Current pain and headache reports
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Curr Pain Headache Rep · Oct 2022
ReviewThe Role of the Autonomic Nervous System in Headache: Biomarkers and Treatment.
In this review, the role of the autonomic nervous system in tension-type headache and migraine is reviewed. ⋯ A pathophysiological model for tension-type headache is proposed that is compatible with most physiological and behavioral literature. A treatment protocol is described that follows from this model. For migraine, incorporating autonomic factors into the pathophysiology offers rationales for behavioral interventions that have been shown to be useful in migraine treatment and a biofeedback protocol is proposed.
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Curr Pain Headache Rep · Oct 2022
ReviewPlatelet-Rich Plasma Injections: Pharmacological and Clinical Considerations in Pain Management.
Regenerative medicine through interventional pain procedures is evolving with data demonstrating efficacy for a number of pain states in recent years. Platelet-rich plasma (PRP), defined as a sample of plasma with a platelet concentration 3 to 5 times greater than the physiologic platelet concentration found in healthy whole blood, releases bioactive proteins which can restore anatomical function in degenerative states. PRP is dense in growth factors, such as platelet-derived growth factor, transforming growth factor-beta1, basic fibroblastic growth factor, vascular endothelial growth factor, and epidermal growth factors. ⋯ To date, well-designed case-control or cohort studies for the use of PRP have demonstrated efficacy in lumbar facet joint, lumbar epidural, and sacroiliac joint injections. At present, there is only level IV evidence indicating the need for larger and more carefully controlled prospective studies. PRP is utilized autogenously in order to facilitate healing and injection and has been studied in the long-term management of discogenic low back pain. In this regard, numerous studies have evaluated PRP to steroid injections in chronic pain states with favorable results. PRP represents an opportunity for a new strategy in the therapeutic treatment of degenerative states of spines, joints, and other locations throughout the body with evolving data demonstrating both safety and long-term efficacy.
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Curr Pain Headache Rep · Oct 2022
ReviewPelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain.
Female urogenital pain (FUGP) affects many women and is often a diagnosis of exclusion. The long path to a diagnosis and subsequent treatment frequently leads to suffering on the individual's behalf (Obstet. Gynecol. 121: 645-50, 2013). Additionally, this delay in diagnosis and thus treatment places stress on the US medical system (Obstet. Gynecol. 121: 645-50, 2013). There is a lack of knowledge regarding the scope of pelvic floor physical therapy (PFPT) across the medical community that may prevent physicians from referring patients (J Urol. 193:1545-53, 2015; Sex Med Rev., 2021). PFPT is a low-risk, potentially high-reward option that should be recognized as part of the multidisciplinary approach to managing FUGP. ⋯ Research databases (PubMed and Cochrane) were used to find articles on FUGP between 2005 and 2022. Systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohorts, and case-study analyses were included in reviewing the literature. The most recent studies in the last 2 years show the benefit of PFPT in certain FUGP diagnoses with improved pain scores and function when compared to no intervention or placebo treatment. The aim of this article is to elucidate the scope of PFPT in the treatment of FUGP with supporting research findings regarding efficacy. It is clear from the literature that PFPT should be recognized by referring physicians as part of a multidisciplinary approach to the treatment of FUGP.
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Curr Pain Headache Rep · Oct 2022
ReviewGiant Cell Arteritis: A Case-Based Narrative Review of the Literature.
Giant cell arteritis (GCA) is a chronic, inflammatory condition, primarily affecting the medium and larger arteries. The purpose of this narrative review is to describe GCA in the context of headache and facial pain, based on a case and the available current literature. Understanding the etiology, pathophysiology, the associated conditions, and the differential diagnoses is important in managing GCA. ⋯ In a patient presenting with unilateral facial/head pain with disturbances of vision, GCA should be considered in the differential diagnosis. There is an association of GCA with several comorbid conditions, and infections including coronavirus-19 (COVID-19) infection. Management of GCA primarily depends upon the identification of the affected artery and prompt treatment. Permanent visual loss and other serious complications are associated with GCA. GCA is characterized by robust inflammation of large- and medium-sized arteries and marked elevation of systemic mediators of inflammation. An interdisciplinary approach of management involving the pertinent specialties is strongly recommended.