Current pain and headache reports
-
Curr Pain Headache Rep · Apr 2009
ReviewIs there a therapeutic window with some antidepressants for analgesic response?
Most antidepressants and anticonvulsants used in chronic pain syndromes have dose- and concentration-response curves developed for their application to treat psychiatric disorders. Because these are important clinical tools in medication management of psychiatric syndromes, it is reasonable to expect that utilizing concentration-effect relationships and known sources of pharmacokinetic variability for determining doses for analgesia may also improve treatment tolerability and outcomes. Efforts to identify dosing "therapeutic windows" or minimum "thresholds" for analgesic efficacy have provided useful guidance for initiating treatment, reducing toxicity, and assisting with decision making in the face of limited therapeutic response. This article reviews the strengths, limitations, and potential of therapeutic drug monitoring of antidepressants and anticonvulsants as analgesics for selected chronic pain syndromes.
-
Virtual reality (VR) is a relatively new technology that enables individuals to immerse themselves in a virtual world. This multisensory technology has been used in a variety of fields, and most recently has been applied clinically as a method of distraction for pain management during medical procedures. Investigators have posited that VR creates a nonpharmacologic form of analgesia by changing the activity of the body's intricate pain modulation system. ⋯ This article presents a comprehensive review of the literature to date exploring the clinical and experimental applications of VR for pain control. The review details specific research methodologies and popular virtual environments. Limitations of the research, recommendations for improvement of future studies, and clinical experiences with VR are also discussed.
-
Illness uncertainty is present for both acute and chronic illnesses and has been described in the literature as a cognitive stressor, a sense of loss of control, and a perceptual state of doubt that changes over time. Illness uncertainty is associated with poor adjustment, but often needs to be appraised as a threat to have its deleterious effect. ⋯ The illness uncertainty literature in relation to pain is somewhat limited but clearly suggests the potential negative impact on the perception of and adjustment to pain. Future research should examine specific predictors of illness uncertainty, how this construct changes over time, and what interventions may be effective in reducing illness uncertainty for individuals who experience pain conditions.
-
Curr Pain Headache Rep · Apr 2009
ReviewEvidence base for the medical treatments used in cluster headache.
Cluster headache (CH) is a strictly unilateral headache that occurs in association with cranial autonomic features. It is an excruciating syndrome and is probably one of the most painful conditions known to exist, with some female patients describing each attack as being worse than childbirth. CH responds to specific therapies, thereby underlying the importance of distinguishing it from other primary headache syndromes and initiating appropriate treatments. This article reviews the evidence base for the medical treatments used in CH.
-
Curr Pain Headache Rep · Apr 2009
ReviewCluster headache and obstructive sleep apnea: are they related disorders?
Patients with cluster headache (CH) have a higher prevalence of sleep apnea, and a possible relationship between these two conditions has been proposed. Although patients suffering from CH attacks often wake up from sleep, sleep apnea has been suggested to be a trigger or an associated abnormality in CH. ⋯ The exact role that sleep apnea plays in the perpetuation or precipitation of CH is still to be determined. This paper discusses the proposed pathophysiological mechanisms of these two entities and the possible relationship between CH and sleep apnea.