Current pain and headache reports
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Curr Pain Headache Rep · Apr 2002
Review Comparative StudyDo over-the-counter medications help the physician manage migraine headache?
The use of over-the-counter-medication in migraine treatment is commonplace. They are often used in addition to physician-prescribed medications and may be used without the full knowledge of the physician. Although considerable evidence suggests their efficacy in migraine treatment, they are rarely used to maximal levels of efficacy and safety. A review of the evidence for these treatments is important for cost effective, well-tolerated, and specific treatment of migraine headache.
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In the United States analgesic-overuse headache is often caused by butalbital-containing analgesics. These agents can cause physical and psychological dependency, and dangerous withdrawal syndromes. ⋯ In the 20 years since analgesic overuse headache was widely recognized, butalbital overuse has remained distressingly common. It is time to ban these agents.
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The triptans have provided a major advance in the treatment of the pain and disability associated with migraine headache. With seven triptans in use or in clinical development, the clinician is faced with the decision of which triptan to prescribe to the patient with migraine. Although the triptans are pharmacologically similar, they each have unique attributes. This article focuses on the pharmacologic differences between triptans with regard to their pharmacokinetics and drug interactions, and provides some helpful tips on how to optimize migraine treatment with the triptans.
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AIDS and AIDS-treatment neuropathies are common in individuals infected with HIV. As patients live longer due to improved antiretroviral therapies, the impact of painful neuropathy on patients' lives may increase. ⋯ Current theories on the pathogenesis of AIDS neuropathies include mitochondrial toxicity secondary to gamma-DNA polymerase inhibition and subsequent abnormal mitochondrial DNA synthesis. Treatment of AIDS neuropathies is directed toward relief of symptoms; however, new evidence suggests that aggressive antiretroviral therapy may also be effective.
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Curr Pain Headache Rep · Apr 2002
ReviewChronic lumbar spine and radicular pain: pathophysiology and treatment.
The lumbar spine forms the foundation and infrastructure of an organic skyscraper equipped with the physiologic capacity to act as a crane for lifting and a crankshaft for walking. Subjected to aging like other "human machinery," the lumbar spine adapts to the wear and tear of gravity and biomechanical loading through structural and neurochemical changes. ⋯ Some compensatory reactions are constructive, but others cause more interference with the organism's capacity to cope. A conceptional understanding of the multifaceted structural, biomechanical, biochemical, medical, and psychosocial influences that compose this mix elucidates the complexity of applying effective treatments.