The Clinical journal of pain
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It is well established that multiple influences regulate cerebral blood flow; the overwhelming evidence continues to suggest that migraine is a disorder, albeit temporary, of cerebral hemodynamics. Thus, the classical theory of migraine is no longer tenable as viewed strictly and rigidly. Perhaps it would be easier to say that the migraine's aura is characterized by reduction in blood flow, often hemispheric, and that sometime during the headache phase cerebral hyperperfusion occurs. ⋯ The blood flow changes do not necessarily correlate with the patient's symptoms. Thus, even now, migraine and other vascular headaches remain as descriptive diagnoses. The final pathology of migraine remains to be determined.
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Comparative Study
Acupuncture treatment in epicondylalgia: a comparative study of two acupuncture techniques.
The purpose of this study was to compare the pain-alleviating effect of classical acupuncture with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, two to three times weekly with 10 treatments in all. ⋯ No such differences could be observed at the follow-ups after 3 months and 1 year. This study showed that classical "deep" acupuncture is superior to superficial needle insertion in the short-term symptomatic treatment of lateral epicondylalgia, but not at 3- and 12-month follow-up.
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A postal survey aimed at studying the prevalence of chronic pain and the need for care because of pain was carried out in a representative sample of a Swedish population. A random sample of the study population has been interviewed and assessed clinically to determine whether a questionnaire method gives the same results as clinical assessment. ⋯ By creating questions more independent of language habits and values, it was shown that it is possible to get better agreement between different descriptions. The best agreement was shown when answers to questions regarding different dimensions of pain were combined in a model for selecting individuals with more serious pain problems.
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The causes, diagnostic features, and therapy of chronic spinal arachnoiditis are reviewed. Two unexpected results from attempted epidural injections (one of lignocaine and clonidine, and one of lignocaine, clonidine, and morphine) in patients with this condition are described. The anatomical abnormalities of the epidural and subarachnoid spaces in such patients and the consequent unpredictable and potentially dangerous results that may follow drug injection into these spaces are discussed.
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Case Reports
Headache in acromegaly: dramatic improvement with the somatostatin analogue SMS 201-995.
Two acromegalic patients with severe headache, persisting after pituitary adenomectomy followed by radiotherapy in one, were treated with the somatostatin analogue SMS 201-995. Both had been resistant to conventional headache therapy and experienced dramatic and rapid relief after the first injection of the analogue. This result persisted with long-term treatment of the drug. Although the mechanism of action of SMS 201-995 in pain remains unclear, the rapid and efficacious analgesic effect of this compound may be one more indication for its use in pituitary tumors associated with cephalalgias.