The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Sep 2000
ReviewCervicogenic headache: mechanisms, evaluation, and treatment strategies.
Cervicogenic headache is a chronic, hemicranial pain syndrome in which the sensation of pain originates in the cervical spine or soft tissues of the neck and is referred to the head. The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibers in the descending tract of the trigeminal nerve converge with sensory fibers from the upper cervical roots. This convergence of nociceptive pathways allows for the referral of pain signals from the neck to the trigeminal sensory receptive fields of the face and head as well as activation of the trigeminovascular neuroinflammatory cascade, which is generally believed to be one of the important pathophysiologic mechanisms of migraine. ⋯ Diagnostic criteria have been established for cervicogenic headache, but presenting characteristics of this headache type may be difficult to distinguish from migraine, tension-type headache, or paroxysmal hemicrania. This article reviews the clinical presentation of cervicogenic headache, its proposed diagnostic criteria, pathophysiologic mechanisms, and methods of diagnostic evaluation. Guidelines for developing a successful multidisciplinary pain management program using medication, osteopathic manipulative treatment, other nonpharmacologic modes of treatment, and anesthetic interventions are presented.
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J Am Osteopath Assoc · Jun 2000
Opinions and reactions of physicians in New Jersey regarding the Oregon Death with Dignity Act.
Physician-assisted suicide (PAS) was legalized in Oregon in 1997. In the study reported here, the authors surveyed a sample of New Jersey physicians with regard to Oregon's Death with Dignity Act and to whether similar legislation should be enacted in New Jersey. A 49-item questionnaire was sent to 563 physicians in New Jersey who were licensed in the specialties of family practice, internal medicine, surgery, psychiatry, and obstetrics/gynecology. ⋯ However, only 47% of respondents indicated that they believed PAS to be consistent with the role of a physician to relieve pain and suffering. Slightly more than half of respondents indicated that they would refuse to participate in PAS and were concerned about issues such as professional and personal liability and the potential for abuse. Physicians in New Jersey will require additional information, education, and discussion of the ethical and legal implications of PAS before a law similar to that in Oregon could be proposed or considered.
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Multiple sclerosis is a common neurologic disorder that often affects the genitourinary system. One of the most common symptoms of multiple sclerosis is the hyperactive bladder. ⋯ Fortunately, the neurogenic bladder dysfunction associated with multiple sclerosis can be treated with a reasonable chance of success. With proper treatment, related symptoms may be brought under control, allowing the physician to concentrate on the more debilitating aspects of this disease.