Current pain and headache reports
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Curr Pain Headache Rep · Apr 2007
ReviewDoes thalidomide have an analgesic effect? Current status and future directions.
Dramatic relief of pain and life-altering changes in quality of life in some patients treated with immunomodulators such as thalidomide compel us to look more closely at unconventional mechanisms that may be involved in propagation of persistent pain. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, and IL-10 are the cytokines with the most evidence in pain modulation. TNF-alpha and IL-1beta seem to initiate neuropathic pain, IL-6 maintains such pain, and IL-10 inhibits this persistent pain. ⋯ Thalidomide may be an alternative for some patients with intractable pain. However, use of thalidomide is limited by its neurotoxic and teratogenic effects. Newer analogues may significantly improve the risk/benefit of using such immunomodulators.
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Curr Pain Headache Rep · Apr 2007
Evidence for a mismatch between the brain's movement control system and sensory system as an explanation for some pain-related disorders.
The motor-control system usually operates below our conscious level, and we only become aware of the complex interaction between desired movements and actual movements when an irregularity in the system occurs. Recently, it has been proposed that such discordances in sensorimotor function may generate pain and other somaesthetic disturbances. This article describes this model of pain and determines how it may be applied to a range of chronic pain conditions in which there is a lack of obvious causal pathology, including complex regional pain syndrome. In addition, we discuss the clinical implications of such a theory and examine how enhancing sensory feedback may reduce chronic pain.
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Cluster headache has long been considered a predominantly male disorder, with much of our knowledge based on studies of men. However, it has become increasingly more recognized in women. Although there are many similarities between men and women in the expression of the disorder, studies over the years have revealed gender differences. This article reviews epidemiologic, clinical, hormonal, and familial differences between male and female cluster patients, examines how they may affect treatment, and suggests studies that may give us a better understanding of the disorder.
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Curr Pain Headache Rep · Apr 2007
ReviewCluster headache: a review of online resources for patients and clinicians.
Technology has revolutionized the ability of both patients and physicians to find and retrieve medical information. In particular, the Internet has become an increasingly important source of information for patients and physicians in all medical fields, including headache. Although these resources may be readily available, it is not certain that those who would benefit most from these websites are aware of their existence or how to differentiate if the website is reputable. This article briefly reviews how patients and physicians can differentiate which sites provide legitimate and reputable information and then focuses on where to find online information on cluster headache.
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Curr Pain Headache Rep · Apr 2007
ReviewThe relationship between cytokines and pain/depression: a review and current status.
Cytokines are small protein molecules secreted in response to immune stimuli. Recent research has outlined important roles for proinflammatory cytokines in the cascade of normal physiologic responses to environmental stresses, encompassing so-called sickness behavior that is thought to be an adaptive response to infection and other illnesses. ⋯ This article reviews evidence that may enhance our understanding of how pathologic symptoms, such as mood disorders and neuropathic pain, may emerge from proinflammatory cytokine activation. Possible conceptualizations of these illnesses and potential treatment implications are explored.