Current pain and headache reports
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Curr Pain Headache Rep · Feb 2009
Review Comparative StudyEpidural steroid injections are useful for the treatment of low back pain and radicular symptoms: pro.
Epidural steroid injection has been used to treat low back pain for many decades. Numerous randomized trials have examined the efficacy of this approach. This review details the findings of older systematic reviews, newer randomized controlled trials, and two recent systematic reviews that examine the effectiveness of this treatment. ⋯ Similarly, there is scant evidence that epidural steroids have any beneficial effect in those with acute low back pain without leg pain or in those with chronic low back or leg pain. However, most studies have demonstrated more rapid resolution of leg pain in those who received epidural steroid injections versus those who did not. The role of epidural steroid injections in the management of acute radicular pain due to herniated nucleus pulposus is simply to provide earlier pain relief.
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At least half of women migraineurs experience menstrual migraine (MM), suggesting a hormonal explanation for the incidence of these headaches. Basic science efforts suggest a relationship between estrogen and the neurotransmitters and neuronal structures critical in the pathophysiology of migraine. ⋯ Triptans have been shown to be effective as both an abortive and short-term preventive treatment, and estradiol has been shown to be an effective short-term preventive treatment. Ergotamines, combinations of drugs such as sumatriptan-naproxen sodium, and rizatriptan with dexamethasone show promise in the treatment of MM.
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Curr Pain Headache Rep · Feb 2009
ReviewPain outcomes: a brief review of instruments and techniques.
Pain is a difficult outcome to measure due to its multifaceted and subjective nature. The need for selecting proper outcome measures is high because of the increasing demand for scientifically valid demonstrations of treatment efficacy. ⋯ This article also reviews some of the more commonly used tools for measuring pain and pain-related disability. By selecting the proper tools and employing them correctly, we can obtain highly reliable and valid measures of pain outcomes in research and clinical care.
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Curr Pain Headache Rep · Feb 2009
Comment Review Comparative StudyEpidural steroid injections are useful for the treatment of low back pain and radicular symptoms: con.
Lumbar epidural steroid injections are commonly performed in the United States for treating radicular low back pain. However, the best available data suggest that the benefit afforded by these injections is quite limited; in fact, new data suggest that in geographic areas where many such injections are performed, more and not fewer spine surgeries are actually completed annually. We suggest that further high-quality studies are required and their results respected through their implementation in daily practice to better ensure that only appropriate patients are advised to undergo this procedure.
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Methodology varies greatly in whiplash studies; therefore, results are not directly comparable. Headache seems to be present in 50% to more than 75% of cases in the acute stage, and in 20% to 30% of cases in the early chronic stage. Headache naturally occurs frequently (> 75% of the cases ) in patients who consult headache specialists due to protracted symptoms. ⋯ In one study, this type of headache was present in 8% at 6 weeks and 1% at 6 years. It was more rare than postwhiplash, unspecified headache. De novo postwhiplash headache may consist of cervicogenic headache and of noncervicogenic headache (probably in the acute phase).