Current pain and headache reports
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Chronic low back pain is one of the most common ailments in modern medicine, with as many as 79% of patients with acute pain continuing to suffer with chronic or recurrent low back pain 1 year after its onset. Lumbar epidural fibrosis and post-lumbar laminectomy syndrome are increasingly recognized as being responsible for persistent low back pain. ⋯ Epidural adhesiolysis with myeloscopy is an interventional technique based on the premise that the three-dimensional visualization of the contents of the epidural space provides the physician with the ability to directly visualize the structures, perform appropriate adhesiolysis, and administer drugs specifically to the target. This review describes pathophysiologic aspects, purposes and goals, rationale and indications, complications, and effectiveness of epidural lysis of adhesions with myeloscopy.
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Curr Pain Headache Rep · Dec 2002
ReviewPsychiatric comorbidity in chronic daily headache: pathophysiology, etiology, and diagnosis.
Chronic daily headache is a challenge for clinical practitioners and researchers. Etiology, pathophysiology, diagnosis, treatment, and prognosis of chronic daily headache present many questions that need answers. ⋯ Psychiatric comorbidity seems to be cross-related to each of these dimensions, although the meanings need to be drawn. Each domain is discussed, considering the status of knowledge and stressing the future lines of research.
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Curr Pain Headache Rep · Dec 2002
ReviewProphylaxis for chronic daily headache and chronic migraine with neuronal stabilizing agents.
Approaches to acute and prophylactic migraine and headache treatment are evolving as our understanding of some of the underlying pathophysiology improves. This article focuses on the emerging use of medications originally introduced for the treatment of seizures (anticonvulsants) as primary therapy for eradicating or reducing migraine and chronic daily headaches. A more accurate term for their pharmacologic mechanisms, if they are used to treat headaches and pain disorders, is neuromodulating or neuronal stabilizing agents. This term refers to their many cellular actions to reduce pain transmission supraspinally, in the spinal cord, and in the brainstem.
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Curr Pain Headache Rep · Dec 2002
ReviewDrug infusions for the diagnosis and treatment of chronic pain.
Diagnostic infusion therapy has several advantages over other routes of drug administration in the management of chronic pain. Although systemic side effects may occur, the procedure is relatively noninvasive and is generally well tolerated by patients. ⋯ This article reviews the scientific and clinical background behind the major classes of drugs used in diagnostic infusion testing, namely local anesthetics, opioids, and a-adrenergic blockers. Clinical application of these agents in the management of chronic pain also is outlined.
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Curr Pain Headache Rep · Dec 2002
Case ReportsAcupuncture in pain medicine: an integrated approach to the management of refractory pain.
As the acupuncture nomenclature permeates medical literature, the artificial barriers to integration of acupuncture and allopathic medicine are disappearing. More patients are looking to their physicians for guidance on how to incorporate acupuncture into their health care, and pain physicians are accepting the challenge. ⋯ Used in an integrated medical model, acupuncture is well suited to deal with many of the functional problems that allopathic medicine is not equipped to address. The result is patient and physician satisfaction.