Current pain and headache reports
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Neuropathic low back pain is examined from a structural standpoint, distinguishing processes that start from chronic inflammation and mechanical compromise and cross into the realm of neuropathy with primary neurogenic pathophysiology. The disease of chronic pain is discussed, examining peripheral and central changes in neuroanatomy, neurophysiology, and neuromolecular dynamics. The limitations of inadequate random controlled trials regarding long-term pharmacologic interventions are contrasted with excellent work in the basic science of chronic pain. Complex rational pharmacologic strategies for structural pathology, central pain processes, sites of medication action, and differing routes of administration are delineated.
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Curr Pain Headache Rep · Jun 2003
ReviewPharmacotherapy for pain in rheumatologic conditions: the neuropathic component.
Nociceptive and neuropathic types of pain occur in rheumatologic conditions. Most clinicians are familiar with the former, but many are not aware of the prevalence of the latter. ⋯ Common rheumatologic conditions and their pathophysiology in relation to pain mechanisms also are described. Pharmacotherapeutic recommendations for the treatment of both types of pain in the common rheumatologic conditions are presented.
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New imaging technology allows us to study neurologic disorders that have had no previous structural basis. There have been recent reports on the involvement of nociceptive pathways in daily headache. A systematic review was performed using key words "chronic daily headache" and "imaging." This paper reviews the literature on imaging studies performed on daily headache with emphasis on the new imaging technology.
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The genetics of migraine is a fascinating and moving research area. Familial hemiplegic migraine, a rare subtype of migraine with a Mendelian pattern of inheritance, is caused by mutations in the chromosome 19 CACNA1A gene in approximately 75% of the families. ⋯ The genetics of the more frequent variants, migraine with and without aura, is more complex. Several loci have been studied in families and case-control studies, but need to be confirmed.