Current pain and headache reports
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Fibromyalgia is a common pain syndrome characterized by widespread pain, tenderness, and a number of other somatic symptoms and syndromes. Although there was original skepticism that any objective abnormalities would be identified in these individuals, at present there are many that have been reproducibly identified, and most point to dysregulation of central nervous system function as a key underlying pathogenic mechanism in this and related illnesses. This article reviews several objective abnormalities or measures that have been identified or used in fibromyalgia, and indicates which of these may be most promising to eventually use as biomarkers to follow the response to treatment or progress of disease over time.
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Menstrual-related migraine (MRM) affects the majority of female migraineurs, with menstrual-associated attacks reported to be more disabling, longer lasting, and less responsive to traditional treatments than nonmenstrual attacks. Emerging evidence suggests that minimizing or eliminating monthly declines in estrogen concentration may be effective in preventing MRM. This article gives a practical overview of current hormonal options, both contraceptive and noncontraceptive. Our intent is to help the reader better understand the differences in currently available formulations and how some of these agents may be utilized as hormonal preventives of MRM.
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Fibromyalgia (FM) and migraine are common chronic disorders that predominantly affect women. The prevalence of headache in patients with FM is high (35%-88%), with migraine being the most frequent type. ⋯ We also discuss the participation of hypothalamic and brainstem centers of pain control, the putative role played by neurotransmitters or neuromodulators on central sensitization, and changes in their levels in the cerebrospinal fluid. Understanding their mechanisms will help to establish new treatment strategies for treating these disabling brain disorders.
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Curr Pain Headache Rep · Oct 2009
ReviewNew techniques for the quantification of fibromyalgia and myofascial pain.
Myofascial pain and fibromyalgia share a number of common features: the patient is uncomfortable; abnormalities can be detected on physical examination; and there is a lack of an objective means to either quantify or visualize their core features. This has undoubtedly contributed to a slowed acceptance of their importance by the medical community. ⋯ Although progress may be somewhat slower in fibromyalgia, in which attention appears to focus on pain sensitivity and functional brain imaging, a number of approaches now seem promising in their ability to quantify the physical and biochemical characteristics of the taut bands and trigger points of myofascial pain. This review focuses on myofascial pain with an emphasis on the growing capability of MRI, microanalytic techniques, and ultrasonography to assess, quantitate, and even visualize the characteristics of these stigmatic lesions.
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Curr Pain Headache Rep · Oct 2009
ReviewPsychological trauma in chronic pain: implications of PTSD for fibromyalgia and headache disorders.
The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy. Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance. Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.