Current pain and headache reports
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Recent advances in the development and administration of chemotherapy for malignant diseases have led to prolonged survival of patients and the promise of a return to normal lives. This progress comes with a price, however, and the nervous system is frequently the target of therapy-induced toxicity. Unlike more immediate toxicities that affect the gastrointestinal tract and bone marrow, chemotherapy-induced neurotoxicity is frequently delayed in onset and may progress over time. In the peripheral nervous system, the major brunt of the toxic attack is directed against the peripheral nerve, targeting the neuronal cell body, the axonal transport system, the myelin sheath, and glial support structures, resulting in chemotherapy-induced peripheral neuropathy.
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Curr Pain Headache Rep · Jun 2008
ReviewMigraine prevention trials and optimized acute therapy: translating lessons learned into clinical practice.
Different classes of drugs, discovered by serendipity, have been used successfully for migraine prevention for more than 40 years. The progressive knowledge of migraine pathophysiology, brain hyperexcitability, and the specific neurotransmitter systems involved in pain perception has driven the attempts at targeting two crucial mechanisms: the restoration of nociceptive dysmodulation and the inhibition of cortical hyperexcitability. ⋯ With the clinical application of this updated information from clinical trials, migraine impact on productivity, quality of life, and suffering will certainly be diminished. We hope that these achievements will create a stable path of management to benefit our patients, without interruption, into the foreseeable future.
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Curr Pain Headache Rep · Jun 2008
ReviewOptimizing circadian cycles and behavioral insomnia treatment in migraine.
Sleep regulation may play a key role in headache management for individuals with migraine. At least among individuals with a predisposition to headache, episodes may be provoked by sleep deprivation or excess, as well as by sleep disorders. Chronobiological patterns have been identified in some forms of headache, including migraine. ⋯ Because sleep represents a potentially modifiable vulnerability to headache, practitioners may wish to consider strategies that restore sleep homeostasis. Behavioral strategies are effective for regulation of sleep and may be abbreviated for headache medical practice settings. This article discusses the nature and prevalence of sleep complaints in migraineurs, conceptualization, and behavioral management of insomnia in the headache practice setting.
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Peripheral neuropathies of identical etiology can be painful or painless. The reason for this difference in clinical presentation is as yet unknown; however, immune mediators, particularly cytokines, may play a role. Cytokines are proteins that are produced by immune and nonimmune cells and are categorized as pro- and anti-inflammatory. ⋯ A proinflammatory cytokine profile seems to be associated with pain in peripheral neuropathies of different etiologies and in other painful disorders such as the complex regional pain syndrome. Specifically, an imbalance between pro- and anti-inflammatory cytokines may contribute to pain generation. A better understanding of the underlying pathophysiology may open new opportunities for the treatment of pain.
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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.