Current pain and headache reports
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Curr Pain Headache Rep · Aug 2006
ReviewChronic paroxysmal hemicrania: from the index patient to the disease.
The first patient with chronic paroxysmal hemicrania (CPH), a 41-year-old woman, first seen in 1961, was followed until an adequate treatment was found, 12 years later. Clinically, attack frequency and duration differed widely from the general pattern of cluster headache. Ocular variables, such as intraocular pressure and corneal indentation pulse amplitudes, also differed in our case (clear symptomatic side increment during attacks) and cluster headache. ⋯ Indomethacin was highly effective in our case, while "cluster headache drugs," such as ergotamine/sumatriptan, were ineffective. Indomethacin was inactive in cluster headache. Accordingly, our case seemed to differ decisively from cluster headache: CPH had been discovered.
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Chronic pain is a costly and prevalent problem. Pain, itself, is a symptom. Pain has received attention in the form of health care policy reform, development of assessment tools, and treatment protocols. ⋯ Many barriers exist in treating chronic pain, especially when treating with opioid analgesics. Pharmacists can help in the assessment and treatment of chronic pain. This article discusses the impact of chronic pain, barriers to care, and the role of the pharmacist in managing chronic opioid therapy.
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Curr Pain Headache Rep · Aug 2006
ReviewMetastatic bone cancer pain: etiology and treatment options.
Painful metastatic bone disease remains a challenge for physicians. The treatment choices available are wide and varied, with each having its appropriate place in the management of painful bone metastases. Radiotherapy remains the mainstay of treatment with or without surgery. Advances in understanding the intricate pathway responsible for pain generation and the addition of agents such as bisphosphonates to the physician's armamentarium further assist in the management of painful bone metastases.
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Curr Pain Headache Rep · Aug 2006
ReviewPrimary trochlear headache and other trochlear painful disorders.
The trochlear region is a source of distinct pain that may give rise to specific primary pain disorders (primary trochlear headache), but also modulate other pre-existing headache disorders such as migraine. The sensory innervation of this region, by a branch of the ophthalmic division of the trigeminal nerve, may explain the modulatory influence of the nociceptive afferents of this region over migraine headache. ⋯ We postulate that nociceptive afferents from the inner part of the orbit may sustain the activation of trigeminal neurons, thus sensitizing or exacerbating migraine. Decreasing the possible wind-up induced from this nociceptive afferent stimulation may be effective in controlling headache.
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Curr Pain Headache Rep · Aug 2006
ReviewChemotherapy-induced peripheral neuropathy: underreported and underappreciated.
Chemotherapy-induced neuropathy is one of the most serious non-life-threatening side effects experienced by patients receiving this group of pharmaceutical agents. Although frequently reversible, some patients may remain with symptoms for the remainder of their lives. Early recognition that "numbness and tingling" in the hands and feet of a patient receiving chemotherapy is due to the antineoplastic drug, with subsequent dose reduction or discontinuation of the offending agent, may prevent the development of serious neurologic dysfunction.