Current pain and headache reports
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Opioid therapy for pain is the subject of numerous randomized clinical trials. Opioids are being developed for delivery by a wide variety of mechanisms. New opioids are becoming available for clinical use. This review surveys recent developments in these clinical trials and provides an overview of what may be expected in the near future for opioid management of pain.
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Migraine is a common, disabling disorder that often requires preventive treatment. The decision to treat migraine preventively generally is based on disability, problems with acute medicines, patient preference, risk of acute medication overuse, special circumstances, and concern that high migraine attack frequency may be a risk factor for chronic daily headache. Migraine and epilepsy are comorbid episodic central nervous system disorders that can have stereotyped symptoms with negative and positive phenomena. ⋯ Valproic acid, topiramate and, to a lesser extent, gabapentin, have demonstrated efficacy in randomized, placebo-controlled trials. Lamotrigine may be effective at controlling migraine aura, but has not demonstrated effectiveness at controlling migraine headache. Anticonvulsants are a useful option for the preventive treatment of migraine.
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Curr Pain Headache Rep · Jun 2004
ReviewStrategies for finding new pharmacological targets for neuropathic pain.
Chronic pain of neuropathic origin is an unmet therapeutic challenge that may require the development of novel drug entities. The resources involved in developing novel drugs and testing them in clinical trials are so large that few candidates can be fully tested in practice. ⋯ At the same time, the research community has identified large numbers of potential pharmacological targets for analgesia in recent years, with individual investigators promoting favorites with increasing zeal. Because of the uncertain predictive value of animal models of neuropathic pain, it is essential to consider rational strategic approaches to selecting the most likely candidate targets.
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Curr Pain Headache Rep · Jun 2004
ReviewTargeted peripheral analgesics therapy for neuropathic pain.
The term targeted peripheral analgesics has been suggested to describe analgesics with a mechanism of action that appears to be primarily through reducing pain transmission within the peripheral nervous system. Key differences between targeted peripheral (topical) and systemic analgesics and the difference between topical and transdermal analgesics are discussed in this article. A review of the clinical conditions, which have been reported to respond to targeted peripheral analgesics, also is described in detail.
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Curr Pain Headache Rep · Jun 2004
ReviewNeuromodulating drugs for the symptomatic treatment of neuropathic pain.
Significant improvement of neuropathic pain has been achieved with studies that have demonstrated efficacy of newer anticonvulsants in relieving this type of pain, by having a neuromodulatory effect on the hyperexcitable damaged nervous system. Two drugs from this class, gabapentin and lamotrigine, have been submitted to a number of clinical trials. ⋯ Pregabalin, the newest agent that has demonstrated efficacy in the treatment of post-herpetic neuralgia, is awaiting approval. A number of available anticonvulsants are undergoing clinical trials and many drugs with neuromodulatory properties are being considered for further development.