Current pain and headache reports
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Although medication costs make up one of the smallest portions of the overall expense of headache care, it is the segment of expense that often impacts the patient most directly. The advent of triptans marked a major advance in migraine therapy, but their high cost has limited their widespread use. ⋯ These include compulsory licensing, exclusive contracting, over-the-counter -availability, and the introduction of generic triptans. Each method impacts the consumer, third-party payer, or pharmaceutical company in a different manner.
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Curr Pain Headache Rep · Apr 2009
ReviewDoes spirituality as a coping mechanism help or hinder coping with chronic pain?
Chronic pain is a complex experience stemming from the interrelationship among biological, psychological, social, and spiritual factors. Many chronic pain patients use religious/spiritual forms of coping, such as prayer and spiritual support, to cope with their pain. This article explores empirical research that illustrates how religion/spirituality may impact the experience of pain and may help or hinder the coping process. This article also provides practical suggestions for health care professionals to aid in the exploration of spiritual issues that may contribute to the pain experience.
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Curr Pain Headache Rep · Apr 2009
ReviewResources for education on pain and its management: a practitioner's compendium.
Knowing enough information about pain and its management to adequately care for people in pain may seem challenging, especially for primary care providers who provide the bulk of pain management services in the United States. Few, if any, primary care providers received training beyond the names of a few analgesics and the rudiments of pain assessments. ⋯ Education may be tied to pain certification or specialization, or provided solely for the benefit of practitioners. Due in large part to the World Wide Web, much information about pain is readily available online.
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Curr Pain Headache Rep · Apr 2009
ReviewAre opioids associated with sleep apnea? A review of the evidence.
Chronic opioid use for nonmalignant pain has increased dramatically; nonillicit unintentional deaths have also increased. This article reviews the physiology of breathing, effects of sleep on respiration, effects of opioids on respiration, potential interactions between sleep and opioids on respiration, and current evidence that chronic opioid use is associated with sleep-disordered breathing.
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Cluster headache (CH) is a highly disabling condition resulting in severe, recurrent unilateral bouts of pain and accompanying autonomic symptoms. This review describes some current views regarding the underlying pathophysiology covering the pain and cranial autonomic (parasympathetic) activation, and highlights the potential importance of the hypothalamus in CH. ⋯ Hypothalamic structures are likely to underlie the circadian and circannual periodicity of attacks and contribute to the pain and autonomic disturbances. We discuss the hypothalamic involvement in CH and modulation of trigeminovascular processing and examine the emerging involvement of the hypothalamic orexinergic system as a possible key pathway in CH pathophysiology.