Pain physician
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The clinical introduction of cortisone in 1949 revolutionized medical care of patients with a host of diseases. Soon after that, the first use of steroids in epidural injections was described in 1952 and 1953. A variety of corticosteroid agents (hydrocortisone, methylprednisolone, triamcinolone, betamethasone) have been applied neuraxially to treat spinal pain and other types of painful conditions. ⋯ These include neural toxicity, separation of pituitary-adrenal axis, weight gain, osteoporosis, as well as many other complications. However, a review of the literature on epidural steroids or other types of neuraxial blockade mentions very few complications that can be directly attributed either to the chemistry or the pharmacology of the steroids, except for reports of adrenal suppression. This review describes various aspects of neuraxial steroids including historical concepts, mechanism of action, pharmacological aspects, side effects, complications and their role in treatment.
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Chronic headache is a significant medical and socioeconomic problem resulting in severe disability and impairment. The term "cervicogenic headache" was coined by Sjaastad in 1983, who also proposed criteria for its diagnosis. Cervicogenic headache as described by Sjaastad et al is characterized as recurrent, long lasting, severe unilateral headache arising from the neck. ⋯ Because of the numerous potential pain generators, neither uniform clinical findings, nor a pathophysiology has been defined for the entity known as cervicogenic headache. Sequential diagnostic injections may elucidate pain generators and differentiate it from other types of headaches. This review describes the epidemiological and clinical aspects of cervicogenic headache, pathophysiology, diagnostic strategies to differentiate it from other common headaches and describes various non-operative treatment strategies.