Current pain and headache reports
-
Curr Pain Headache Rep · Aug 2009
ReviewVertebroplasty in the management of painful bony metastases.
Percutaneous vertebroplasty is the injection of bone cement, usually polymethylmethacrylate into the vertebral body. This procedure is most often performed in a percutaneous fashion on an outpatient (or short-stay) basis. Among other indications, the procedure is designated for painful vertebral compression fractures due to primary or metastatic spinal tumors. ⋯ The overall risk of the procedure is low, although serious complications (including spinal cord compression) can occur. Recent advances in technique and materials may reduce the incidence of adverse outcomes. Proper patient selection and meticulous technique are required to achieve best results and to avoid complications.
-
Curr Pain Headache Rep · Aug 2009
ReviewMedical imaging in the diagnosis and management of cancer pain.
Within the past few decades medical imaging has evolved very rapidly, now becoming an indispensable tool for the diagnosis, treatment, and follow-up of patients with cancer-related pain. Multiple imaging modalities are available for the assessment of cancer patients, each one with different advantages and limitations that are important to consider at the time we order a diagnostic study or plan an image-guided procedure. This article reviews the role that various imaging modalities play in the management of cancer pain and provides an overview of the latest technological advances.
-
Curr Pain Headache Rep · Aug 2009
ReviewOveruse of acute migraine medications and migraine chronification.
Among individuals with episodic migraine, the influence of excessive acute medication use on the development of chronic migraine depends upon within-person characteristics (eg, headache frequency), class of drug, and frequency of medication use. Available data suggest that opioids induce migraine chronification (progression), and the effect is dose dependent (critical dose around 8 days of exposure per month) and more pronounced in men. Barbiturates also induce migraine progression, and the effect is dose dependent (critical dose around 5 days of exposure per month) and more pronounced in women. ⋯ NSAIDs protect against migraine progression unless individuals have 10 or more headache days per month (when they become inducers, rather than protective). Finally, caffeine-containing over-the-counter products increase risk of progression. While we await randomized trials, these findings should inform the choice of acute migraine treatments with the goal of reducing the risk of migraine progression to chronic migraine.