Current pain and headache reports
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Curr Pain Headache Rep · Aug 2008
Case ReportsPain management in palliative care oncology patients.
Palliative care is an interdisciplinary approach to relieving aversive symptoms in people with life-threatening illnesses; it aims to improve the lives of patients and their loved ones, the "patient-family unit." Palliative care should occur in parallel with all other medical interventions. Indeed, good symptom management is important in helping patients cope with the unpleasantness associated with potentially curative or life-prolonging interventions; it is absolutely essential near the end of life. ⋯ When systemic medications fail, due to inadequate analgesia or burdensome side effects, invasive techniques may complement, or replace, systemic therapy. Using a case-based format, we illustrate some complex issues that clinicians face and offer strategies to improve the lives of oncology patients with pain.
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Curr Pain Headache Rep · Jun 2008
ReviewFacilitating communication with patients for improved migraine outcomes.
Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. ⋯ The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.
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Curr Pain Headache Rep · Jun 2008
ReviewEvolving understandings about complex regional pain syndrome and its treatment.
Complex regional pain syndrome (CRPS) is still a puzzling disease. Although pathophysiologic understanding has improved, not every aspect of this challenging neuropathic pain syndrome has been explored. Typical symptoms of CRPS are sensory, motor, and autonomic dysfunctions. ⋯ Treatment usually requires a multidisciplinary approach, including medical and nonmedical therapies. The common therapeutic aim is to maintain or restore normal function of the affected extremity. Beyond highlighting pathophysiologic concepts, this article describes recent therapeutic approaches.
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Curr Pain Headache Rep · Jun 2008
ReviewStatus of immune mediators in complex regional pain syndrome type I.
Complex regional pain syndrome type I (CRPS-I) can affect an extremity after minor trauma or operation. The pathogenesis of this syndrome is unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response, but neurogenic dysregulation is also a contributor. ⋯ An induction of CRPS-like symptoms by application of neuroinflammatory mediators was shown recently. Local inflammation is involved in the pathophysiology of CRPS-I. We must expand our knowledge of pathophysiologic mechanisms, and we are still far away from using inflammatory markers in diagnosis and follow-up of CRPS-I.
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Curr Pain Headache Rep · Jun 2008
ReviewPutative mechanisms of the relationship between obesity and migraine progression.
Studies suggest that obesity is associated with migraine progression from an episodic into a chronic form. We discuss putative mechanisms to justify this relationship. Several of the inflammatory mediators that are increased in obese individuals are important in migraine pathophysiology, including interleukins and calcitonin gene-related peptide. ⋯ Substances that are important in metabolic control are nociceptive at certain levels. Hypothalamic dysfunction in the orexin pathways seems to be a risk factor for both conditions. In addition, we discuss the importance of metabolic syndrome and autonomic dysfunction in modulating the obesity/migraine progression relationship.