Current pain and headache reports
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Curr Pain Headache Rep · Mar 2016
ReviewNew Pain Management Options for the Surgical Patient on Methadone and Buprenorphine.
Perioperative management of patients receiving opioid addiction therapy presents a unique challenge for the anesthesiologist. The goal of pain management in this patient population is to effectively manage postoperative pain, to improve patient satisfaction and outcomes, and to reduce the cost of health care. Multimodal analgesics, including nonsteroid anti-inflammatory drugs, intravenous acetaminophen, gabapentanoid agents, and low-dose ketamine infusions, have been used to improve postoperative pain and to reduce postoperative opioid use. ⋯ Other postoperative pain management options include patient-controlled analgesia, intravenous, and transdermal, in addition to neuraxial and regional anesthesia techniques. Special patient populations include the parturient on long-term opioid therapy. Recommendations for use of opioids in these patients during labor and delivery and in the postpartum period are discussed.
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Chronic migraine is defined as having more than 15 headache days in a month, half of these showing migraine features, for at least 3 months. It is a chronic painful syndrome with aspects such as psychiatric comorbid, decreased quality of life, and environmental and intrinsic psychological factors that make face-to-face treatment difficult. Children and adolescent migraine differ from adults as a result of growing brain and evolving disorder. In this paper, we will emphasize the definition, diagnosis, epidemiology, burden of life, and management of chronic migraine in children and adolescent.
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Presently, the gold standard for pain control in laboring patients is neuraxial blockade, which includes a spinal, epidural, or a combined spinal-epidural technique. In conjunction with neuraxial blockade or by itself, some of the other agents employed related to labor pain include opioids, non-opioids, nitrous oxide, patient-controlled analgesia (PCA), and distraction therapy. Alternative treatments include acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques. ⋯ There are limited published data on the use of acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques in the alleviation of labor pain. These alternative therapies maybe considered as an adjuvant as the analgesic efficiency is inferior to that provided by typical standard pharmacotherapy. Future studies are warranted to evaluate the role of immersion virtual reality in alleviating labor pain.
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Curr Pain Headache Rep · Jan 2016
ReviewUpdate on the Pharmacological Treatment of Chronic Migraine.
Chronic migraine (CM) is a common and disabling disorder that remains underdiagnosed and poorly treated. Significant unmet therapeutic needs add to the burden of this disorder; even when CM is recognized, effective treatment options are limited and randomized controlled trials supporting the use of various preventive medications are sparse. In this review, we discuss the available options for CM treatment. ⋯ Advancements in the understanding of migraine pathogenesis have identified new targets for both acute and preventive treatment and have engendered the development of targeted and mechanism-based therapies. The need for more effective treatment for CM patients, which has long since been identified, is now being addressed. Several of the emerging treatments for migraine prevention are under investigation specifically for CM or high-frequency episodic migraine.
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Curr Pain Headache Rep · Jan 2016
ReviewUpdate of Inpatient Treatment for Refractory Chronic Daily Headache.
Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. ⋯ Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.