Current pain and headache reports
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Patients with spinal cord injury (SCI) may experience several types of chronic pain, including peripheral and central neuropathic pain, pain secondary to overuse, painful muscle spasms, and visceral pain. An accurate classification of the patient's pain is important for choosing the optimal treatment strategy. In particular, neuropathic pain appears to be persistent despite various treatment attempts. ⋯ Nevertheless, treatment remains difficult and inadequate. In line with the recommendations for peripheral neuropathic pain, evidence from randomized controlled treatment trials suggests that tricyclic antidepressants and pregabalin are first-line treatments. This review highlights the diagnosis and classification of SCI pain and recent improvements in the understanding of underlying mechanisms, and provides an update on treatment of SCI pain.
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Curr Pain Headache Rep · Jun 2012
ReviewWhy HURT? A review of clinical instruments for headache management.
The Global Campaign against Headache, directed by the non-governmental organization Lifting The Burden (LTB) in official relations with the World Health Organization (WHO), aspires to reduce the global burden of headache. Ultimately this calls for improvements in headache management, largely in primary care, where most people with headache receive medical care. In support, LTB is developing a range of headache management aids for primary care. ⋯ The first draft of the HURT was created by an expert consensus group, meeting at WHO headquarters in Geneva, Switzerland. The final version came about through multiple refinements following psychometric testing. Assessment of clinical utility is ongoing in multiple countries.
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Curr Pain Headache Rep · Jun 2012
ReviewQuantitative sensory testing of neuropathic pain patients: potential mechanistic and therapeutic implications.
Quantitative sensory testing (QST) is a widely accepted tool to investigate somatosensory changes in pain patients. Many different protocols have been developed in clinical pain research within recent years. In this review, we provide an overview of QST and tested neuroanatomical pathways, including peripheral and central structures. ⋯ Clinically, QST may be useful for 1) the identification of subgroups of patients with different underlying pain mechanisms; 2) prediction of therapeutic outcomes; and 3) quantification of therapeutic interventions in pain therapy. Combined with sensory mapping, QST may provide useful information on the site of neural damage and on mechanisms of positive and negative somatosensory abnormalities. The use of QST in individual patients for diagnostic purposes leading to individualized therapy is an interesting concept, but needs further validation.
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Curr Pain Headache Rep · Jun 2012
ReviewEpidemiology of neuropathic pain and its impact on quality of life.
Epidemiology is an important clinical tool in designing and evaluating management and prevention strategies, and is particularly relevant to neuropathic pain. However, there is a relative lack of accurate information available. In one sense, neuropathic pain describes a symptom or a mechanism, rather than a specific disease; on the other hand, there are sufficient similarities in the effects and response to treatment between different causes to make it worthwhile to consider neuropathic pain as a distinct condition. ⋯ Estimates of prevalence that are based on specific causes of neuropathic pain tend to be lower (1-2%) than those that are based on reports of the classic symptoms (6-8%), and further methodological research is needed. All neuropathic pain is associated with poor general health, comparable with other severe chronic diseases. The importance of newly proposed risk factors, including genetic factors, still needs to be assessed at a population level.
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Curr Pain Headache Rep · Jun 2012
ReviewSpinal cord stimulation: neurophysiological and neurochemical mechanisms of action.
Chronic neuropathic pain can significantly reduce quality of life and place an economic burden on individuals and society. Spinal cord stimulation (SCS) is an alternative approach to the treatment of neuropathic pain when standard pharmacological agents have failed. However, an improved understanding of the mechanisms by which SCS inhibits pain is needed to enhance its clinical utility. This review summarizes important findings from recent studies of SCS in animal models of neuropathic pain, highlights current understanding of the spinal neurophysiological and neurochemical mechanisms by which SCS produces an analgesic effect, and discusses the potential clinical applicability of these findings and future directions for research.