Current pain and headache reports
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Curr Pain Headache Rep · Feb 2006
ReviewRational multidrug therapy in the treatment of neuropathic pain.
Multidrug therapy (MDT) has been widely accepted and used as a standard of practice in most areas of medical practice, including neuropathic pain. Because neuropathic pain is a new field of medical science and practice, standards for its treatment including MDT are still evolving. In this article, we present rationale and principals for the MDT of neuropathic pain based on our best understandings of the underlying mechanisms of the disease processes and the actions of drugs, the goal being to maximize benefits and minimize adverse effects. MDT for neuropathic pain is based on a comprehensive clinical neuropathic pain assessment and ongoing monitoring of the drug therapy's efficacy and adverse effects, administering one drug at the time.
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Curr Pain Headache Rep · Feb 2006
ReviewNeuropsychologic aspects of post-traumatic headache and chronic daily headache.
The management of patients with chronic refractory head pain remains a treatment challenge. Treatment focus should be multidisciplinary as patients evolve into a deteriorated status with psychologic, social, vocational, and cognitive dysfunction. ⋯ The patient with post-traumatic head pain copes with head injury sequelae. Issues related to worker's compensation, insurance, disability decisions, and litigation are intrinsic to these patient groups.
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Curr Pain Headache Rep · Feb 2006
ReviewIntravenous treatment of chronic daily headaches in the outpatient headache clinic.
The most likely future of aggressive headache treatment will reside in the sphere of the specialist's clinic. This is a far more cost- and time-effective mode of treating intractable chronic daily headaches (CDH), including chronic migraines. We have used this technique successfully in our clinic for many years. ⋯ Patients can be offered a maximum degree of success for control of their intractable headaches. In this article, approaches to aggressive treatment of ongoing CDH using intravenous methods of therapy are discussed. All of these can be performed in the clinic setting, avoiding some of the costly aspects of treatment that are present in an emergency room setting.
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Curr Pain Headache Rep · Dec 2005
ReviewThe use of opioids in the treatment of osteoarthritis: when, why, and how?
As life expectancy increases every decade, the incidence and prevalence of osteoarthritis (OA) also will increase. Despite progress in our knowledge of the pathophysiology of OA, the management of OA-mediated pain continues to challenge physicians. Concern regarding the cardiovascular effects of cyclooxygenase-2 inhibitors and the gastrointestinal and renal side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in general has limited the use of these medications in the management of chronic non-cancer pain. ⋯ When used as part of a multimodal approach to pain control, opioids are a safe and effective treatment for joint pain, including that of OA. Patients for whom NSAIDs are contraindicated, or for whom combined acetaminophen, tramadol, and NSAID therapy is ineffective, may be started on low-dose opioids and titrated as needed and tolerated. Patient education and informed consent, exercise, complementary medicine, and the use of a controlled substance agreement increases the likelihood of patient compliance with treatment guidelines, improving functional capacity and quality of life.