Current pain and headache reports
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Patients with rheumatoid arthritis and osteoarthritis have relied upon NSAIDs as a cornerstone of their analgesic regime for decades. The choice of anti-inflammatory agents broadened for this group of patients when the selective inhibitors of cyclooxygenase-2 enzyme were developed. ⋯ This also led to a reevaluation of data concerning more traditional NSAIDs, and surprisingly, a similar trend was seen. The US Food and Drug Administration has recommended that both classes of drugs carry a black box warning with regard to gastrointestinal and cardiovascular risks.
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Curr Pain Headache Rep · Dec 2007
ReviewThe post-NSAID era: what to use now for the pharmacologic treatment of pain and inflammation in osteoarthritis.
Traditionally, clinicians have relied heavily on the use of NSAIDs to treat the pain of osteoarthritis, as numerous studies have proven these agents effective. However, controversy has arisen regarding their use as first-line therapy, due to increasing awareness of their cardiovascular risks. ⋯ Although these agents may still be useful in many patients, concerns over side effects have begun to limit their use, and patients and clinicians are reaching for alternate agents. This review highlights the evidence behind the effectiveness of other, non-NSAID pharmacologic options in the treatment of pain and inflammation in osteoarthritis.
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Curr Pain Headache Rep · Dec 2007
ReviewChallenges of nonpharmacologic interventions in chronic tension-type headache.
Interest in nonpharmacologic interventions for chronic tension-type headache has increased in recent years, with many professional organizations recommending behavioral treatments such as relaxation training, biofeedback, and cognitive-behavioral therapy alongside pharmacologic treatments. Although the efficacy of behavioral interventions is well-documented, several potential barriers in dissemination and implementation exist that have precluded more widespread adoption of behavioral treatments. This article briefly reviews the core components and efficacy of behavioral treatments for tension-type headache and outlines challenges to their broader clinical use as they occur at the levels of empirical research, treatment availability and delivery, and common clinical problems. Strategies for addressing these challenges are suggested, and directions for needed research are noted.
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The therapy for tension-type headache remains insufficient, and recent advances have been scarce. Although tricyclic antidepressants are at the forefront of treatment advances, upcoming agents tentatively modifying central sensitization are promising. ⋯ This article reviews current treatments, emphasizing newer approaches. Much remains to be achieved.
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Migraine and tension-type headache (TTH) are highly prevalent primary headaches that remain underdiagnosed and undertreated in clinical practice. The similarities and differences between migraine and TTH may impose diagnostic challenges as well as management difficulties. ⋯ The continuum concept is a possible key to the understanding of this association. Future studies are necessary to clarify epidemiology, pathophysiology, and management of these two most prevalent headaches.