Current pain and headache reports
-
Although opioid analgesics are safe and effective tools for the treatment of moderate to severe pain, there remain large gaps in understanding of the effects of these drugs on the many dimensions of functioning. This article summarizes the biomedical evidence addressing cognitive effects of the opioid analgesics. Current evidence indicates that cognitive function can be influenced by use of opioid analgesics, although the effects vary between drugs, are thought to be most significant with mixed-activity drugs, codeine, propoxyphene, and meperidine, and are generally most concerning during the first few days after starting opioid therapy, before tolerance develops. Blanket policies regarding the activities of driving and working are inappropriate; this issue is best addressed on a patient-specific basis.
-
Curr Pain Headache Rep · Jan 2008
ReviewOccipital nerve stimulation for medically intractable headache.
There is an unmet need, and thus a continued search, for effective treatments for patients with chronic daily headache who do not respond to or tolerate conventional therapies. Recent interest has focused on the use of occipital nerve stimulation (ONS) to treat patients with chronic, disabling headaches who are not adequately controlled by usual therapies. ⋯ Electrical stimulation of the occipital nerve has both peripheral and central nervous system effects that modulate nociception. The exact role for ONS will evolve as our understandings of its physiologic effects, efficacy, and safety grow.
-
Patients with rheumatoid arthritis and osteoarthritis have relied upon NSAIDs as a cornerstone of their analgesic regime for decades. The choice of anti-inflammatory agents broadened for this group of patients when the selective inhibitors of cyclooxygenase-2 enzyme were developed. ⋯ This also led to a reevaluation of data concerning more traditional NSAIDs, and surprisingly, a similar trend was seen. The US Food and Drug Administration has recommended that both classes of drugs carry a black box warning with regard to gastrointestinal and cardiovascular risks.
-
Curr Pain Headache Rep · Dec 2007
ReviewThe post-NSAID era: what to use now for the pharmacologic treatment of pain and inflammation in osteoarthritis.
Traditionally, clinicians have relied heavily on the use of NSAIDs to treat the pain of osteoarthritis, as numerous studies have proven these agents effective. However, controversy has arisen regarding their use as first-line therapy, due to increasing awareness of their cardiovascular risks. ⋯ Although these agents may still be useful in many patients, concerns over side effects have begun to limit their use, and patients and clinicians are reaching for alternate agents. This review highlights the evidence behind the effectiveness of other, non-NSAID pharmacologic options in the treatment of pain and inflammation in osteoarthritis.
-
Curr Pain Headache Rep · Dec 2007
ReviewChallenges of nonpharmacologic interventions in chronic tension-type headache.
Interest in nonpharmacologic interventions for chronic tension-type headache has increased in recent years, with many professional organizations recommending behavioral treatments such as relaxation training, biofeedback, and cognitive-behavioral therapy alongside pharmacologic treatments. Although the efficacy of behavioral interventions is well-documented, several potential barriers in dissemination and implementation exist that have precluded more widespread adoption of behavioral treatments. This article briefly reviews the core components and efficacy of behavioral treatments for tension-type headache and outlines challenges to their broader clinical use as they occur at the levels of empirical research, treatment availability and delivery, and common clinical problems. Strategies for addressing these challenges are suggested, and directions for needed research are noted.