The Clinical journal of pain
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This article reviews the literature and describes clinical methods of providing analgesia for acute pain using epidural and intrathecal (spinal) opiates. The mechanism of action of these drugs, their basic pharmacology and spinal pharmacodynamics, and useful drugs and dosages are presented. The side effects of these drugs when administered by injection and possible ways to diminish their incidence and severity are discussed. A clinical protocol for the dosage and selection of these drugs is included.
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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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An inpatient headache treatment unit provides a special environment for those patients whose headaches have failed to respond to outpatient therapy. Outpatient therapy may be precluded for a variety of treatment issues, including detoxification, initiation of copharmacy prophylactic medical therapy, and intravenous treatment for intractable chronic cluster headache and status migrainous headache. These complex medical treatments are viewed as some of the most valuable therapies by the patients and, at least in part, significantly decrease both headache indexes utilized in this survey. ⋯ Treatment failures may be due to variations in the etiology of chronic muscle contraction headache and posttraumatic headache. Denial of psychological factors in headache may also contribute to treatment failure. Habituation to analgesics and ergots may decrease patient response as compared with those not dependent.