Current pain and headache reports
-
After several decades of senescence, the twin fields of hyperuricemia and gout have again regained attention in both the scientific and clinical spheres, and this review highlights several recent advancements. Specifically, we review newly discovered mechanisms of uric acid-induced inflammation, uric acid's putative role as a "danger signal" in innate immunity, the possible link between hyperuricemia and cardiovascular disease, and evolutionary evidence suggesting that hyperuricemia conferred a survival advantage in primates (when the gene for uricase was lost) several million years ago. Finally, we provide an overview of the current approach to gout, as well as what treatments are on the horizon.
-
During the past 2 years, a great deal of evaluation has been conducted on the cardiovascular (CV) effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase (COX)-2 inhibitors. This review focuses on the effects of the NSAIDs and COX-2 inhibitors on blood pressure and CV events. Clinical trial databases for NSAIDs and COX-2 inhibitors have shown varying levels of destabilization of blood pressure control in treated hypertensive patients as well as variable incident rates of the development of arrhythmias, congestive heart failure, myocardial infarction, and stroke. Nonselective and COX-2 selective NSAIDs can be used carefully in arthritis patients with hypertension and stable CV disorders (excluding congestive heart failure and moderate to severe kidney dysfunction) when the individual clinical benefit of anti-inflammatory therapy outweighs the CV and gastrointestinal risk.
-
Curr Pain Headache Rep · Oct 2007
ReviewTreatment of chronic low back pain with botulinum neurotoxins.
In a double-blind, randomized, placebo-controlled study, administration of botulinum toxin A (Botox; Allergan Inc., Irvine, CA) into paraspinal muscles using a novel technique produced significant pain relief in 60% of patients with chronic, refractory low back pain. A similar yield of 53% was noted in a prospective, randomized, open-label study of 75 patients, with 14 months of follow-up. In this study, an early response predicted later responsiveness, with 91% of the responders continuing to respond to repeat injections. ⋯ The dose per injection site was 50 U (Botox), with the total dose per session not to exceed 500 U. Side effects were uncommon and consisted of a transient, mild flu-like reaction in 5% of the patients. Botulinum treatment of paraspinal muscles can reduce pain in a substantial number of patients with refractory chronic low back pain and is safe in the recommended doses.
-
Headaches represent one of the most common reasons why children and adolescents seek medical attention and are the primary reason that they are referred to pediatric neurology practices. The most common headache syndromes diagnosed are migraine, tension-type, and chronic daily headache, and the bulk of recent medical literature regarding headache in children has focused on these clinical entities. ⋯ The most intriguing subset included in the International Headache Society's classification system is the so-called "periodic syndromes of childhood that are precursors to migraine." These syndromes, quite peculiar to children, present a wide variety of episodic symptoms, including movement disorders, vomiting, ataxia, and vertigo, and may not include headache at all. This article provides an overview of some of the more unusual headache syndromes in children and adolescents.
-
Headache may be considered primary or secondary, and secondary headaches may be caused by intracranial disorders or medical/systemic disorders. In many cases, headache may be a presenting symptom of the medical disorder, and accurate diagnosis will lead to specific treatment. ⋯ Medical causes of headache are so diverse that uniform screening tests are not useful. History and examination must guide the differential diagnosis, and management plans must be individualized.