Current pain and headache reports
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Fibromyalgia syndrome (FMS) is now understood as a chronic pain syndrome, and recent evidence indicates it is not a pure psychosomatic disorder. We review the current knowledge in FMS pain pathways, focusing on the central system sensitization phenomenon and the abnormalities in the inhibitory pain systems. ⋯ These features include the nerve growth factor actions and failure of the endocannabinoid system. In addition, we review new immunological aspects of FMS, both in their humoral (autoantibodies, antipolymer antibodies) and cytokine (interleukin-2) aspects.
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Curr Pain Headache Rep · Oct 2008
ReviewNeuromodulators for the treatment of headache disorders and fibromyalgia.
Migraine and fibromyalgia are prevalent and disabling disorders with few preventive medications approved by the US Food and Drug Administration (FDA). Neuromodulators (or antiepileptic drugs; AEDs) are often effective in the treatment of these conditions. ⋯ For fibromyalgia, pregabalin has recently been approved in the United States. We review the use of AEDs in the preventive treatment of these highly prevalent disorders.
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Curr Pain Headache Rep · Oct 2008
ReviewCentral mechanisms in the maintenance of chronic widespread noninflammatory muscle pain.
Chronic widespread pain (CWP) conditions such as fibromyalgia and myofascial syndromes are characterized by generalized pain, tenderness, morning stiffness, disturbed sleep, and pronounced fatigue. However, CWP pathophysiology is still unclear. A number of hypotheses have been proposed as the underlying pathophysiology of CWP: muscular dysfunction/ischemia, central sensitization, and a deficit in endogenous pain-modulating systems. ⋯ Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models. These changes likely reflect alterations in supraspinal modulation of nociception, and include increases in excitatory and decreases in inhibitory modulation pathways. These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization, and the consequent pain and hyperalgesia.
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Curr Pain Headache Rep · Oct 2008
ReviewReligiousness and spirituality in fibromyalgia and chronic pain patients.
The influence of psychosocial factors on pain experience and patient response has received increasing interest and recognition. Patients with chronic pain from several sources (eg, musculoskeletal, cancer, or sickle cell) usually report that religiousness and spirituality are important in their lives. ⋯ The best available evidence supports a positive association between religiousness and spirituality, with higher well-being and positive affect, and a negative association with depressive and anxiety symptoms. We discuss the importance of addressing spiritual issues in clinical practice, and increasing and improving research on religiousness/spirituality in chronic pain patients.
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The high incidence and prevalence of headaches in the pediatric population has a significant impact on patients and their families. Migraine, the most common headache disorder for which pediatric patients see a physician, remains underdiagnosed. ⋯ This article presents limitations of the present diagnostic criteria for migraine, and the proposed modifications to these criteria may assist the clinician with early recognition. Further research in pediatric headaches is needed to help reveal additional pathophysiologic mechanisms and improve diagnostic criteria.