Current pain and headache reports
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Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree of anxiety is a normal response to having a severe medical illness. ⋯ There are a variety of psychopharmacologic, psychotherapeutic, and complementary/alternative treatments available. A comprehensive approach to care includes these approaches in an individualized way. Terminal sedation is examined as a compassionate option for relieving intractable distress at the end of life.
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Curr Pain Headache Rep · Aug 2003
ReviewRecent advances in malignant bowel obstruction: an interface of old and new.
Malignant bowel obstruction continues to be a difficult problem for patients with abdominal and pelvic primary tumors and tumors originating in other sites. The main treatment options consist of surgery, stenting, and pharmacotherapy. Despite recent advances, the impact of available treatment modalities on symptom control, longevity, quality of life, and associated health care costs have not been evaluated rigorously. This article reviews the available data and suggests an approach to the management of this challenging patient population.
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Curr Pain Headache Rep · Aug 2003
ReviewShort-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review.
The clinical features of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome have been reviewed in 50 patients reported in the English language literature. SUNCT syndrome is a rare condition that predominates slightly in men. The mean age at onset is 50 years. ⋯ SUNCT was thought to be highly refractory to treatment. However, recent open-label trials of lamotrigine, gabapentin, topiramate, and intravenous lidocaine have produced beneficial therapeutic responses. These results offer the promise of better treatments for this syndrome, but require validation in controlled trials.
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Headache is a frequent symptom in women of childbearing age and during pregnancy. Benign and pathologic headaches may change in response to changes in estrogen after conception. Expected patterns of change are described for headaches that occur commonly during pregnancy. In addition, although treatment options are limited during pregnancy, a variety of effective medication and nonmedication treatments are available and should be offered to women with benign headaches that persist into the second trimester of pregnancy.
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The relationship between sleep and sleep disorders and headache remains unclear. Clinical experience and numerous studies document some sort of relationship, but the exact nature remains understudied and complex. Changes in sleep duration and sleep quality appear to be capable of affecting headaches of different types. ⋯ Obstructive sleep apnea also may cause a specific headache when awakening, which is different from migraine or tension headache and disappears after treatment of the sleep and breathing disturbance. Hypnic headache is another type of sleep-exclusive headache that has been proposed. Hypnic headaches are brief, moderately severe, and affect the elderly primarily.