known. As some pain mechanisms seem to be correlated to en dogenous morphine-like substances, i t was our purpose to v e r i f y a similar c o r r e l a t i o n between endorphins (E) and essential TN. Methods: CSF endorphin levels were examined in 12 patients with TN; in 6 of them the pain was controlled by a pharmacological treatment with carbama zepine. The other 6 had pain attacks and received no drug. Further CSF samples were examined in all patients to evaluate the E,levels af t e r selective percutaneous Gasserian ganglion thermocoagulation; in all cases pain simptomatology disappeared completely a f t e r the surgical treatment. Results were compared with CSF E. levels in 7 normal subjects without pain problem and in 9 patients with cancer pain at d i f f e r e n t s i t e . Results: Non s t a t i s t i c a l l y s i g n i f i c a n t difference betv,een CSF E. levels in trigeminal patients under drug treatment and those receiving no therapy was noted. Similar results were observed comparing patients with IN and normal subjects. Patients suffering of chronic cancer pain seem to have lower CSF E. levels than normal subjects and those affected by TN. Conclusion: As no clear difference between CSF E. levels of patients suffering of TN and normal subjects was found in the present research, i t is our opinion that the ethiopathogenesis of TN is not surely correlable to endogenous morphine-like substances. PAINFUL

ANUS

317 Slide Fri 16:15 Theatre C

SYNDROME.

R.A.Boas, Pain Clinic, A u c k l a n d Hospital, N e w Zealand.

A survey of 300 p a t i e n t s who u n d e r w e n t ano rectal e x c i s i o n r e v e a l e d that 12% d e s c r i b e s u b j e c t i v e anal s e n s a t i o n s a s s o c i a t e d w i t h severe pain or d i s c o m f o r t in the absence of local disease. The features of their p r e s e n t a t i o n and the t r e a t m e n t of several cases in the pain clinic suggest a syndrome of p h a n t o m anus may be r e l a t i v e l y common after this type of surgery. The salient features are: i. Onset soon after surgery. 2. Tight, pressure, b u r s t i n g s e n s a t i o n felt in the anus. 3. Severe aching or b u r n i n g pain in nearly half of the cases. 4. Pain and d i s c o m f 6 r t from h a r d seating but 25% claim pain w i t h tiredness or o c c u r r i n g spontaneously. 5. Rest and the use of soft cushions give relief but s t a n d a r d analgesics have little effect. 6. Best relief o b t a i n e d w i t h anti e p i l e p t i c agents. The syndrome of P h a n t o m Anus and a s s o c i a t e d d i a g n o s i s and m a n a g e m e n t w i l l be presented.

pain,

its

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