Current pain and headache reports
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Idiopathic intracranial hypertension is a secondary headache disorder characterized by headaches and visual symptoms. It most frequently occurs in obese women of childbearing age. However, many secondary causes exist, and it may affect children, men, and slim individuals. Prompt recognition, evaluation, and treatment are needed to prevent permanent visual loss.
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Curr Pain Headache Rep · Feb 2007
ReviewExtended-duration agents for perioperative pain management.
Perioperative pain management has drastically evolved over the years to satisfy current unmet needs. Intermittent delivery of drugs has been replaced by continuous delivery systems involving oral, neuraxial, and peripheral nerve block routes of administration. One current standard of perioperative pain management is an epidural injection of an opioid such as morphine, fentanyl, or hydromorphone, with or without the addition of a local anesthetic, such as bupivacaine. ⋯ This class of drugs comprises MS Contin (Purdue Pharma LP, Stamford, CT), OxyContin (Purdue Pharma LP), Opana ER (Endo Pharmaceuticals, Chadds Ford, PA), and DepoDur (Endo Pharmaceuticals). There are also phase II trials in progress examining controlled-release formulations of local anesthetics. This review discusses extended- and controlled-release agents administered perioperatively.
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Peripheral nerve blockade (PNB) for orthopedic surgery is usually performed without visual guidance, relying mainly on surface anatomic landmarks and electrical stimulation to localize nerves. Moreover, multiple trial and error attempts to place a needle can frustrate the operator, cause unwarranted pain to the patient, and waste valuable time in the operating room. ⋯ The recent application of ultrasound (US) to PNB affords real-time imaging of the target nerve, needle, and surrounding vasculature, such that needle proximity to the nerve is ensured and vascular puncture avoided. This article reviews the advantages, principles, and techniques of US for the most common types of PNB.
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Spontaneous intracranial hypotension (SIH) is caused by leakage of cerebrospinal fluid (CSF), with resultant CSF hypovolemia and intracranial hypotension. Although in some patients SIH may be preceded by minor trauma, it often occurs in the absence of any identifiable initiating event. ⋯ Treatment ranges from conservative management, such as bed rest and hydration, to invasive procedures, such as lumbar puncture with autologous blood patch, CT-guided fibrin glue injection at the site of the leak, and open surgical intervention. Outcomes vary from complete resolution of CSF leak with alleviation of symptoms to continued and/or recurrent leaks with chronic unremitting symptomatology.
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Curr Pain Headache Rep · Feb 2007
ReviewInterventions for low back pain: what does the evidence tell us.
Although interventional therapy for chronic spinal pain continues to be popular among patients and providers, the scientific evidence supporting these techniques has lagged behind their presence in the market. This article collates both classic and more recent experimental results involved in the interventional assessment and treatment of chronic spinal pain, and presents key findings for physicians. Although much of the body of evidence is either unsupportive or inconclusive, there are some definitive findings involving each technique that can help shape rational practice. As interventional pain medicine seeks to become a more validated specialty, introspection and advancing science will be key to this development.