Current pain and headache reports
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Chronic daily headache (CDH) is a fairly common but disabling disorder that disproportionately affects women and afflicts individuals across all stages of adulthood. It is a dynamic disorder, marked by relatively high rates of remission and incidence. ⋯ The purpose of this article is to understand the CDH classification; determine the prevalence and associated demographic profile of CDH as derived from population-based studies; outline identified risk factors for development or persistence of CDH; and understand which risk factors may be more amenable to intervention. Understanding the factors that put people at risk for developing CDH helps to inform possible clinical interventions and also determines which individuals may be most in need of preventive efforts.
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The chronicity of pain is the feature of pain that is least understood and most directly linked with our inability to effectively manage pain. Acute pain is relatively responsive to our current pharmacologic and interventional armamentarium. However, as pain persists, our ability to treat effectively diminishes and the patient's frustration and resource utilization increases. This article explores our current understanding of the factors linked to pain duration and the transition from acute to chronic pain in both human and animal models, and across a spectrum of human chronic pain conditions.
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Curr Pain Headache Rep · Feb 2009
Review Comparative StudyEpidural steroid injections are useful for the treatment of low back pain and radicular symptoms: pro.
Epidural steroid injection has been used to treat low back pain for many decades. Numerous randomized trials have examined the efficacy of this approach. This review details the findings of older systematic reviews, newer randomized controlled trials, and two recent systematic reviews that examine the effectiveness of this treatment. ⋯ Similarly, there is scant evidence that epidural steroids have any beneficial effect in those with acute low back pain without leg pain or in those with chronic low back or leg pain. However, most studies have demonstrated more rapid resolution of leg pain in those who received epidural steroid injections versus those who did not. The role of epidural steroid injections in the management of acute radicular pain due to herniated nucleus pulposus is simply to provide earlier pain relief.
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This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. ⋯ Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.