Current pain and headache reports
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Curr Pain Headache Rep · Feb 2010
ReviewThe "other" headaches: primary cough, exertion, sex, and primary stabbing headaches.
Primary cough headache, primary exertional headache, primary sexual headache, and idiopathic stabbing headache are included in "Other Primary Headaches" (Group 4) in the International Classification of Headache Disorders, 2nd edition (ICHD-II). Headaches provoked by cough, exertion, and sex have different age distributions, but they do share some clinical and pathogenic characteristics. The triggering activities frequently involve Valsalva-like maneuvers, which may explain part of the pathogenesis. ⋯ Of note, some patients with sexual headache had reversible cerebral vasoconstriction syndromes. Recent large-scaled studies have revealed that the ICHD-II criteria of these four headache disorders cannot be completely fulfilled. Further revisions for the ICHD-II criteria are required based on these results of the evidence-based studies.
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Curr Pain Headache Rep · Feb 2010
ReviewCurrent developments in intraspinal agents for cancer and noncancer pain.
Since the late 1980s, intrathecal (IT) analgesic therapy has improved, and implantable IT drug delivery devices have become increasingly sophisticated. Physicians and patients now have myriad more options for agents and their combination, as well as for refining their delivery. ⋯ We review this algorithm and the emerging therapy included. This article provides an update on newly approved as well as emerging IT agents and the advances in technology for their delivery.
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The role of the psychologist in chronic headache needs to be tailored to the patient's presentation. For some patients, psychological issues need to be directly addressed (eg, psychiatric comorbidity, difficulties coping with headache, significant problems with sleep and/or stress, medication overuse, and history of abuse). Other situations (eg, patients' beliefs about their readiness to change ability to actively manage headaches, medication adherence, and managing triggers) involve behavioral/psychological principles even when there is no direct contact with a psychologist. This article reviews the literature on the importance of psychological issues in headache management and provides suggestions for how to address behavioral and cognitive factors and their potential for improved headache care.
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Addiction to opioid analgesics is an important and yet underinvestigated clinical issue, which has substantial implications in opioid therapy for chronic pain management. Problematic opioid use, including compulsive opioid seeking and addiction, arises in some fraction of opioid-treated chronic pain patients. The connection between chronic pain and opioid addiction is a complex interplay between psychological, epidemiological, and neurobiological factors. Herein, we explore this critical relationship.
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Chronic orofacial pain (COFP) is an umbrella term used to describe painful regional syndromes with a chronic, unremitting pattern. This is a convenience term, similar to chronic daily headaches, but is of clinically questionable significance: syndromes that make up COFP require individually tailored diagnostic approaches and treatment. ⋯ For many years, COFP and headache have been looked upon as discrete entities. However, we propose the concept that because COFP and headaches share underlying pathophysiological mechanisms, clinical characteristics, and neurovascular anatomy, they should be classified together.