Current pain and headache reports
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The problem of therapeutic opioid misuse largely affects patients who need opioids to treat chronic pain conditions. Opioid misuse is rarely an overt clinical problem during end of life or acute pain treatment. Misuse attaches a stigma to opioid use, and makes many patients and prescribers reluctant to use these uniquely effective drugs, even when misuse is unlikely. ⋯ However, cancer is no longer such an explosive disease, and many cancer sufferers can now expect to have a prolonged, even normal, lifespan. They may need pain treatment, but this treatment should not be modeled on palliative care paradigms. This article describes the underlying mechanisms of opioid dependence and its progression to addiction, and suggests a cautious approach to opioid treatment of chronic cancer pain that aims to minimize the problem of misuse.
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Clinical and subclinical hypothyroidisms are common conditions in the population. Clinic-based studies suggest that hypothyroidism may be an exacerbating factor for some primary headaches. ⋯ We also review the prevalence, etiology, and principles of treatment of hypothyroidism. Because hypothyroidism is a treatable cause of secondary headaches, doctors should be aware of this relationship.
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Nummular headache is a rare primary headache disorder characterized by focal and well-circumscribed pain fixed within a round-, oval-, or elliptical-shaped region of the head. The pain is usually mild to moderate in intensity but may be severe. Nummular headache is most common in women in the fourth to fifth decade of life. ⋯ Many patients experience superimposed exacerbations of pain, lasting from seconds to days. Sensory phenomena, such as paresthesias, allodynia, and dysesthesias, are frequently reported in the region of the pain. Treatment with gabapentin, tricyclic antidepressants, or botulinum toxin may be helpful.
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Most patients with cancer pain achieve good analgesia using traditional analgesics and adjuvant medications; however, an important minority of patients (2% to 5%) suffers from severe and refractory cancer pain. For these individuals, spinal analgesics (intrathecal or epidural) provide significant hope for pain relief over months or years of treatment to help improve quality of life. ⋯ A variety of opioids, local anesthetics, clonidine, ketamine, and other analgesics are available for the spinal route of administration and should be titrated to clinical effect or intolerable side effect. This article discusses the appropriate selection of patients for spinal analgesics, reviews current recommended infusion systems and current spinal analgesics, discusses possible complications, and includes practical suggestions for patient management.
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High-altitude headache (HAH) is an important public health problem because many of the millions of visitors to locations high above sea level get significant headaches each year. Headache is the most common symptom of acute exposure to high altitude. ⋯ This article describes the clinical picture of AMS and CMS. The clinical characteristics of HAH are presented, its pathophysiology is discussed, and the acute and preventive treatment options are reviewed.