Current pain and headache reports
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Curr Pain Headache Rep · Oct 2007
ReviewMyofascial dysfunction associated with chronic pelvic floor pain: management strategies.
Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.
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Fibromyalgia (FM) is a painful syndrome that is more common in women than in men. Whether FM has an organic basis or whether it is psychosomatic is debated. ⋯ Preliminary evidence indicates that melatonin, a molecule that is endogenously produced and is available as an over-the-counter supplement, may be effective in treating the pain associated with this syndrome. Although melatonin is commonly known as a sleep aid (sleep/wake problems are common in FM sufferers), it has a variety of other beneficial effects that may account for its potential benefits in the treatment of FM.
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Curr Pain Headache Rep · Oct 2007
ReviewTreatment of chronic low back pain with botulinum neurotoxins.
In a double-blind, randomized, placebo-controlled study, administration of botulinum toxin A (Botox; Allergan Inc., Irvine, CA) into paraspinal muscles using a novel technique produced significant pain relief in 60% of patients with chronic, refractory low back pain. A similar yield of 53% was noted in a prospective, randomized, open-label study of 75 patients, with 14 months of follow-up. In this study, an early response predicted later responsiveness, with 91% of the responders continuing to respond to repeat injections. ⋯ The dose per injection site was 50 U (Botox), with the total dose per session not to exceed 500 U. Side effects were uncommon and consisted of a transient, mild flu-like reaction in 5% of the patients. Botulinum treatment of paraspinal muscles can reduce pain in a substantial number of patients with refractory chronic low back pain and is safe in the recommended doses.
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Headache may be considered primary or secondary, and secondary headaches may be caused by intracranial disorders or medical/systemic disorders. In many cases, headache may be a presenting symptom of the medical disorder, and accurate diagnosis will lead to specific treatment. ⋯ Medical causes of headache are so diverse that uniform screening tests are not useful. History and examination must guide the differential diagnosis, and management plans must be individualized.
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There are mounting data supporting comorbidity of fibromyalgia syndrome (FMS) and psychiatric conditions. These include depression, panic disorders, anxiety, and post-traumatic stress disorder (PTSD). ⋯ A link between PTSD symptoms and FMS has been reported, and both conditions share similar symptomatology and pathogenetic mechanisms. Assessment of comorbid psychiatric disorders in FMS patients has clinical implications because treatment in these patients should focus both on physical and emotional dimensions of dysfunction.