Current pain and headache reports
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Lumbar radicular pain is a frequent medical pathology and represents a significant burden on society. The diagnosis of sciatica is largely clinical, in the setting of a combination of radicular pain and neurologic deficits (motor, reflexes, and/or sensation) or a positive straight leg raise test. Imaging is generally not necessary for sciatica, except in the presence of warning signs or in the setting of persisting or worsening pain. ⋯ The choice of a conservative treatment approach combined with simple analgesics in the initial stages seems to be reasonable. A detailed discussion with the patient is important to explain the fact that surgery may only be necessary in the event of pain persisting in excess of 3 months or because of the development or worsening of a neurologic deficit. More high quality studies are clearly required to assist the medical practitioner in knowing how best to treat this group of patients.
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Treatment options for neuropathic pain have limited efficacy and use is fraught with dose-limiting adverse effects. The endocannabinoid system has been elucidated over the last several years, demonstrating a significant interface with pain homeostasis. Exogenous cannabinoids have been demonstrated to be effective in a range of experimental neuropathic pain models, and there is mounting evidence for therapeutic use in human neuropathic pain conditions. This article reviews the history, pharmacologic development, clinical trials results, and the future potential of nonsmoked, orally bioavailable, nonpsychoactive cannabinoids in the management of neuropathic pain.
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Migraine aura consists of fully reversible focal neurologic symptoms that may precede or coexist with headache in a significant minority of migraine patients. Typical aura symptoms include visual, sensory, and language disturbances. ⋯ Ongoing study suggests that susceptibility to migraine aura and CSD may be genetically mediated. CSD appears to be a potential target for future development of migraine-specific preventive therapies.
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Patients with osteoarthritis (OA) primarily seek treatment due to pain and disability, yet the primary endpoints for rodent OA models tend to be histological measures of joint destruction. The discrepancy between clinical and preclinical evaluations is problematic, given that radiographic evidence of OA in humans does not always correlate to the severity of patient-reported symptoms. ⋯ While obvious differences exist between quadrupedal and bipedal gait sequences, the gait abnormalities seen in humans and in rodent OA models reflect similar compensatory behaviors that protect an injured limb from loading. The purpose of this review is to describe these compensations and current methods used to assess rodent gait characteristics, while detailing important considerations for the selection of gait analysis methods in rodent OA models.
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Curr Pain Headache Rep · Oct 2014
ReviewSufficiency and necessity in migraine: how do we figure out if triggers are absolute or partial and, if partial, additive or potentiating?
Migraine is, to a great extent, a genetically determined disorder and once it has manifested itself, it generally continues for years if not for decades. While the migraine is active, headaches can seemingly occur spontaneously but are often reportedly precipitated by events or factors, known as migraine triggers, the interplay of which is the topic of this paper. Among migraine triggers, the menstrual cycle is an important one that probably accounts for much of the excess of migraine in women compared with men. ⋯ Having identified trigger-headache associations, it needs to be determined which triggers are causative in the individual, either singly or in combination with others. This requires running an experiment with the individual that involves behavioral intervention to change exposure to a given trigger and determine whether that improves migraine. The ubiquitous adoption of the smart phone as a personal-data entry device, along with the possibility of bringing the results of sophisticated statistical analysis into the hands of patients and physicians, may well provide us with an important set of tools that will finally allow the unravelling of the age-old migraine-trigger puzzle.