Current pain and headache reports
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Curr Pain Headache Rep · Feb 2004
ReviewTreatment of cervicothoracic pain and cervicogenic headaches with regenerative injection therapy.
Significant progress has been made in interventional pain management. Despite this progress, patients continue to present a diagnostic and therapeutic challenge. ⋯ Several placebo-controlled studies, together with uncontrolled studies, indicate the effectiveness of regenerative injection therapy in treating painful ligament and tendon pathology. As stated in July 2003 by Mooney, this treatment has advanced "from the fringe to the frontier of medical care."
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Estrogen exerts a strong influence on episodic headaches, such as migraine and tension-type headache. A relationship between sex hormones and chronic daily headache (CDH) is less well established. ⋯ In addition, gender differences in CDH prevalence in pediatric and adult populations support a hormonal influence. Few studies have evaluated the ability of gynecologic events, such as menses, to influence CDH.
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Curr Pain Headache Rep · Feb 2004
Radiation risk management during fluoroscopy for interventional pain medicine physicians.
Because of serious radiographic-induced skin injuries that may have been caused by the inappropriate use of fluoroscopy during the performance of radiograph-guided invasive procedures, the US Food and Drug Administration (FDA) issued an advisory in 1994 suggesting that the key to preventing such unfortunate mishaps may be physician education, training, and credentialing in the safe operation of fluoroscopic equipment. The purpose of this article is to familiarize the interventional pain medicine physician with the physics of ionizing radiation and how to limit patient exposure through the optimum setting of tube current and voltage, the use of limited beam-on time, tight collimation, and the elimination of the nonessential use of the magnification mode on a fluoroscopy unit. In addition, the use of personal protection equipment and the knowledge needed to interpret the personal exposure record of each practitioner is discussed. All of this information will assist the interventional pain medicine physician in meeting the recommended FDA training and credentialing requirements.
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Chronic daily headache is a significant problem in children and adolescents. The goal of this review is to paint a picture of this malady. The epidemiology is unclear because definitions have not been uniform. ⋯ Because the disease duration and the transformation period are so different in children with this disorder, shoehorning children into adult criteria may be problematic. Nevertheless, this article presents an approach to diagnosis and treatment based on what is present in the literature, what has worked with adults, and the consensus among pediatric headache practitioners. Because there is little literature on this subject, the review ends with a series of questions for future study.
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Most neuropathic analgesic medications have been introduced initially for other medical conditions. Anticonvulsants, local anesthetics, and antidepressants later were found to be effective in the treatment of neuropathic pain. Carbamazepine and the newer anticonvulsants such as gabapentin, lamotrigine, topiramate, and oxcarbazepine are being used as first-line or adjunctive therapy. ⋯ All of the available analgesics have considerable side effects, which necessitate careful titration. Future drug research may focus on developing medications specifically for neuropathic pain. These designer agents may have more desirable action without the unwanted side effects.