Current pain and headache reports
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Curr Pain Headache Rep · Jan 2013
ReviewPeripheral neuromodulation and headaches: history, clinical approach, and considerations on underlying mechanisms.
Implantable peripheral neurostimulation was introduced in 1969 as a potential treatment for certain neuropathic pain syndromes, primarily involving the limbs. While a few early studies included implants for occipital neuralgia, serious interest in its potential as a treatment for head pain came only after our 1999 report of positive findings in a series of patients with occipital neuralgia. ⋯ While most found a therapeutic response, the degree of that response varied significantly, and analysis suggests that the issue of paresthesia concordancy may be central, both in explaining the data, as well as providing direction for future endeavors. Therefore, while at present peripheral neurostimulation is gaining increasing acceptance as a treatment for chronic headaches, the precise clinical indications and procedures, as well as the underlying neurophysiological mechanisms, are still being worked out.
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Since its original description in 1990, blockade of the ganglion impar (ganglion of Walther) has become a widely used intervention in the management of pelvic and perineal pain. We review the indications, techniques, and evidence for this pain intervention.
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Interventional pain procedures are critical in the diagnosis and management of a variety of facial pain conditions. Trigeminal neuralgia (TN) is the most frequent diagnosis for facial pain, with a reported prevalence 10 times greater than persistent idiopathic facial pain (PIFP). Although pharmacological treatments and psychological interventions benefit many patients with these diagnoses, the pain remains disabling for a significant portion of others. Percutaneous interventions targeting the gasserian ganglion and its branches have proven effective in the management of TN, while there is also supportive evidence for treating the sphenopalatine ganglion in PIFP.
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Curr Pain Headache Rep · Dec 2012
ReviewPsychological issues in the evaluation and treatment of tension-type headache.
Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic tension-type headache, is rarely impairing, more frequent tension-type headache can occur with significant disability and psychological comorbidity. Appreciating the psychological impact, assessing the associated biopsychosocial issues, and understanding patients' coping styles are important in forming an appropriate treatment plan and maximizing treatment outcomes. ⋯ This may be particularly applicable to special populations, including pediatric patients, pregnant patients and geriatric. Psychological assessment and treatment may be done conjointly with medication management and expands treatment options. There is great need to continue researching the effects of psychological treatments, standardizing interventions and making them available to the wider population.
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Curr Pain Headache Rep · Dec 2012
ReviewImaging pain in arthritis: advances in structural and functional neuroimaging.
Arthritis is a heterogeneous disease characterized by joint stiffness, swelling, and pain. Although primarily considered a peripheral joint disease, the severity of pain reported by arthritis patients does not always reflect the extent of joint pathology detectable by conventional means. ⋯ Of these methods, functional magnetic resonance imaging is exploited for short-term evoked pain examination and treatment evaluation; 'resting-state' approaches provide insight into fluctuations in pain; perfusion imaging captures elements of on-going clinical pain; and morphological brain assessment provides evidence for long-term structural changes in the brain associated with chronic pain. Further insight into arthritic pain processing at the brain-systems level could in the future be provided by combined neuroimaging approaches, specifically investigating the interactions between functional and structural alterations.