Current pain and headache reports
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Curr Pain Headache Rep · Oct 2008
ReviewCentral mechanisms in the maintenance of chronic widespread noninflammatory muscle pain.
Chronic widespread pain (CWP) conditions such as fibromyalgia and myofascial syndromes are characterized by generalized pain, tenderness, morning stiffness, disturbed sleep, and pronounced fatigue. However, CWP pathophysiology is still unclear. A number of hypotheses have been proposed as the underlying pathophysiology of CWP: muscular dysfunction/ischemia, central sensitization, and a deficit in endogenous pain-modulating systems. ⋯ Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models. These changes likely reflect alterations in supraspinal modulation of nociception, and include increases in excitatory and decreases in inhibitory modulation pathways. These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization, and the consequent pain and hyperalgesia.
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Curr Pain Headache Rep · Oct 2008
ReviewReligiousness and spirituality in fibromyalgia and chronic pain patients.
The influence of psychosocial factors on pain experience and patient response has received increasing interest and recognition. Patients with chronic pain from several sources (eg, musculoskeletal, cancer, or sickle cell) usually report that religiousness and spirituality are important in their lives. ⋯ The best available evidence supports a positive association between religiousness and spirituality, with higher well-being and positive affect, and a negative association with depressive and anxiety symptoms. We discuss the importance of addressing spiritual issues in clinical practice, and increasing and improving research on religiousness/spirituality in chronic pain patients.
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The high incidence and prevalence of headaches in the pediatric population has a significant impact on patients and their families. Migraine, the most common headache disorder for which pediatric patients see a physician, remains underdiagnosed. ⋯ This article presents limitations of the present diagnostic criteria for migraine, and the proposed modifications to these criteria may assist the clinician with early recognition. Further research in pediatric headaches is needed to help reveal additional pathophysiologic mechanisms and improve diagnostic criteria.
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Curr Pain Headache Rep · Oct 2008
ReviewAdolescent issues in migraine: a focus on menstrual migraine.
Migraine commonly affects adolescents, and menstrual migraine often begins in young girls. If undiagnosed or ineffectively treated, migraine can lead to disability, school absenteeism, emotional or social difficulties, and chronification of headache. Thus, recognizing and accurately diagnosing migraine and menstrual migraine, developing effective treatment strategies (both pharmacologic and nonpharmacologic), and educating both the adolescent and her parents are important in order to minimize the potential early disability of this disorder and limit the otherwise likely progression of migraine to a disabling disorder of adulthood.
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Curr Pain Headache Rep · Oct 2008
ReviewThe role of extraocular and facial muscle trigger points in cephalalgia.
Trigger points play a part in the development and maintenance of chronic headache states. This article reviews the physiology of trigger points, with a focus on the -latest understanding of their biochemistry. The importance of facial muscle and extraocular muscle trigger points is only beginning to be understood; the data exploring their role in headache are reviewed. The concept of central sensitization and the way in which it relates to trigger points and headache is explained, along with treatment strategies for helping patients with their pain.