Current pain and headache reports
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Curr Pain Headache Rep · Oct 2022
ReviewDermatologic Symptoms and Syndromes Associated with Headache.
Headache disorders are often accompanied by associated symptoms involving organ systems other than the central and peripheral nervous system, including the integumentary, cardiovascular, and musculoskeletal system. However, skin changes or conditions are not commonly associated with headache disorders. Recognition of possible etiologies of headache in patients with bruising, rash, or neurocutaneous disorders can help guide workup and management. The purpose of this article is to review the various dermatologic presentations associated with headache. ⋯ Multiple review articles and retrospective studies have noted the association between head pain with dermatologic changes including ecchymoses, inflammatory skin conditions, and neurocutaneous disorders. Postulated mechanisms include activation of the trigeminal autonomic system and involvement of similar pro-inflammatory molecules. In this review, we discuss three different classes of rashes including ecchymoses, inflammatory skin conditions, and neurocutaneous disorders, all of which have been associated with migraine and/or headache. We discuss the possible underlying pathophysiology and treatment options.
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Pain medicine is rapidly expanding. The gap in treatment for patients with chronic pain in between traditional conservative therapy and major invasive surgery is closing. Neuromodulation is one therapeutic area that has continued to show promise for treatment of chronic pain. Our aim is to review updates in non-invasive neuromodulation (NIN) techniques as an adjunct for various chronic pain conditions. ⋯ Overall, the literature suggests that NIN techniques such as tCDS, TMS, TENS, tVNS, and HIFUS/LIFUS have utility in treating various types of chronic pain and have a promising future. There is a better understanding of the mechanistic basis for pain relief from NIN, as well as refinement in technology improving NIN therapy success. Future studies will need to focus on continuing to refine protocols for optimal benefit from NIN as well as implementing larger RCTs to improve the quality of data being generated in the field.
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Curr Pain Headache Rep · Oct 2022
ReviewThe Role of the Autonomic Nervous System in Headache: Biomarkers and Treatment.
In this review, the role of the autonomic nervous system in tension-type headache and migraine is reviewed. ⋯ A pathophysiological model for tension-type headache is proposed that is compatible with most physiological and behavioral literature. A treatment protocol is described that follows from this model. For migraine, incorporating autonomic factors into the pathophysiology offers rationales for behavioral interventions that have been shown to be useful in migraine treatment and a biofeedback protocol is proposed.
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Curr Pain Headache Rep · Oct 2022
ReviewPlatelet-Rich Plasma Injections: Pharmacological and Clinical Considerations in Pain Management.
Regenerative medicine through interventional pain procedures is evolving with data demonstrating efficacy for a number of pain states in recent years. Platelet-rich plasma (PRP), defined as a sample of plasma with a platelet concentration 3 to 5 times greater than the physiologic platelet concentration found in healthy whole blood, releases bioactive proteins which can restore anatomical function in degenerative states. PRP is dense in growth factors, such as platelet-derived growth factor, transforming growth factor-beta1, basic fibroblastic growth factor, vascular endothelial growth factor, and epidermal growth factors. ⋯ To date, well-designed case-control or cohort studies for the use of PRP have demonstrated efficacy in lumbar facet joint, lumbar epidural, and sacroiliac joint injections. At present, there is only level IV evidence indicating the need for larger and more carefully controlled prospective studies. PRP is utilized autogenously in order to facilitate healing and injection and has been studied in the long-term management of discogenic low back pain. In this regard, numerous studies have evaluated PRP to steroid injections in chronic pain states with favorable results. PRP represents an opportunity for a new strategy in the therapeutic treatment of degenerative states of spines, joints, and other locations throughout the body with evolving data demonstrating both safety and long-term efficacy.
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Curr Pain Headache Rep · Oct 2022
ReviewPelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain.
Female urogenital pain (FUGP) affects many women and is often a diagnosis of exclusion. The long path to a diagnosis and subsequent treatment frequently leads to suffering on the individual's behalf (Obstet. Gynecol. 121: 645-50, 2013). Additionally, this delay in diagnosis and thus treatment places stress on the US medical system (Obstet. Gynecol. 121: 645-50, 2013). There is a lack of knowledge regarding the scope of pelvic floor physical therapy (PFPT) across the medical community that may prevent physicians from referring patients (J Urol. 193:1545-53, 2015; Sex Med Rev., 2021). PFPT is a low-risk, potentially high-reward option that should be recognized as part of the multidisciplinary approach to managing FUGP. ⋯ Research databases (PubMed and Cochrane) were used to find articles on FUGP between 2005 and 2022. Systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohorts, and case-study analyses were included in reviewing the literature. The most recent studies in the last 2 years show the benefit of PFPT in certain FUGP diagnoses with improved pain scores and function when compared to no intervention or placebo treatment. The aim of this article is to elucidate the scope of PFPT in the treatment of FUGP with supporting research findings regarding efficacy. It is clear from the literature that PFPT should be recognized by referring physicians as part of a multidisciplinary approach to the treatment of FUGP.