Current pain and headache reports
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Illness uncertainty is present for both acute and chronic illnesses and has been described in the literature as a cognitive stressor, a sense of loss of control, and a perceptual state of doubt that changes over time. Illness uncertainty is associated with poor adjustment, but often needs to be appraised as a threat to have its deleterious effect. ⋯ The illness uncertainty literature in relation to pain is somewhat limited but clearly suggests the potential negative impact on the perception of and adjustment to pain. Future research should examine specific predictors of illness uncertainty, how this construct changes over time, and what interventions may be effective in reducing illness uncertainty for individuals who experience pain conditions.
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Cluster headache (CH) is a neurovascular headache disease characterized by recurrent, strictly unilateral, severe pain attacks. Despite its typical clinical features, including circadian rhythm of the attacks and ipsilateral autonomic dysfunction, the underlying pathophysiology of CH is still unclear. Electrophysiological data point to central disinhibition of the trigeminal nociceptive system as one of the key mechanisms of CH pain. ⋯ One biochemical correlate is probably represented in dysfunctions of serotonergic raphe nuclei-hypothalamic pathways. Structural and functional imaging data show an alteration of hypothalamic structures in CH patients, supporting the hypothesis that the hypothalamus, according to its function as a circadian pacemaker, plays a pivotal role in CH pathology. Cortical and brainstem reflexes are reviewed to illuminate the pathophysiology of CH.
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Cluster headache was first described over 300 years ago, but in the last century our knowledge of the disorder has exploded through both clinical observation and epidemiological data. Although some of the data are conflicting and more need to be obtained, much is known about the disorder. This article reviews the data to date on the prevalence and incidence of the disorder, population differences including gender and race, genetics, comorbid conditions, risk factors for development of the disorder, prognosis, and socioeconomic burden.
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Curr Pain Headache Rep · Apr 2009
ReviewIs there a therapeutic window with some antidepressants for analgesic response?
Most antidepressants and anticonvulsants used in chronic pain syndromes have dose- and concentration-response curves developed for their application to treat psychiatric disorders. Because these are important clinical tools in medication management of psychiatric syndromes, it is reasonable to expect that utilizing concentration-effect relationships and known sources of pharmacokinetic variability for determining doses for analgesia may also improve treatment tolerability and outcomes. Efforts to identify dosing "therapeutic windows" or minimum "thresholds" for analgesic efficacy have provided useful guidance for initiating treatment, reducing toxicity, and assisting with decision making in the face of limited therapeutic response. This article reviews the strengths, limitations, and potential of therapeutic drug monitoring of antidepressants and anticonvulsants as analgesics for selected chronic pain syndromes.