Expert review of neurotherapeutics
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The use of botulinum toxin type A continues to be investigated by the US FDA for potential use in the treatment of headache. As part of this process there has been extensive research conducted by individual study sites as well as multicenter trials. To date, the majority of the focus has been on migraine headache as well as on tension-type headache. ⋯ At the same time, additional work has been performed to understand the mechanism by which botulinum toxin type A may work to alleviate migraine. This work may contribute substantially to improving outcomes with botulinum toxin type A. Characterization of the mechanism of action in pain may be crucial to outcomes because many issues are related to central sensitization.
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Postnatal depression is a common condition that may have a significant negative impact on both infant and mother, often remaining undiagnosed and untreated. Development of effective means of detection, prevention and treatment of postnatal depression is a major health challenge. ⋯ No preventive or therapeutic studies, however, have provided evidence for long-term success. There is a need for future research into the prevention and treatment of postnatal depression including the assessment of long-term effects on the child's development as well as feasibility in relation to cost-effectiveness.
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Acute pain is a symptom that originates from actual ongoing or impending tissue damage. Pain is an individual subjective experience and varies markedly among individuals. For this reason, patient involvement is essential, with the most reliable indicator of severity being patient self-report. ⋯ Nevertheless, despite the availability of drugs and techniques for its effective management, postoperative pain remains undertreated. It is now accepted that the solution to the problem of inadequate pain relief lies not only in the development of new analgesic drugs or technologies but also in the development of an appropriate organization to utilize existing expertise. Methods used to control postoperative pain are numerous; this review focuses on pharmacological and anesthetic methods.
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Expert Rev Neurother · Mar 2007
ReviewProstatitis and chronic prostatitis/chronic pelvic pain syndrome.
The prevalence of prostatitis is extremely high, with up to 16% of men diagnosed with prostatitis at some point throughout their lifetime. However, the etiology appears to be multifactorial and standard treatment regimens have been altered significantly in recent years. The purpose of this review is to examine the changing scientific views on the causes and treatment of prostatitis, chronic prostaitis and chronic pelvic pain syndrome. ⋯ Current NIH classifications, which stratify prostatitis into four categories, are discussed, as is the NIH Chronic Prostatitis Symptom Index, the primary tool used to assess symptomatology. Diagnostic examinations are studying the need for the four-glass test and its practical replacement by the two-glass test. Multimodal treatment therapy is then discussed, including recent data on biofeedback and evaluation of the role of pelvic floor dysfunction in prostatitis.