Current pain and headache reports
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Curr Pain Headache Rep · Aug 2002
ReviewPeripheral and central sensitization in fibromyalgia: pathogenetic role.
Characteristic symptoms of fibromyalgia syndrome include widespread pain, fatigue, sleep abnormalities, and distress. Patients with fibromyalgia show psychophysical evidence of mechanical, thermal, and electrical hyperalgesia. Peripheral and central abnormalities of nociception have been described in fibromyalgia. ⋯ They include sensitization of vanilloid receptor, acid-sensing ion channel receptors, and purino-receptors. Tissue mediators of inflammation and nerve growth factors can excite these receptors and cause extensive changes in pain sensitivity, but patients with fibromyalgia lack consistent evidence for inflammatory soft tissue abnormalities. Therefore, recent investigations have focused on central nervous system mechanisms of pain in fibromyalgia.
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Myofascial pain is a common cause of regional chronic pain. Myofascial trigger points can refer pain to the head and face in the cervical region, thus contributing to cervicogenic headache. When identified properly, cervical myofascial pain is a treatable component of headache management. This article reviews current literature on the pathophysiology, diagnosis, and management of cervical myofascial pain.
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Curr Pain Headache Rep · Aug 2002
ReviewCervicogenic headache: interventional, anesthetic, and ablative treatment.
Cervicogenic headache is becoming an accepted clinical syndrome in which headache pain is thought to originate from the cervical spine. Unfortunately, there are no diagnostic imaging techniques of the cervical spine and associated structures that can determine the exact source of pain. ⋯ This suggests that consistent reproducible anatomic and neurophysiologic pathways exist for the reproduction of typical clinical pain patterns and the ability of neuroblockade to consistently interrupt these pain pathways. This article describes the essential anatomy required to understand the use of diagnostic nerve blocks, and their predictive value in anticipating response to neuroablative and interventional therapy with a review of the major interventional, anesthetic, and ablative techniques for cervicogenic headache.
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The use of botulinum toxin for movement disorders and cosmesis led to an accidental discovery of its beneficial effect on headaches. Extensive anecdotal evidence and several controlled trials suggest that intermittent and chronic migraines and chronic tension headaches may respond to this treatment. The effect of a single treatment, which is simple to administer, can last for 3 months. ⋯ Prophylactic pharmacotherapy of migraine headaches is limited in its efficacy and has a potential for systemic side effects. This makes botulinum toxin a preferred treatment for many patients. The large controlled trials that are underway may lead to a wider acceptance of this treatment by neurologists and pain specialists.
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Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by diffuse pain and tender points, which have been present for more than 3 months. Many patients with systemic illnesses can have diffuse pain similar to that found in fibromyalgia, including rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and joint hypermobility. ⋯ In addition, there has been interest throughout the past 10 years in infectious diseases including hepatitis C, Lyme disease, coxsackie B, HIV, and parvovirus infection, which may cause or trigger fibromyalgia. This paper provides a framework to use when identifying these diseases as part of the evaluation of a patient with chronic widespread musculoskeletal pain.