Current pain and headache reports
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Curr Pain Headache Rep · Jan 2008
ReviewOccipital nerve stimulation for medically intractable headache.
There is an unmet need, and thus a continued search, for effective treatments for patients with chronic daily headache who do not respond to or tolerate conventional therapies. Recent interest has focused on the use of occipital nerve stimulation (ONS) to treat patients with chronic, disabling headaches who are not adequately controlled by usual therapies. ⋯ Electrical stimulation of the occipital nerve has both peripheral and central nervous system effects that modulate nociception. The exact role for ONS will evolve as our understandings of its physiologic effects, efficacy, and safety grow.
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Percutaneous vertebroplasty is the injection of a vertebral compression fracture (VCF) with bone cement, generally polymethylmethacrylate. Percutaneous kyphoplasty is the placement of balloons into the vertebral body with an inflation/deflation sequence to create a cavity before the cement injection. These procedures are most often performed in a percutaneous fashion on an outpatient (or short stay) basis. ⋯ Much evidence favors the use of this procedure for pain associated with these disorders. The overall risks of the procedure are low, but serious complications (including spinal cord compression) can occur. With good patient selection and careful technique, these complications are avoidable, making the risk-to-benefit ratio highly favorable.
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Curr Pain Headache Rep · Jan 2008
Review Historical ArticlePeripheral nerve stimulation for chronic pain.
Electrical stimulation has been used since ancient times to treat painful conditions. Electrotherapy for pain was largely consigned to the realm of quackery until the introduction of the Gate Control Theory by Melzack and Wall in 1965 provided a rationale for direct stimulation of peripheral nerves. Since that time, peripheral nerve stimulation has been applied to the treatment of painful conditions throughout the body, beginning with the major nerves of the extremities and culminating today in precise subcutaneous field stimulation targeted to specific areas of neuropathic pain. This article reviews the history, development, and current areas of interest in peripheral nerve stimulation for the treatment of neuropathic pain.
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Population studies suggest that obesity is associated with migraine progression from episodic to chronic daily headaches. Although not a risk factor for episodic migraine, obesity is associated with frequent and severe headaches among migraineurs. We suggest that obesity is an exacerbating factor for migraine. ⋯ We review the clinical evidence that links obesity and migraine progression. We then review the potential pathophysiologic mechanisms to support this relationship. We close by briefly discussing clinical interventions related to obesity and migraine.
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Curr Pain Headache Rep · Jan 2008
ReviewIntradiscal electrothermal therapy, percutaneous discectomy, and nucleoplasty: what is the current evidence?
Over the past decade, there has been a surge of minimally invasive techniques aimed at treating both discogenic low back pain (LBP) and radicular pain. This article assesses the current evidence for three such treatments: intradiscal electrothermal therapy (IDET), percutaneous discectomy, and nucleoplasty. An electronic search of the literature carried out using the Cochrane Library database (2007) and Medline (1966-2007) identified 77 references relating to IDET, 363 to percutaneous discectomy, and 36 to nucleoplasty. ⋯ Other RCTs show that percutaneous intradiscal radiofrequency thermocoagulation is ineffective for the treatment of discogenic LBP. Trials of automated percutaneous discectomy suggest that clinical outcomes after treatment are at best fair and often worse when compared with microdiscectomy. There are no published RCTs assessing Coblation (ArthroCare Spine, Stockholm, Sweden) technology.