Current pain and headache reports
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Curr Pain Headache Rep · Jan 2014
ReviewCervical radicular pain: the role of interlaminar and transforaminal epidural injections.
Chronic neck pain and cervical radicular pain are relatively common in the adult population. Treatment for chronic radicular pain recalcitrant to conservative management includes surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. Although there have been multiple systematic reviews and randomized clinical trials of cervical interlaminar epidural injections, the literature is sparse in reference to cervical transforaminal epidural injections. ⋯ The evidence is poor, however, for cervical transforaminal epidural injections. Complications with cervical interlaminar epidural injections are rare, but more commonly occur with transforaminal epidural injections and can be fatal. Emerging concepts in pain include further randomized trials; proper placebo design; focus on control design (either active control or placebo control); and appropriate methodologic quality assessment and evidence synthesis.
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Fascia is composed of collagenous connective tissue surrounding and interpenetrating skeletal muscle, joints, organs, nerves, and vascular beds. Fascial tissue forms a whole-body, continuous three-dimensional viscoelastic matrix of structural support. The classical concept of its mere passive role in force transmission has recently been disproven. ⋯ Imbalance of this regulatory mechanism results in increased or decreased myofascial tonus, or diminished neuromuscular coordination, which are key contributors to the pathomechanisms of several musculoskeletal pathologies and pain syndromes. Here, we summarize anatomical and biomechanical properties of fascial tissue with a special focus on fascial dysfunctions and resulting clinical manifestations. Finally, we discuss current and future potential treatment options that can influence clinical manifestations of pain syndromes associated with fascial tissues.
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Chronic pain conditions are associated with an elevated risk for suicide. Of particular importance is the question of why pain conditions might be linked to increased suicide risk. ⋯ Bridging across research areas and drawing on the interpersonal-psychological theory of suicide, we suggest that chronic pain may facilitate the development of a key risk factor for suicide: fearlessness about death. Given that chronic pain can lead to (and be exacerbated by) depression, engender hopelessness, facilitate a desire for escape through death, and erode the natural fear of dying, clinicians must be aware of psychological processes that can combine to create elevated suicide risk in patients with chronic pain, and they should also assess and treat suicide risk factors in these patients.
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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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Curr Pain Headache Rep · Jan 2014
ReviewPainful connections: densification versus fibrosis of fascia.
Deep fascia has long been considered a source of pain, secondary to nerve pain receptors becoming enmeshed within the pathological changes to which fascia are subject. Densification and fibrosis are among such changes. They can modify the mechanical properties of deep fasciae and damage the function of underlying muscles or organs. ⋯ This review provides an overall description of deep fasciae and the mechanical properties in order to identify the various alterations that can lead to pain. Diet, exercise, and overuse syndromes are able to modify the viscosity of loose connective tissue within fascia, causing densification, an alteration that is easily reversible. Trauma, surgery, diabetes, and aging alter the fibrous layers of fasciae, leading to fascial fibrosis.