The Clinical journal of pain
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Within acute pain management, as within any rapidly expanding field of therapeutic endeavor, novel treatment modalities may on occasion overreach their scientific foundations. In general, a cautionary theme is expressed regarding the utilization of various therapies, lest their overzealous clinical implementation jeopardizes the advancement of this highly promising field. ⋯ The subject of dosing for acute pain conditions with opiates via the epidural route versus intravenous opioid administration is discussed from the perspectives of practicality and risk/benefit assignments. The advisability and means of using demand-mode techniques in order to resolve the central issue of inherent benefits of opioid administration via one route or another is also presented.
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Headache is a common symptom following head trauma and not related to the degree of trauma. The term post-head-trauma syndrome is used to denote a group of symptoms following head trauma. Dizziness, vertigo, perceptual changes, memory loss, paresthesias, and tinnitus have been reported as well as psychological disturbances. ⋯ Often diagnostic studies do not reveal an abnormality. Treatment consists of diagnosing the type of headache and targeting appropriate therapy. Long-term prognosis is good, the majority of patients recovering after 1 year.
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The diagnosis and management of various HA syndromes in children and adolescents have been reviewed. The decision as to whether a child's HA is organic or functional may be a difficult one, but a thorough and systematic history and examination coupled with selected laboratory tests will usually guide the examiner to the correct diagnosis.
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Physicians have in their armamentaria of drugs and techniques sufficient methods of relieving postoperative pain to maintain an analgesic state in postsurgical patients. The extent of the problem, and the options available, are discussed and described.
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Capsaicin application to human nasal mucosa was found to induce painful sensation, sneezing, and nasal secretion. All of these factors exhibit desensitization upon repeated applications. The acute effects induced by capsaicin (300 micrograms/100 microliters) application to the nasal mucosa were studied in healthy volunteers and cluster headache patients. ⋯ Likewise, the time course of desensitization to the painful sensation and nasal secretion induced by capsaicin applied for five consecutive days in control subjects was almost superimposable to those observed in the nasal mucosa of cluster headache patients. The number of spontaneously occurring attacks was significantly reduced in the 60 days after the end of capsaicin treatment. Whether the beneficial effect induced by capsaicin application to the nasal mucosa could be ascribed to a specific action on sensory neurons remains unknown.