Current pain and headache reports
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Curr Pain Headache Rep · Dec 2003
ReviewInduction and assessment of muscle pain, referred pain, and muscular hyperalgesia.
Muscle pain can be induced and assessed experimentally by a variety of methods. Ischemic and exercise-induced muscle pain are typical endogenous pain models; external stimulation with mechanical, electrical, and chemical modalities constitute the exogenous models. These models are a good basis to study the muscle sensitivity, muscle pain responses under normal and pathophysiologic conditions, and drug efficacy on specific muscle pain mechanisms. ⋯ The experimental test paradigm must include different stimulation modalities (multimodal) to obtain sufficiently advanced and differentiated information about the human nociceptive system under normal and pathophysiologic conditions because the different stimuli activate different receptors, pathways, and mechanisms. This may be a useful approach in future mechanism-based classification and treatment of muscle pain. Similarly, the multimodal approach is important in clinical studies to provide evidence for which specific muscle pain modalities and mechanisms are affected and how they are modulated by pharmacologic approaches.
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Curr Pain Headache Rep · Dec 2003
ReviewEvaluation of treatments for myofascial pain syndrome and fibromyalgia.
Myofascial pain syndrome (MPS) and fibromyalgia (FM) are complex conditions and pose significant challenges to clinicians and patients. This chapter explores available treatments for MPS and FM in the context of pathophysiology, clinical evidence, and experimental support. This information may prove to be helpful in designing individualized treatment for patients with these complex syndromes. New treatments should be critically and carefully evaluated as they appear.
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Careful evaluation of the chronic headache patient can reveal the presence or absence of musculoskeletal factors to be causative or contributory to the headache condition. This article presents a review of the literature surrounding physical findings in patients with cervicogenic and musculoskeletal sources of pain and specific treatment with physical therapy. Included in the discussion is the identification of muscular and joint involvement in a given headache, the relevance of postural, range of motion, and strength deficits, and appropriate individualized treatment strategies with a review of relevant outcome studies. Possible mechanisms for treatment effects also are considered.
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Curr Pain Headache Rep · Dec 2003
ReviewPsychologic and behavioral management of tension-type headache: treatment procedures.
Used as an adjunct or alternative to medication treatment, psychologic and behavioral approaches to tension-type headache decrease headache frequency, affective distress, and headache-related disability. These approaches directly address the psychologic and behavioral factors that contribute to the disorder and to the individual headache episodes. ⋯ Recent attempts to make treatment more accessible to a wider range of tension-type headache sufferers include using medical personnel to deliver treatment from physician practices and using existing and emerging technologies to provide care in a purely self-administered format without face-to-face contact with therapists. These attempts are promising, but remain preliminary; therefore, there is a need for further development and testing.