Current opinion in otolaryngology & head and neck surgery
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Curr Opin Otolaryngol Head Neck Surg · Jun 2004
ReviewBotulinum toxin and the management of chronic headaches.
There is an increasing number of reports on botulinum toxin in pain therapy, in particular in headache treatment. Therefore, the studies available from reference systems and published congress contributions on the prophylactic treatment of idiopathic and cervicogenic headache with botulinum toxin were analyzed with respect to study design, headache diagnosis, and the significance of results. ⋯ Most open studies and case reports suggest an efficacy of botulinum toxin in headache prophylaxis but double-blind, placebo-controlled studies do not confirm this assumption. Larger controlled studies are needed for a definite evaluation of subgroups that might possibly benefit from such a treatment. Migraine, tension-type headache, and cervicogenic headache cannot be regarded as a general indication for a treatment with botulinum toxin.
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Curr Opin Otolaryngol Head Neck Surg · Jun 2004
ReviewContemporary trends in acute pain management.
In the management of acute pain, the ability to prevent the onset of pain in the immediate postoperative period, lessen its intensity, and interfere with the development of sensitization contributing to hyperalgesia for days following a procedure can greatly benefit the patient, rather than postoperative attempts to decrease pain after it has reached full intensity. ⋯ Careful selection of an effective analgesic regimen can prevent the stress and anxiety associated with acute postoperative pain and breakthrough pain. Pain prevention has greater benefits than attempts at rescue therapy when pain exacerbation occurs. A variety of pain management regimens are presented based on empirical estimates of pain intensity and an application of sound pharmacological principles.