Current pain and headache reports
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Curr Pain Headache Rep · Feb 2003
ReviewTargeted topical peripheral analgesics in the management of pain.
The term "targeted peripheral analgesics" has been developed to describe analgesics whose mechanism of action appears to be primarily through reducing pain transmission within the peripheral nervous system. Key differences between targeted peripheral and systemic analgesics and the difference between topical and transdermal analgesics are discussed. A review of the clinical conditions that have reportedly responded to targeted peripheral analgesics is described in detail in this article.
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Recent discoveries in opioid pharmacology help explain the enormous variability in clinical responses to these powerful analgesics. Although there is only one m opioid receptor gene, splice variants of that gene's expression result in a panoply of different functioning receptors. Other sources of variable response include polymorphisms in the m opioid receptor regulatory region, and pharmacokinetic differences because of cytochrome P-450 mono-oxygenase heterogeneity. ⋯ Among them are the N-methyl-D-aspartate receptor, protein kinase C gamma activity, nitric oxide synthase, and GM1 ganglioside content of the neuronal membrane. Clinical studies undercut the routine use of meperidine in most settings. Other studies have shown better ways to diminish opioid side effects.
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Curr Pain Headache Rep · Feb 2003
Review Comparative StudyAnticonvulsants for the treatment of neuropathic pain syndromes.
This article is an evidence-based summary of randomized clinical trials published in peer-reviewed journals regarding the efficacy of anticonvulsants for the treatment of neuropathic pain.
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Curr Pain Headache Rep · Feb 2003
Review Comparative StudyErgotamine and dihydroergotamine: a review.
The ergot alkaloids were the first specific antimigraine therapy available. However, with the advent of the triptans, their use in the treatment of migraine has declined and their role has become less clear. This review discusses the pharmacology, efficacy, and safety of the ergots. ⋯ Ergotamine is still widely used in some countries for the treatment of severe migraine attacks. It is generally regarded as a safe and useful drug if prescribed for infrequent use, in the correct dose, and in the absence of contraindications; however, safer and more effective options do exist in the triptans. In patients with status migrainous and patients with frequent headache recurrence, ergotamine is still probably useful.
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Curr Pain Headache Rep · Feb 2003
Review Comparative StudyThe role of anticonvulsants in preventive migraine therapy.
The mainstay of migraine treatment is pharmacotherapy. There have been numerous medications used to prevent migraine headaches, including b-blockers, calcium-channel blockers, anticonvulsants, and nonsteroidal anti-inflammatory drugs. ⋯ The mechanism of action of antiepileptics is not fully understood, but they all share a common role in enhancing gamma-aminobutyric acid-mediated inhibition. This article reviews the role of anticonvulsants in preventive migraine therapy.