Current pain and headache reports
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Chronic pain has long been considered an important risk factor for suicidal behavior. Less well understood are the factors associated with the increased risk for suicide death within chronic pain populations. ⋯ However, in all likelihood, there are aspects of chronic pain itself that add uniquely to an individual's suicide risk profile. Lastly, we address a theoretical perspective and offer recommendations for clinical practice.
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Curr Pain Headache Rep · Jan 2014
ReviewAn update on botulinum toxin A injections of trigger points for myofascial pain.
Myofascial pain syndrome (MPS) is a common chronic pain condition that is characterized by distinct "trigger points." Despite current treatments with physical therapy, analgesics, anti-depressants and trigger-point injections, myofascial pain remains a challenging chronic pain condition in clinical practice. Botulinum toxin A (BTX-A) can cause prolonged muscle relaxation through inhibition of acetylcholine release. It may offer some advantages over the current treatments for MPS by providing a longer sustained period of pain relief. ⋯ Eight trials were found according to the above criteria and are summarized in Table 1. There are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS. However, further clinical trials with considerations of minimizing placebo effect, repeated dosing, adequate coverage of trigger points, and using ultrasound confirmation and guidance are required to provide conclusive evidence for BTX-A in the treatment of myofascial pain.
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Curr Pain Headache Rep · Jan 2014
Review Historical ArticleHistorical and present state of neuromodulation in chronic pain.
Neuromodulation is based on the revolutionary concept that paresthesia-inducing electrical stimulation could be analgesic. Its historical basis emanates from Melzack and Wall's gate control theory of pain proposed in 1965. Neuromodulation has given us ready access to the systems of pain modulation and helped mature the understanding of the pathophysiology of pain. ⋯ However, the present understanding of pain is rudimentary and evidence that neuromodulation works is modest. This paper emphasizes the historical antecedents, present state, and emerging future of 3 commonly applied neuromodulatory techniques--spinal cord stimulation, peripheral nerve and field stimulation, and deep brain stimulation--for chronic pain. It is hoped this article will enhance the understanding of neuromodulation and its role in pain management.
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Chronic migraine (CM) is a subtype of migraine broadly defined by the presence of headache at least 15 days per month. Emerging evidence suggests that CM and episodic migraine (EM) differ not only in headache frequency, but that they are distinct clinical entities. Because individuals with CM are more disabled, they demonstrate higher societal burden than those with EM. ⋯ The second, the International Burden Migraine Study (IBMS), is a Web-based survey conducted in North America, Western Europe, Asia/Pacific, and Brazil. The third is a clinic-based survey performed in Taiwan. This review discusses results of these studies with regard to healthcare resource use (and related direct costs) and loss of productivity (and related indirect costs) from the perspective of cost-effectiveness of new therapeutic approaches to CM.
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Curr Pain Headache Rep · Jan 2014
ReviewIntrathecal therapy for chronic pain: current trends and future needs.
The management of chronic pain continues to pose many challenges to healthcare providers. Intrathecal drug delivery systems (IDDS) provide an effective therapy for patients suffering from chronic pain intractable to medical management. ⋯ In addition, there remains a need to enhance physician knowledge on the pharmacodynamics and pharmacokinetics of intrathecal drug delivery and promote further research into this field and drug delivery modalities. The purpose of this article is to provide a comprehensive review of the determinants of successful intrathecal drug delivery with an emphasis on its use in noncancer pain.