Current pain and headache reports
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Curr Pain Headache Rep · Apr 2006
ReviewChronic widespread pain and psychiatric disorders in veterans of the first Gulf War.
More than 10% of the 700,000 American troops who served during the first Gulf War (GW) are receiving treatment for a constellation of diffuse and frequently poorly defined medical and psychiatric symptoms that have been designated the GW syndrome by both clinicians and the popular media. The current clinical consensus is that the symptoms reported in GW veterans are the sequela of combat and other stressful events that have been identified in the veterans of other wars and armed conflicts. ⋯ Research has confirmed a close bimodal relationship between chronic pain and psychiatric symptoms. Investigators are now exploring the efficacy of treatment approaches that address the close relationship between chronic pain and mental illness in this challenging patient population.
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Curr Pain Headache Rep · Apr 2006
ReviewAre functional capacity evaluations affected by the patient's pain?
Functional capacity evaluations (FCE) are comprehensive batteries of performance-based tests used commonly to inform return-to-work decisions for injured workers. As many people undergoing FCE have painful musculoskeletal conditions limiting their work ability, pain becomes a critical factor in the assessment of function. This paper considers the available literature related to the influence of pain on FCE, which clearly indicates FCEs are behavioral assessments influenced by pain intensity and other pain-related constructs. ⋯ As such, for purposes of claims adjudication, FCE should not be considered a purely "objective" indicator of functional impairment independent of subject or evaluator perceptions. FCE may have some value for facilitating return-to-work or re-integrating chronically disabled workers into the workforce, although pain factors must be taken into consideration when making predictions about future work status. Shorter FCEs could potentially be as effective as more lengthy protocols.
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Cluster headache has been defined by the International Headache Society (IHS) as one of the primary headaches. A primary headache is a headache that has no other known cause, such as infection or trauma. ⋯ The IHS has described cluster headache as "attacks of severe, strictly unilateral pain that is orbital, supraorbital, temporal or in any combination of these sites, lasting 15 to 180 minutes." In the author's practice, as a dentist treating orofacial pain, patients with cluster headache have dental or midfacial complaints as a primary presentation. This paper introduces such presentations based on interviews with cluster headache patients, with the main purpose of having midfacial complaints considered as an important presentation to be added to the IHS diagnostic criteria for cluster headache.
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Curr Pain Headache Rep · Apr 2006
Review Case ReportsCluster headache: a case-based review of diagnostic and treatment approaches.
Cluster headache is one of the worst pain syndromes known to mankind. Medical treatment is highly effective in most cases, but because cluster headache is rare, many physicians are not familiar with the details of its management. This article reviews three common presentations of cluster headache to illustrate standard approaches to its treatment. Algorithms for acute, preventive, and transitional (bridge) therapy are provided.
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Chronic pain is one of the frequently encountered clinical problems that is difficult to cure. Hyperbaric oxygen (HBO) therapy has been reported in chronic pain syndromes with promising results. In this review, we focus on the effectiveness of HBO in fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. ⋯ However, physicians performing HBO must be aware of oxygen toxicity. Another problem regarding HBO is the scarcity of centers administering it. Further research is required focusing on the optimal treatment protocol, the cost/benefit ratio, and the safety of HBO in chronic pain management.