Current pain and headache reports
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Curr Pain Headache Rep · Aug 2001
ReviewRegional myofascial pain syndrome and headache: principles of diagnosis and management.
Myofascial pain is frequently overlooked in dealing with headache pain. Myofascial pain is defined as pain and/or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point is a focus of hyperirritability in the muscle, that when compressed, is locally tender, and if sensitized, gives rise to referred pain and tenderness. The therapy for myofascial pain requires enhancing central inhibition through pharmacology or behavioral techniques and simultaneously reducing peripheral inputs through physical therapies including exercises and trigger point-specific therapy.
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Curr Pain Headache Rep · Aug 2001
ReviewCervicogenic headache: anatomic basis and pathophysiologic mechanisms.
Cervicogenic headache is pain perceived in the head but referred from a primary source in the cervical spine. The physiologic basis for this pain is convergence between trigeminal afferents and afferents from the upper three cervical spinal nerves. The possible sources of cervicogenic headache lie in the structures innervated by the C1 to C3 spinal nerves, and include the upper cervical synovial joints, the upper cervical muscles, the C2-3 disc, the vertebral and internal carotid arteries, and the dura mater of the upper spinal cord and posterior cranial fossa. Experiments in normal volunteers have established that the cervical muscles and joints can be sources of headache.
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This article reviews current literature on the role of manual medicine in the diagnosis and treatment of cervicogenic headache. Manual diagnostic procedures and treatment procedures are described for the cervical spine. ⋯ Muscle energy technique is suggested as a safe and effective treatment when somatic dysfunction of the cervical spine is found in association with the diagnostic criteria for cervicogenic headache. Lastly, a suggested clinical approach to this problem from a manual medicine perspective is given.
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Curr Pain Headache Rep · Aug 2001
ReviewQuality-of-life, legal-financial, and disability issues in fibromyalgia.
Patients with fibromyalgia have an altered quality of life that is hard to quantitate using existing indices. The principal legal issues associated with the syndrome are: Does fibromyalgia exist? Can it be caused by or flared by stress or trauma? Does disability apply to fibromyalgia and if so, how? These issues are critically reviewed.
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The view that fibromyalgia syndrome (FMS) is a psychiatric disorder or can be caused by stress or abuse is unproven. The construct of posttraumatic FMS has not been adequately validated. ⋯ More research examining specific psychological processes in FMS is desirable. Because of the potential for harm to patients, clinicians should be cognizant of possible undue influences on medical opinion by agencies providing health care and research funding.