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      Retrospective study to identify trigeminal–cervical ocular referred pain as a new causative entity of ocular pain

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          Abstract

          Purpose

          To determine the prevalence and clinical characteristics of trigeminal–cervical (TC) ocular referred pain.

          Methods

          A retrospective study of 1,680 patients seen during 2002–2010 was performed in an ocular surface specialty center to identify patients with or without TC pain defined as ocular pain with ipsilateral trigger points located at the occipital region. Patients with refractory TC pain despite topical anesthetics and conventional treatments received interventional injection to each trigger point.

          Results

          A total of 81 (4.8%) patients (study group) with TC pain and 241 patients (control group) without TC pain were identified out of the 1,680 patients over an 8 year period. There was no difference in age, gender, prior surgeries, medications, non-pain symptoms, pain laterality, and concomitant ocular diseases between the 2 groups. Multivariate regression analysis showed that patients with TC pain had a significant correlation with persistent deep ocular pain, ipsilateral trigger points ( f 2=99, p<0.001) but not headaches ( f 2=0.09, p=0.5). Injection at the trigger points achieved complete or partial pain resolution with a low recurrence rate in 43 of 45 (96%) patients with TC pain.

          Conclusion

          TC pain defined herein may be a different entity of ocular pain and can indeed be differentiated from other ocular pain by the referral character so that one may avoid mislabeling it as undetermined or as a reason to unnecessarily overtreat concomitant ocular diseases.

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          Most cited references 19

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          The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment

          Chronic pain is currently under-diagnosed and under-treated, partly because doctors’ training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.
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            Autologous Serum Tears for Treatment of Photoallodynia in Patients with Corneal Neuropathy: Efficacy and Evaluation with In Vivo Confocal Microscopy.

            Patients suffering from corneal neuropathy may present with photoallodynia; i.e., increased light sensitivity, frequently with a normal slit-lamp examination. This study aimed to evaluate the efficacy of autologous serum tears (AST) for treatment of severe photoallodynia in corneal neuropathy and to correlate clinical findings with corneal subbasal nerve alterations by in vivo confocal microscopy (IVCM).
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              Sir Charles Sherrington's the integrative action of the nervous system: a centenary appreciation.

               Robert Burke (2007)
              In 1906 Sir Charles Sherrington published The Integrative Action of the Nervous System, which was a collection of ten lectures delivered two years before at Yale University in the United States. In this monograph Sherrington summarized two decades of painstaking experimental observations and his incisive interpretation of them. It settled the then-current debate between the "Reticular Theory" versus "Neuron Doctrine" ideas about the fundamental nature of the nervous system in mammals in favor of the latter, and it changed forever the way in which subsequent generations have viewed the organization of the central nervous system. Sherrington's magnum opus contains basic concepts and even terminology that are now second nature to every student of the subject. This brief article reviews the historical context in which the book was written, summarizes its content, and considers its impact on Neurology and Neuroscience.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                25 July 2017
                : 10
                : 1747-1754
                Affiliations
                [1 ]Ocular Surface Center
                [2 ]Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
                [3 ]Department of Ophthalmology, Ninth People’s Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People’s Republic of China
                Author notes
                Correspondence: Scheffer CG Tseng, Ocular Surface Center, 7000 SW 97th Avenue, Suite 213, Miami, FL 33173, USA, Tel +1 305 274 1299, Fax +1 305 274 1297, Email stseng@ 123456ocularsurface.com
                Article
                jpr-10-1747
                10.2147/JPR.S140895
                5536137
                © 2017 Tseng et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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