Current pain and headache reports
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Curr Pain Headache Rep · Apr 2010
ReviewThe effect of morphine on glial cells as a potential therapeutic target for pharmacological development of analgesic drugs.
Opioids have played a critical role in achieving pain relief in both modern and ancient medicine. Yet, their clinical use can be limited secondary to unwanted side effects such as tolerance, dependence, reward, and behavioral changes. Identification of glial-mediated mechanisms inducing opioid side effects include cytokine receptors, kappa-opioid receptors, N-methyl-D-aspartate receptors, and the recently elucidated Toll-like receptors. Newer agents targeting these receptors such as AV411, MK-801, AV333, and SLC022, and older agents used outside the United States or for other disease conditions, such as minocycline, pentoxifylline, and UV50488H, all show varied but promising profiles for providing significant relief from opioid side effects, while simultaneously potentiating opioid analgesia.
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Cluster headache (CH) is a rare, excruciating primary headache disorder. A genetic basis has been suggested by family and twin studies, but the mode of transmission seems to vary and the amount of heritability is unclear. The number of genetic association studies investigating variants implicated in the pathophysiology of CH is limited. ⋯ However, it only appears to account for a part of the genetic susceptibility for CH, and additional genetic and environmental factors are likely implicated. Pharmacogenetic studies have suggested that the GNB3 825C > T polymorphism may modify treatment response to triptans among CH patients by altering the signal transduction cascade via G protein-coupled receptors. Genetic studies in CH are notoriously difficult due to the complex nature of the disorder and the low prevalence of CH.
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Curr Pain Headache Rep · Apr 2010
ReviewFear of pain as a prognostic factor in chronic pain: conceptual models, assessment, and treatment implications.
Chronic pain is a pervasive health care issue affecting over 50 million Americans and costing more than $100 billion dollars annually in lost productivity and health care costs. As a financially and emotionally taxing condition, the families and friends of people with chronic pain, as well as society at large, are affected. ⋯ This article summarizes current understanding of the role of pain-related fear in the onset of acute pain incidents, the transition of acute pain to chronic, and the pain severity and disability of patients with ongoing chronic pain conditions. Treatments demonstrated to reduce pain-related fear are presented, evidence demonstrating their efficacy at reducing disability and pain severity are summarized, and recent criticisms of the fear-avoidance model and future directions are considered.
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Curr Pain Headache Rep · Apr 2010
ReviewStrategies for the prevention and management of neonatal and infant pain.
Health care professionals caring for neonates (birth to 28 days of life) and infants up to 1 year of age have a professional and ethical responsibility to provide safe and effective pain management during painful procedures. Despite 14 years of research reports highlighting that sick infants are exposed to large numbers of painful procedures with minimal or no provision of pain management strategies, and generation of abundant evidence to support effectiveness of pain reduction strategies, insufficient practice changes have been made. As untreated pain in infancy has both immediate and longer-term negative consequences, such as increased sensitivity and responses to subsequent pain, it is imperative that widespread sustained practice changes are made to reduce the burden of pain. This review highlights recent advances within the past 2 to 3 years in pain management of acute procedural pain for neonates and infants, proposes recommendations for future research, and addresses practical implications and challenges for implementing best pain management practices.
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Curr Pain Headache Rep · Apr 2010
ReviewRole of sphenopalatine ganglion neuroablation in the management of cluster headache.
Cluster headache is a primary neurovascular headache. It is a strictly unilateral head pain that is associated with cranial autonomic symptoms and usually follows circadian and circannual patterns. ⋯ The sphenopalatine ganglion (SPG), located in the pterygopalatine fossa, is involved in the pathophysiology of cluster headache and has been a target for blocks and other surgical approaches. Percutaneous radiofrequency ablation of the SPG was shown to have encouraging results in those patients with intractable cluster headaches.