Current pain and headache reports
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Curr Pain Headache Rep · Apr 2008
ReviewMirror visual feedback for the treatment of complex regional pain syndrome (type 1).
Mirror visual feedback was originally devised as a therapeutic tool to relieve perceived involuntarily movements and paralysis in the phantom limb. Since this pioneering work was conducted in the mid-1990s, the technique has been applied to relieve pain and enhance movement in other chronic conditions such as stroke and complex regional pain syndrome (CRPS) type 1. This review describes how mirror visual feedback was first developed with amputees, its original application in CRPS, and how further research has demonstrated its potential benefit within graded motor imagery programs. We discuss the potential mechanisms behind this technique and consider the implications for clinical practice.
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About 1% of all chronic cluster headache patients become intractable (iCCH; ie, they are refractory to adequate regimens of all established preventive drugs). Various lesional interventions have been attempted in these patients, none with lasting benefits. In recent years, nondestructive neurostimulation methods have raised new hope. ⋯ At this stage, it should be the preferred first-line invasive therapy for iCCH. Recent case reports mention efficacy of supraorbital and vagus nerve stimulation. Whether these neurostimulation methods have a place in the management of iCCH patients remains to be determined.
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Curr Pain Headache Rep · Apr 2008
ReviewEndocrinology of cluster headache: potential for therapeutic manipulation.
Cluster headaches have always been among the most intriguing of the commonly recognized primary headache syndromes. This clinical interest is related to a number of factors, including the intense but short-lived nature of the pain, its sexual predilection, associated trigeminal autonomic dysfunction, and the remarkable circadian and circannual periodicity of cluster periods. Recent advances in neuroimaging and neuroendocrinology have shed light on the pivotal role of the hypothalamus in the biology of cluster headache. We discuss these revelations, along with current clinical observations in headache and sleep medicine.
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Curr Pain Headache Rep · Apr 2008
ReviewFunctional and structural neuroimaging in trigeminal autonomic cephalalgias.
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features. They include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing. Until recently, primary headache disorders, including the TACs, were widely considered to be caused by peripheral mechanisms such as vascular changes or neurogenic inflammation. ⋯ Functional imaging studies have demonstrated hypothalamic activation in all the TACs. Furthermore, neuroimaging studies using voxel-based morphometry and magnetic resonance spectroscopy techniques have demonstrated structural and biochemical alterations, respectively, in the hypothalamus of patients with cluster headache. These studies suggest that the hypothalamus plays a crucial role in the pathophysiology of TACs, thereby supporting the notion that these disorders are primarily due to central rather than peripheral mechanisms.
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Curr Pain Headache Rep · Apr 2008
ReviewIs high hypnotic suggestibility necessary for successful hypnotic pain intervention?
Hypnotic suggestibility is a trait-like, individual difference variable reflecting the general tendency to respond to hypnosis and hypnotic suggestions. Research with standardized measures of hypnotic suggestibility has demonstrated that there are substantial individual differences in this variable. Higher suggestibility has been found to be associated with greater relief from hypnotic pain interventions. ⋯ Thus, high hypnotic suggestibility is not necessary for successful hypnotic pain intervention. However, the available evidence does not support the efficacy of hypnotic pain interventions for people who fall in the low hypnotic suggestibility range. However, some studies suggest that these individuals may benefit from imaginative analgesia suggestions, or suggestions for pain reduction that are delivered while the person is not in hypnosis.