Current pain and headache reports
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Curr Pain Headache Rep · Aug 2008
ReviewAssessment and management of breakthrough pain in cancer patients: current approaches and emerging research.
Cancer pain is highly prevalent and often severe. Fortunately, most cancer pain can be readily managed, with up to 90% of patients responding well to standard interventions. However, breakthrough cancer pain-brief flares of severe pain superimposed on baseline pain-is common, difficult to manage, and often negatively impacts patients' quality of life. ⋯ However, because of its sudden onset and severity, oral opioids often fall short of providing adequate control. Research into novel approaches to pain management has identified several innovative strategies for this difficult cancer pain problem. We describe current approaches to assess, define, characterize, and treat breakthrough cancer pain, and summarize recent clinical research on novel agents, novel routes of drug delivery, and other advances in its management.
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Caffeine is the most widely consumed psychostimulant drug in the world. With intermittent exposures, caffeine may act as a mild analgesic for headache or as an adjuvant for the actions of other analgesics. ⋯ At dosages achieved by common dietary intake, caffeine acts as a potent antagonist of central and peripheral nervous system adenosine receptors. The complex effects of caffeine on headache disorders suggest important roles for adenosine in these disorders and in the induction of caffeine dependency.
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Curr Pain Headache Rep · Aug 2008
ReviewAssessment and management of psychiatric issues during cancer treatment.
Since its beginnings in the mid-1970s, the field of psycho-oncology has developed rapidly. A substantial body of literature has evolved toward identifying key issues for psychiatric treatment and care management of cancer patients. The spectrum of cancer care encompasses patient experiences through initial diagnosis, active treatment, after-care and survivorship, as well as palliative care and end-of-life. This article highlights recognition and management of psychiatric syndromes in the context of cancer care.
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Pain is highly prevalent in cancer patients and primarily managed by medical oncologists. This article reviews cancer pain syndromes related to cancer and sequelae of treatment. ⋯ There are numerous barriers to care, which arise from both the physician and patient. We review approaches that diminish these barriers to improve treatment of cancer pain.
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The term ophthalmoplegic migraine (OM) was first coined by Charcot in 1890. This condition was included as a migraine variant in the first Headache Classification of the International Headache Society in 1988. Based on postcontrast enhancement seen on MRI in some patients who were diagnosed with OM, there was a suggestion that this could be an inflammatory/demyelinating disorder; therefore, it was moved out of the "migraine" group and repositioned as a "neuralgia" in the revised 2004 classification. ⋯ Based on a survey of literature on OM in the post-imaging era, this article highlights the fact that enhancement on magnetic resonance is not a sine qua non for the diagnosis of OM. Some diagnostic dilemmas are discussed, and a protocol is included for documentation of clinical findings in future case reports on a prospective basis. Hopefully, this will help in modification of the criteria, better understanding the etiology, correct diagnosis, and determining appropriate treatment for OM.