Current pain and headache reports
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Curr Pain Headache Rep · Feb 2001
ReviewThe role of the dorsal column pathway in visceral nociception.
Neurosurgeons have successfully used punctate midline myelotomy to relieve visceral cancer pain in human patients. Animal experiments demonstrate a visceral nociceptive pathway in the posterior column that is more effective than the spinothalamic tract in activating thalamic neurons, eliciting behavioral responses and triggering increases in regional cerebral blood flow. This visceral nociceptive pathway involves postsynaptic dorsal column neurons in the central, visceral processing region of the spinal cord. Axons from the sacral cord ascend near the midline and from the thoracic cord at the junction of the gracile and cuneate fasciculi.
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Cluster headache is an uncommon yet well-defined neurovascular syndrome occurring in both episodic and chronic varieties. The most striking feature of cluster headache is the unmistakable circadian and circannual periodicity. Inheritance may play a role in some families. ⋯ Transitional prophylaxis involves the short-term use of either corticosteroids or ergotamine derivatives. The cornerstone of maintenance prophylaxis is verapamil, yet methysergide, lithium, and divalproex sodium may also be employed. In some patients, melatonin or topiramate may be useful adjunctive therapies.
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Curr Pain Headache Rep · Feb 2001
ReviewGender differences and hormonal modulation in visceral pain.
Women seek healthcare and are diagnosed more frequently with chronic somatic and visceral pain conditions relative to men. These conditions tend not to be life-threatening disorders, but rather ones that decrease people's quality of life, impinge on work and recreational activities, and increase healthcare resource utilization. With increased awareness of basic gender differences in biology and responsiveness to therapies, there has been renewed interest in factors which may account for the gender disparity in chronic visceral pain conditions. Basic and clinical evidence primarily from patients with irritable bowel syndrome has provided initial insights into visceral pain sensitivity, perception, and responsitivity.
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Patients with chronic pelvic pain are usually evaluated and treated by gynecologists, gastroenterologists, urologists, and internists. In many patients with chronic pelvic pain the examination and work-up remain unrevealing and no specific cause of the pain can be identified. In these cases it is important to recognize that pain is not only a symptom of pelvic disease, but that the patient is suffering from a chronic pelvic pain syndrome. ⋯ This article outlines treatment options currently available. Despite the challenge inherent in the management of chronic pelvic pain, many patients can be treated successfully using a multidisciplinary pain management approach. The first important step is to recognize that patients with chronic pelvic pain might suffer from a chronic visceral pain syndrome.