Current pain and headache reports
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Curr Pain Headache Rep · Mar 2020
ReviewPerioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview.
Point of care ultrasound (POCUS) has played a role across almost every medical specialty. Although anesthesiologists have been using bedside ultrasound for nerve blocks and vascular access for many years now, there has been a recent push to incorporate whole-body POCUS into anesthesiologists' training and daily practice. This article provides a brief overview of the indications, techniques for image acquisition, and general principles in interpreting basic images. ⋯ Whole-body POCUS can provide quick diagnoses and impact clinical management across relevant pre-, intra-, and post-operative settings. Anesthesia providers need to understand different applications for POCUS, including focused cardiac ultrasound (FoCUS), lung ultrasound (LUS), gastric ultrasound, abdominopelvic ultrasound, and the use of ultrasound for airway management. Currently, there is no standard ultrasound curriculum for anesthesiology residents, and teaching methods include informal bedside teaching, structured expert demonstration, didactic lectures, and simulations. Model/simulation-based lecture series may be effective in teaching ultrasound to anesthesiology residents, and e-learning and traditional didactics are both equally effective in teaching POCUS applications such as LUS and focused assessment with sonography in trauma (FAST). Creating protocol-guided frameworks for POCUS, such as I-AIM (indication, acquisition, interpretation, medical decision making), can also ensure more consistent and reliable diagnoses and interpretations of findings. Applications of POCUS should be focused, goal-oriented, easily learned, rapidly performable at bedside, accurate, and reliable. A variety of studies have shown this potential for POCUS in assessing cardiac, pulmonary, and intraabdominal pathologies, making it an emerging area of interest in medicine. The incorporation of POCUS into perioperative medicine provides an important tool to ensure continued improvement in coordinating care for patients in the perioperative period.
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Curr Pain Headache Rep · Mar 2020
ReviewA Comprehensive Review of the Treatment and Management of Pain in Sickle Cell Disease.
Sickle cell disease (SCD) is a hematological disorder which leads to serious complications in multiple organ systems. While significant research has addressed many of the effects of acute pain episodes and end-organ damage connected to this disease, little has approached the chronic pain state associated with this condition. ⋯ Associated chronic pain represents a significant detractor from the quality of life experienced by these patients, affecting over half of those with SCD on more days than not. Current treatment typically is centered upon preventing and responding to acute vasoocclusive crises, presumably because this is the most common reason for hospitalization in these patients. The lack of management of chronic pain symptoms leaves many with SCD in a state of suffering. In this review, the treatment methodologies of SCD patients are examined including alternative treatments, both pharmaceutical and non-pharmaceutical, as well as procedural approaches specifically aimed at reducing chronic pain in these patients.
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Curr Pain Headache Rep · Mar 2020
ReviewA Comprehensive Review of Over-the-counter Treatment for Chronic Migraine Headaches.
Migraine headaches are a neurologic disorder characterized by attacks of moderate to severe throbbing headache that are typically unilateral, exacerbated by physical activity, and associated with phonophobia, photophobia, nausea, and vomiting. In the USA, the overall age-adjusted prevalence of migraine in female and male adults is 22.3% and 10.8%, respectively. ⋯ Migraine is a disabling disease that ranks as the 8th most burdensome disease in the world and the 4th most in women. The overarching hypothesis of migraine pathophysiology describes migraine as a disorder of the pain modulating system, caused by disruptions of the normal neural networks of the head. The activation of these vascular networks results in meningeal vasodilation and inflammation, which is perceived as head pain. The primary goals of acute migraine therapy are to reduce attack duration and severity. Current evidence-based therapies for acute migraine attacks include acetaminophen, four nonsteroidal anti-inflammatory drugs (NSAIDs), seven triptans, NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics, and several anti-emetics. Over-the-counter medications are an important component of migraine therapy and are considered a first-line therapy for most migraineurs. These medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks. The lower cost of over-the-counter medications compared with prescription medications also makes them a preferred therapy for some patients. In addition to their efficacy and lower cost, over-the-counter medications generally have fewer and less severe adverse effects, have more favorable routes of administration (oral vs. subcutaneous injection), and reduced abuse potential. The purpose of this review is to provide a comprehensive evidence-based update of over-the-counter pharmacologic options for chronic migraines.
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Diverse musculoskeletal disorders and neuropathic symptoms of the face pose significant diagnostic challenges. In particular, temporal tendinosis is generally overlooked in the medical and dental literature and is therefore a poorly understood topic and often problematic cause of chronic orofacial pain. In this article, we explore temporal tendinosis as a cause of unresolved orofacial pain by reviewing the complex anatomy of the temporalis muscle, common presentations of temporal tendinosis, possible etiologies for injury and place a strong emphasis on required diagnostic evaluation and clinical management. ⋯ Temporal tendinosis remains under diagnosed due to a combination of anatomical complexity and incomplete description in the majority of general anatomy medical textbooks. The two main presentations are unilateral facial pain with or without temporal headache and pain radiating from the distal temporalis tendon to the temporalis muscle. Diagnosis should be made with a combination of focused history, physical examination and specialised imaging, preferably with ultrasound but with MRI an alternate option. While many management options are available, optimal treatment remains unclear. Temporal tendinosis is an under-recognised and under-treated condition. Despite the fact that orofacial pain is one of the single most common complaints of patients presenting to physicians or dentists, it is widely acknowledged that training for diagnosis and manage of temporal tendinopathy among primary care physicians in both medical and dental professions is inadequate. This may result in extensive workups, leading to suboptimal management and chronic pain syndromes.
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Curr Pain Headache Rep · Mar 2020
ReviewCurrent Concepts in the Management of Vertebral Compression Fractures.
This comprehensive review of current concepts in the management of vertebral compression fractures is a manuscript of vertebral augmentation literature of risk factors, clinical presentation, and management. The objective of this review is to compare outcomes between multiple augmentation techniques and ongoing discussions of effectiveness of vertebral augmentation procedures. ⋯ Vertebral compression fractures (VCFs) are a prevalent disease affecting approximately 1.5 million US adults annually. VCFs can cause severe physical limitations, including back pain, functional disability, and progressive kyphosis of the thoracic spine that ultimately results in decreased appetite, poor nutrition, impaired pulmonary function, and spinal cord compression with motor and sensory deficits. The deconditioning that affects patients with vertebral compression fractures leads to mortality at a far higher rate than age-matched controls. The management of vertebral compression fractures has been extensively discussed with opponents arguing in favor or restricting conservative management and against augmentation, while proponents argue in favor of augmentation. The literature is well established in reference to the effects on mortality when patients undergo treatment with vertebral augmentation; in over a million patients with vertebral compression fractures treated with vertebral augmentation as compared with patients treated with non-surgical management, the patients receiving augmentation performed well with a decrease in morbidity and mortality. Summary of the literature review shows that understanding the risk factors, appropriate clinical evaluation, and management strategies are crucial. Analysis of the evidence shows, based on level I and II studies, balloon kyphoplasty had significantly better and vertebroplasty tended to have better pain reduction compared with non-surgical management. In addition, balloon kyphoplasty tended to have better height restoration than vertebroplasty.