Current pain and headache reports
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Curr Pain Headache Rep · Aug 2006
ReviewMigraine and intranasal contact point headache: is there any connection?
It has been suggested that contact point can trigger headache in individuals with migraine. In this article, we review the anatomy of the sinonasal cavity. ⋯ We close by presenting our personal casuistic in the surgical treatment of patients with contact point and refractory headaches. In migraineurs with contact point, surgery may improve the headaches.
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Supraorbital neuralgia is a rare disorder clinically characterized by the following triad: 1) forehead pain in the territory supplied by the supraorbital nerve, without side shift; 2) tenderness on either the supraorbital notch or traject of the nerve; and 3) absolute, but transitory relief of symptoms upon supraorbital nerve blockade. The pain presents with a chronic or intermittent pattern. In addition, there may be signs and symptoms of sensory dysfunction (hypoesthesia, paresthesia and allodynia), and typical "neuralgic features" (lightning pain and exteroceptive precipitating mechanisms). However, sensitive and neuralgic features are not constantly present and seem to be more frequent in the secondary, usually post-traumatic, forms.
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Therapeutic massage as a cancer pain intervention appears to be safe and effective. Patients who receive massage have less procedural pain, nausea, and anxiety and report improved quality of life. The use of massage in cancer care centers and hospitals is on the rise. ⋯ Most studies to date are small but promising. Exact methodology and best practices warrant further investigation by the industry. More randomized clinical trials and case studies must be conducted.
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Recent advances in the development and administration of chemotherapy for malignant diseases have been rewarded with prolonged survival rates. The cost of progress has come at a price and the nervous system is frequently the target of chemotherapy-induced neurotoxicity. Unlike more immediate toxicities that effect the gastrointestinal tract and bone marrow, chemotherapy-induced neurotoxicity is frequently delayed in onset and may progress over time. ⋯ Each agent exhibits a spectrum of toxic effects unique to its mechanism of toxic injury, and recent study in this field has yielded clearer ideas on how to mitigate injury. Combined with the call for a greater recognition of the potentially devastating ramifications of CIPN on quality of life, basic and clinical researchers have begun to investigate therapy to prevent neurotoxic injury. Preliminary studies have shown promise for some agents including glutamine, glutathione, vitamin E, acetyl-L-carnitine, calcium, and magnesium infusions, but final recommendations await prospective confirmatory studies.
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Inadequately managed cancer pain continues to be a significant problem despite increased awareness, improved knowledge and understanding of pain pathophysiology, and standardized treatment guidelines of this distressing and debilitating symptom complex. Small subsets of patients who are refractory to optimal medical management because of drug toxicity or unsatisfactory analgesia may be candidates for exteriorized or implantable intrathecal drug delivery systems. ⋯ With adjuncts such as local anesthetics and clonidine, intrathecal therapy also allows for broader therapeutic options in the most difficult of cases. In general, intrathecal therapy is underused despite evidence of its efficacy, safety, and cost-effectiveness.