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Analgesic effect of tocainide in neuralgia
EFFECTS OF CONDITIONING VIBRATORY STIMULATION IN EXPERIMENTA AND CLINICAL ORO-FACIAL PAIN. A. Ekblom and P. Hansson, Department of Physiology II, Karolinska Institutet, Box 60400, S 104 01 Stockholm, Sweden. Aim: In the present study we compare and quantify the pain reducing effa of different frequencies of vibratory stimulation and placebo in experimental and clinical pain in subjects suffering acute oro-facial pain. Methods: 25 subjects suffering acute oro-facial pain following operative remm teeth participated. Clinical pain was measured using a visual analogue scale and a graphic rating scale (GSR) permitting continous induced pain (noxious heat) registration of perceived pain. Experimentally applied to facial skin was produced using a pair of Peltier elements feedback controlled from a thermocouple measuring facial skin tmeperature. Pain was recorded using GSR. Influence of extraorally applied vibratory stimulation for 30 minutes at 10, 100 and 200 Hz and placebo stimulation was studied on both clinical and experimental pain. Results: Vibratory stimulation at 100 Hz was most effective in reducing botli?@Zmental and clinical pain. Post conditioning effects on experimental pain did not last for more than 15-30 min following cessation of vibratory stimulation although clinical pain was depressed or abolished for 1 to 12 hours. Conclusions: Clinical pain is more effectively suppressed and at a longer time scale compared with experimental pain. Differencies may be due to different spatio-temporal nerve impulse patterns in experimental versus clinical pain with concomittant differencies in susceptability to peripheral afferent conditioning stimulation.
ANALGESIC EFFECT OF TOCAINIDE IN NEURALGIA. U Lindblom and P LindstrGm*, Department of Neurology, Karolinska Hospital,[ %i!$";' 1 Box 60500, S-104 01 Stockholm, Sweden. Introduction: It has been demonstrated that lidocaine, given intravenously, can block the pain in trigeminal neuralgia (Kugelberg, E and Lindblom, U, J Neurol, Neurosurg and Psych 1959, 22, 36-43). This may be analogous to the wellknown analgesic effect of anticonvulsive drugs in tic douloureux and some other conditions with paroxysmal neuralgia since lidoCaine has an antiepileptic action (Bernhard, C G & Bohm, E, Local Anaesthetics as Anticonvulsants, Almqvist & Wiksell, Uppsala, 1965). Unfortunately lidocaine can not be administered orally or for long term treatment because it is quickly metabolised. Recently, tocainide (TonocardR), a derivative of lidocaine with long action and excellent bioavailability on oral medication, was introduced as a cardiac antiarrhytmicum. It was of obvious interest to try this drug also in tic douloureux as well as in other types of neuralgia. Methods and results: Tocainide, 400 mg t i d was given to five patients with tic douloureux in an open pilot study. The disease was in an active stage which required medication. All patients reported pain relief comparable to that of carbamazepine and less side effects. A positive effect was also observed in two of three patients with causalgia. No pain relief was obtained in three cases with postherpetic neuralgia. Conclusion: Tocainide may offer an alternative treatment in tic douloureux and possibly in some other types of neuralgia. A double blind study has been started for further documentation which will be presented at the Congress. It is hypothesised that tocainide acts by blocking Na+ channels which may be formed in excess in the pathogenetic foci.
ANALGESIC EFFECT OF TOCAINIDE IN NEURALGIA. U Lindblom and P LindstrGm*, Department of Neurology, Karolinska Hospital,[ %i!$";' 1 Box 60500, S-104 01 Stockholm, Sweden. Introduction: It has been demonstrated that lidocaine, given intravenously, can block the pain in trigeminal neuralgia (Kugelberg, E and Lindblom, U, J Neurol, Neurosurg and Psych 1959, 22, 36-43). This may be analogous to the wellknown analgesic effect of anticonvulsive drugs in tic douloureux and some other conditions with paroxysmal neuralgia since lidoCaine has an antiepileptic action (Bernhard, C G & Bohm, E, Local Anaesthetics as Anticonvulsants, Almqvist & Wiksell, Uppsala, 1965). Unfortunately lidocaine can not be administered orally or for long term treatment because it is quickly metabolised. Recently, tocainide (TonocardR), a derivative of lidocaine with long action and excellent bioavailability on oral medication, was introduced as a cardiac antiarrhytmicum. It was of obvious interest to try this drug also in tic douloureux as well as in other types of neuralgia. Methods and results: Tocainide, 400 mg t i d was given to five patients with tic douloureux in an open pilot study. The disease was in an active stage which required medication. All patients reported pain relief comparable to that of carbamazepine and less side effects. A positive effect was also observed in two of three patients with causalgia. No pain relief was obtained in three cases with postherpetic neuralgia. Conclusion: Tocainide may offer an alternative treatment in tic douloureux and possibly in some other types of neuralgia. A double blind study has been started for further documentation which will be presented at the Congress. It is hypothesised that tocainide acts by blocking Na+ channels which may be formed in excess in the pathogenetic foci.