Current pain and headache reports
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Curr Pain Headache Rep · Apr 2014
ReviewLumbar sympathetic treatment in the management of lower limb pain.
The sympathetic system has been a target for interventional treatment since the early half of the 20th century. One area targeted for treatment has been the lumbar sympathetics for lower limb pain. Physicians have treated various neuropathic and ischemic conditions employing the use of sympathetic procedures as a mode of treatment, yet the studies strongly supporting the utility of the procedure have been lacking. ⋯ Many studies have reported positive results with blockade and neurolysis, but review of the literature reveals poor strength quality and small sample population. These reports should be viewed as building blocks for more robust investigation. Interpretation of the results should be performed with caution, and translation into common practice implemented on a case by case basis.
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Paroxysmal hemicrania (PH) is an underreported and underdiagnosed primary headache disorder. It usually begins in the third or fourth decade of life. The recent observations indicate that it is equally prevalent in both males and females. ⋯ The hallmark of PH is the absolute cessation of the headache with indomethacin. However, a range of drugs may show partial to complete relief in certain groups of patients. Neuromodulatory procedures, such as greater occipital nerve blockade, blockade of sphenopalatine ganglion and neurostimulation of the posterior hypothalamus, are reserved for refractory PH.
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Spinal cord stimulation (SCS) is minimally invasive and reversible therapy for treatment of severe, otherwise nonresponsive chronic pain. Such approach is relatively safe, with very few side-effects, not addictive, and provides enduring therapeutic response. ⋯ In addition, neurostimulation has been used to treat refractory angina, chronic abdominal pain, peripheral vascular disease, and vaso-occlusive syndromes. Clinical use of spinal cord stimulation is expanding at very fast pace, and new technological modalities in SCS will provide a new clinical evidence with likely better pain control.