Current pain and headache reports
-
Migraine patients often report intolerance to odours. Migraineurs report odours may trigger attacks, that they experience osmophobia during attacks, and olfactory hypersensitivity between attacks. In this paper we discuss olfactory mechanisms in migraine. ⋯ The study results confirm that hypersensitivity to odour is a common feature in women with migraine. Migraine pathophysiology likely explains this particular vulnerability. We discuss these pathophysiologic mechanisms and hypotheses relating odour intolerances and migraine.
-
Despite ongoing efforts, neither effective treatments nor mechanistic understanding of the pathogenesis of human neuropathic pain exists. Genetic association studies may point to the novel molecules that mediate neuropathic pain, facilitating its understanding and management. ⋯ This article summarizes and discusses current strategies to optimize population-based association studies of human neuropathic pain focusing on principles of measuring neuropathic pain phenotypes and genotyping techniques. We also consider advantages and challenges of study designs and statistical analyses.
-
Curr Pain Headache Rep · Jun 2010
ReviewBehavioral management of migraine headache triggers: learning to cope with triggers.
The literature on migraine triggers is reviewed, including the most common triggers, interactions between triggers, the research evidence related to the capacity of self-reported triggers to precipitate headaches, and the neurobiologic pathways by which triggers induce migraine attacks. An argument is developed against the standard advice to avoid migraine triggers as the best way of preventing attacks, based on conceptual and practical criticisms, and consideration of cognate literatures on chronic pain, stress, and anxiety. A small number of studies suggest that exposure to headache triggers has the same effect as exposure to anxiety-eliciting stimuli, with short exposure associated with increased pain response and prolonged exposure associated with decreased pain response. On the basis of this literature, "learning to cope with triggers" is advocated, where controlled exposure and approach/confront strategies are used to manage migraine triggers, except in cases where such an approach would probably be inappropriate.
-
Curr Pain Headache Rep · Jun 2010
ReviewSpinal cord mechanisms of chronic pain and clinical implications.
Chronic pain is a prevalent and challenging problem for most medical practitioners. Because of the complex pathologic mechanisms involved in chronic pain, optimal treatment is still under development. The spinal cord is an important gateway for peripheral pain signals transmitted to the brain. ⋯ These events induce multiple inflammatory and neuropathic processes in the spinal cord dorsal horn, and trigger modification and plasticity of local neural circuits. As a result, ongoing noxious signals to the brain are amplified and prolonged, a phenomenon known as central sensitization. In this review, the molecular events associated with central sensitization, as well as their clinical implications, are discussed.
-
Curr Pain Headache Rep · Apr 2010
ReviewThe effect of morphine on glial cells as a potential therapeutic target for pharmacological development of analgesic drugs.
Opioids have played a critical role in achieving pain relief in both modern and ancient medicine. Yet, their clinical use can be limited secondary to unwanted side effects such as tolerance, dependence, reward, and behavioral changes. Identification of glial-mediated mechanisms inducing opioid side effects include cytokine receptors, kappa-opioid receptors, N-methyl-D-aspartate receptors, and the recently elucidated Toll-like receptors. Newer agents targeting these receptors such as AV411, MK-801, AV333, and SLC022, and older agents used outside the United States or for other disease conditions, such as minocycline, pentoxifylline, and UV50488H, all show varied but promising profiles for providing significant relief from opioid side effects, while simultaneously potentiating opioid analgesia.