Current pain and headache reports
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Most patients who have been diagnosed with cancer will experience pain at some point during the course of their disease. Often, opioid analgesics are not enough to completely alleviate the patient's pain and the selection of appropriate adjunct analgesic agents is critical. This article reviews the mechanisms of action and analgesic effects of several classes of antidepressants to enable the clinician to select the appropriate agent for the patient.
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This article reviews the features of an uncommon malady termed "the exploding head syndrome." Sufferers describe terrorizing attacks of a painless explosion within their head. Attacks tend to occur at the onset of sleep. The etiology of attacks is unknown, although they are considered to be benign. Treatment with clomipramine has been suggested, although most sufferers require only reassurance that the spells are benign in nature.
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Complex regional pain syndromes (CRPS) (formerly reflex sympathetic dystrophy and causalgia) are neuropathic pain conditions that are initiated by an extremity trauma or peripheral nerve lesion. Clinical definition and scientific understanding of CRPS are still evolving; however, both the clinical picture and therapeutic options are significantly influenced by a dysfunction of the sympathetic nervous system. Recent investigations suggest functional central abnormalities and a peripheral inflammatory component in the pathophysiology of CRPS. Interdisciplinary treatment includes physical, pharmacologic, and invasive interventional therapy, as well as stimulation techniques.
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Drug selection for the acute treatment of migraine is based on comorbid disorders, coexistent diseases, and the patient's pain profile and specific needs and expectations. Patients should be instructed to tailor their treatment strategy to meet their specific needs by varying their medications according to pain intensity. This will aid in successful headache management, by increasing compliance and decreasing disability and cost.
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Curr Pain Headache Rep · Apr 2001
ReviewPsychological assessment and treatment of patients with neuropathic pain.
Studies on the psychological assessment and treatment of neuropathic pain conditions, including postherpetic neuralgia (PHN), diabetic neuropathy, complex regional pain syndrome, post spinal cord injury, post amputation, and AIDS-related neuropathy, are reviewed. Although limited information is currently available, the findings are consistent with the larger literature on chronic pain and indicate that the assessment of neuropathic pain needs to include measurement of multiple dimensions of quality of life. ⋯ Case series of successful treatment of neuropathic pain are reported, primarily in the area of biofeedback. As with other chronically painful conditions, it is likely that cognitive-behavioral interventions will improve the quality of life in neuropathic pain conditions.