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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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.
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A number of classifications of headache have appeared in medical and professional journals. In addition to these formal diagnostic classifications, a number of articles have addressed the relationship of sexual functioning to headache etiology, course, and prevalence. To this end, many headache specialists have developed a classification for what are termed "sexual headaches." To date, these sexual headaches have been limited to migraine and muscle contraction (tension) headache patterns. We present, for the first time, two case studies documenting the role of sexual activity in both etiology and course of cluster headache.
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The rationale for improving analgesic therapy is presented. After reviewing the role of drug pharmacokinetic and pharmacodynamic variability in determining the quality of pain relief, newer developments in acute pain management are described: newer opioid and nonopioid analgesic drugs; alternative drug delivery systems; nonpharmacologic approaches, use of combination analgesic therapy. Finally, several possible future research trends in acute pain management are discussed.