Current pain and headache reports
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Fibromyalgia (FM) is a painful syndrome that is more common in women than in men. Whether FM has an organic basis or whether it is psychosomatic is debated. ⋯ Preliminary evidence indicates that melatonin, a molecule that is endogenously produced and is available as an over-the-counter supplement, may be effective in treating the pain associated with this syndrome. Although melatonin is commonly known as a sleep aid (sleep/wake problems are common in FM sufferers), it has a variety of other beneficial effects that may account for its potential benefits in the treatment of FM.
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There are mounting data supporting comorbidity of fibromyalgia syndrome (FMS) and psychiatric conditions. These include depression, panic disorders, anxiety, and post-traumatic stress disorder (PTSD). ⋯ A link between PTSD symptoms and FMS has been reported, and both conditions share similar symptomatology and pathogenetic mechanisms. Assessment of comorbid psychiatric disorders in FMS patients has clinical implications because treatment in these patients should focus both on physical and emotional dimensions of dysfunction.
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A family history of migraine is very frequently noted when evaluating a child for recurrent headaches. This implies an inherited or genetic basis as a component to the underlying pathophysiology. A variety of techniques have begun to elucidate this contribution, including historical observation, population-based studies including family and twin studies, gene polymorphism association studies, and specific gene identification for isolated migraine subtypes. This line of investigation should progress in the future to a better understanding of migraine and clarification of the diagnostic subtypes for a genotype-phenotype association.
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The red ear syndrome is a rare syndrome originally described by Lance in 1994. It involves pain in and around the ear and associated autonomic phenomena, the most significant of which is cutaneous erythema of the ear ipsilateral to the pain and obvious to the patient and examiner during the attack. It may well represent an auriculo-autonomic cephalgia and/or be part of the group of disorders recognized as trigeminal autonomic cephalalgias. As a syndrome, it still lacks specificity in regard to etiology, mechanisms, and treatment but is important to recognize clinically because of its associations.
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Successful management of pain in the cancer patient requires careful assessment of the components of the pain complaint and accurate diagnosis of the cause of pain. Symptomatic management of pain involves pharmacotherapeutic strategies that focus on opioid use. ⋯ Failure to continuously monitor opioid use generally results in overtreatment or undertreatment of pain. The cognitive and psychomotor effects of long-term opioid therapy are not well-defined and merit further study.