Current pain and headache reports
-
Curr Pain Headache Rep · Feb 2002
ReviewElectroconvulsive therapy in the management of chronic pain.
Electroconvulsive therapy (ECT) is used predominantly to treat major depressive illness but has also been used for chronic pain. ECT causes a variety of neurochemical and neurophysiologic effects, some of which may interact with the pathophysiologic mechanisms in complex pain states. An extensive literature on the use of ECT in pain patients identifies subgroups for whom ECT may result in substantial pain relief. In this article, we review the literature on the use of ECT in pain patients, suggest possible neurobiologic bases for the efficacy of ECT in such patients, and conclude with our recommendations for current clinical practice.
-
Curr Pain Headache Rep · Feb 2002
ReviewWhat predicts evolution from episodic to chronic cluster headache?
Over the last few years, attention has increasingly been focused on the evolution of cluster headache over time. Predictive factors have been identified that are correlated with an increased risk of unfavorable evolution from the episodic form to the chronic form of cluster headache. Late onset, the presence of sporadic attacks, a high frequency of cluster periods, and short-lived duration of remission periods when the headache is still in its episodic form all correlate with a possible worsening of the clinical picture over time. The reasons for evolution of episodic cluster headache to chronic are still unknown, but some factors, such as head trauma and other lifestyle factors--eg, cigarette smoking and alcohol intake--have been suggested as having a negative influence on the course of cluster headache over time.
-
Curr Pain Headache Rep · Feb 2002
ReviewThe psychopharmacologic treatment of depression and anxiety in the context of chronic pain.
Chronic pain afflicts millions of people, commonly causing depression and anxiety. These conditions must be treated to achieve a good functional outcome from pain treatment. ⋯ Antidepressants with noradrenergic and serotinergic activity, and anticonvulsants, which may also stabilize mood, are effective in neuropathic pain. Other medications have limited but important pharmacotherapeutic roles.
-
Curr Pain Headache Rep · Feb 2002
ReviewHow could the validity of the DSM-IV pain disorder be improved in reference to the concept that it is supposed to identify?
This article examines the dilemmas inherent in psychiatry's attempts to incorporate pain disorders into the standard psychiatric nomenclature. Each succeeding Diagnostic and Statistical Manual has broadened the concept of pain disorders, and, gradually, the diagnosis has become increasingly removed from the original idea of "psychogenic pain." The advantage of this broadening has been the increased use of the diagnosis in clinical settings. ⋯ After examining this problem, the article looks at some alternative models, and offers some generalizations regarding the dimensions of the pain experience. The article ends by tentatively offering some suggestions for future approaches to pain diagnoses in psychiatry.
-
This last decade has seen remarkable progress made toward unraveling the mystery of primary headache disorders like migraine and cluster. The vascular theory has been superseded by recognition that neurovascular phenomena seem to be the permissive and triggering factors in migraine and cluster headache. ⋯ Prior to these imaging techniques it was impossible to study the primary headache disorders because these had no structural basis. There is now an increasing body of evidence that the brain is involved primarily in cluster and migraine and that vessel dilatation is an epiphenomenon.