Current pain and headache reports
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Curr Pain Headache Rep · Jun 2020
ReviewUtilizing the Biopsychosocial Model in Concussion Treatment: Post-Traumatic Headache and beyond.
To discuss recent literature concerning the application of the biopsychosocial model in the management of concussion and post-concussion headache. ⋯ Current research suggests that the biopsychosocial model is applicable to the concussion management process, particularly management of post-concussion headache. Such application is best illustrated by current active treatment strategies such as exercise, multifaceted rehabilitation, and psychosocial interventions targeting improved patient outcomes. Overall, the biopsychosocial model has significant applications to the management of concussion, particularly post-concussion headache. Presentation and recovery following concussion and post-traumatic headache is multifaceted and includes the continuum of biological, psychological, and social considerations. In order to fully understand the widespread clinical utility and application of such models, there is a continued need for researcher, practitioner, and patient integration and collaboration to determine the most effective assessment and treatment strategies.
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Curr Pain Headache Rep · Jun 2020
ReviewA Comprehensive Review of the Treatment and Management of Myofascial Pain Syndrome.
Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points. The purpose of this comprehensive review is to provide updated information on prevalence, pathophysiology, and treatment modalities with a focus on interventional modalities in managing MPS. ⋯ Though MPS can present acutely, it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime. MPS is an often-overlooked component of pain with overarching effects on society, including patient quality of life, physical and social functioning, emotional well-being, energy, and costs on health care. The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety. MPS is poorly understood and remains a challenging condition to treat. Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS. Additional studies are warranted to get a better understanding of managing myofascial pain.
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Curr Pain Headache Rep · Jun 2020
ReviewExercise and Migraine Prevention: a Review of the Literature.
This review intends to characterize the recent literature pertaining to the role of aerobic exercise in the prevention of migraine. Areas of consensus within that literature may be used to guide clinical practice, allowing for the promulgation of evidence-based practice recommendations. ⋯ The past decade has seen the publication of numerous high-quality studies that explore aspects of exercise's effects on migraine prevention, including its success as a stand-alone prevention strategy, as well as its non-inferiority to some pharmacologic preventive measures. Exercise often tops providers' lists of recommended lifestyle modifications that help reduce migraine burden. Biologically, exercise suppresses inflammatory modulators, including numerous cytokines, and stress hormones, like growth hormone and cortisol. Exercise has also been shown to affect microvascular health, which may be implicated in cortical spreading depression. Psychologically, there is evidence that exercise improves migraine self-efficacy and internalizes the locus of control, leading to reduced migraine burden. Randomized control trials have demonstrated that a sufficiently rigorous aerobic exercise regimen alone is sufficient to yield a statistically significant reduction in migraine frequency, intensity, and duration. Higher-intensity training appears to confer more benefit. Studies have also demonstrated non-inferiority of exercise compared with certain pharmacologic prophylactic interventions, like topiramate. However, the addition of exercise to a traditional preventive regimen may provide added benefit. Special populations, like those with comorbid neck pain or tension headache, may benefit from exercise; and patients who cannot tolerate high-impact exercise may even benefit from low-impact exercise like yoga. Therefore, exercise is a reasonable evidence-based recommendation for migraine prevention.
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Curr Pain Headache Rep · Jun 2020
ReviewA Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome.
Postmastectomy pain syndrome (PMPS) remains poorly defined, although it is applied to chronic neuropathic pain following surgical procedures of the breast, including mastectomy and lumpectomy in breast-conserving surgery. It is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy. Though the onset of pain is most likely to occur after surgery, there may also be a new onset of symptoms following adjuvant therapy, including chemotherapy or radiation therapy. ⋯ The underlying pathophysiology is likely multifactorial, although exact mechanisms have yet to be elucidated. In this regard, neuralgia of the intercostobrachial nerve is currently implicated as the most common cause of PMPS. Numerous pharmacological options are available in the treatment of PMPS, including gabapentinoids, tricyclic antidepressants, selective serotonin reuptake inhibitors, NMDA receptor antagonists, and nefopam (a non-opioid, non-steroidal benzoxazocine analgesic). Minimally invasive interventional treatment including injection therapy, regional anesthesia, botulinum toxin, and neuromodulation has been demonstrated to have some beneficial effect. A comprehensive update highlighting current perspectives on the treatment of postmastectomy pain syndrome is presented with emphasis on treatments currently available and newer therapeutics currently being evaluated to alleviate this complex and multifactorial condition.
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The purpose of this review is to examine the multitude of factors which may impact learning and academic performance in patients with pediatric migraine. ⋯ A range of associations of varying degree were noted between pediatric migraine and conditions such as ADHD, learning disabilities, sleep disorders, and psychiatric comorbidities with regard to headache pain and school functioning. Recent literature highlights the importance of sleep in relation to headache, mood disorders, and learning in youth and the emerging role of perfectionism. Children with migraine remain at risk for school related and learning difficulties which may be primarily due to pain, due to other medical and psychiatric comorbidities commonly found in this population, or a combination. The relationships are complex and further studies are needed to clearly elucidate the shared biological and environmental pathophysiologic mechanisms.