The Clinical journal of pain
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Infrared imaging (thermography) has developed rapidly over the past 10-15 years as a diagnostic imaging procedure. Despite scientific validation and proven use in the clinical setting, neuromuscular thermography has met with much criticism and skepticism. ⋯ The basic scientific foundation of medicine should preclude the prejudicial influence of emotion, politics, and anecdotes. Scientific investigations, for more than 2 decades now, have demonstrated that neuromuscular thermography is of proven value in the clinical evaluation of various pain disorders and neuromuscular conditions, including radicular pathology.
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Surgical indications do not forecast outcomes as well as they should. A review of the literature demonstrates a significant rate of overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back surgery, and pain-relieving procedures. ⋯ Arguments against this approach and a plea for the development of tighter focused indications are presented. Implications for cost saving and reduction in suffering are discussed.
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Migraine headache variants consist of the complicated migraine headache subtypes such as basilar artery migraine, migraine equivalents, and late-life migraine accompanients. Although these disorders occur infrequently, diagnosis may be more difficult. Generally, comprehensive diagnostic studies are required to rule out underlying pathogenic conditions that may present with similar symptom complexes. Standard migraine treatment is often useful in these disorders; however, migrainous variants deserve special therapeutic considerations.
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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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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.