Current pain and headache reports
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Curr Pain Headache Rep · Aug 2004
Review Case ReportsPainful ophthalmoplegia: overview with a focus on Tolosa-Hunt syndrome.
Painful ophthalmoplegia is an important presenting complaint to emergency departments, ophthalmologists, and neurologists. The etiological differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies including vascular (eg, aneurysm, carotid dissection, carotid-cavernous fistula), neoplasms (eg, primary intracranial tumors, local or distant metastases), inflammatory conditions (eg, orbital pseudotumor, sarcoidosis, Tolosa-Hunt syndrome), infectious etiologies (eg, fungal, mycobacterial), and other conditions (eg, microvascular infarcts secondary to diabetes, ophthalmoplegic migraine, giant cell arteritis). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that if left untreated, can be associated with significant morbidity or mortality. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids, but should be diagnoses of exclusion.
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Topical analgesics exert their analgesic benefit locally and without significant systemic absorption. The mechanism of the topical analgesic is unique to the specific medication. ⋯ Topical analgesics have been studied in an increasing number of painful clinical conditions; the results of many of these studies are summarized in this review. Recent data suggest that at least one topical analgesic, although applied peripherally, may result in central nervous system alterations of pain processing.
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An integrated palliative care plan with goals of therapy that change throughout a child's illness will reflect an individualized, child-centered, and family-centered approach to care. This care plan will act as a foundation to assist and guide all providers, from the primary pediatrician to the subspecialty surgeon, in providing interventions that will most benefit a child and add life to the child's years.
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Ophthalmoplegic migraine is a rare condition, previously thought to represent a variant of migraine. Recent observations regarding its usual clinical presentation and common magnetic resonance imaging findings have given rise to speculation that this illness is more likely to represent an inflammatory cranial neuropathy. The recent revision of the International Headache Classification has reclassified ophthalmoplegic migraine from a subtype of migraine to the category of neuralgia. ⋯ Differential diagnosis is rather large, although most other possible causes of ophthalmoplegia and headache have distinctive presentations or can be excluded with fairly straightforward diagnostic testing. Optimal prophylactic and acute treatment is still unclear, but migraine prophylactic medications such as b blockers and calcium channel blockers have been proposed. Steroids have been used with mixed results.
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Curr Pain Headache Rep · Aug 2004
ReviewAssessing aberrant drug-taking behaviors in the patient with chronic pain.
Tremendous progress has been made in the study and treatment of pain in the past two decades. The growing problem of prescription drug abuse has forced the field to take a new look at opioid prescribing and to seek balance between its risks and benefits. Every pain clinician must become better acquainted with the principles of addiction medicine as they apply to pain management. The assessment of aberrant behaviors in patients with chronic pain is one key aspect of mastering these principles.