Current pain and headache reports
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Curr Pain Headache Rep · Jun 2004
ReviewToward a molecular genetic classification of familial hemiplegic migraine.
The genetics of migraine is a fascinating and rapidly moving research area. Familial hemiplegic migraine, a rare subtype of migraine with a Mendelian pattern of inheritance, is caused by mutations in the chromosome 19 CACNA1A gene or in the chromosome 1 ATP1A2 gene. Familial migraine variants are classified on the basis of clinical, descriptive criteria, but this is insufficient. In the future, a diagnostic classification based on mutation-analysis is needed.
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Curr Pain Headache Rep · Jun 2004
ReviewAnti-inflammatory agents for the treatment of musculoskeletal pain and arthritis.
Pain produced by musculoskeletal disorders commonly misconceived as having mechanical etiology often is caused by inflammatory mechanisms. Simple analgesics (ie, those that lack anti-inflammatory action) often are used to treat musculoskeletal pain when an anti-inflammatory analgesic may be more effective for the painful condition. This review addresses the anti-inflammatory agents available for the symptomatic management of common inflammatory musculoskeletal conditions including osteoarthritis, rheumatoid arthritis, and low back pain.
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Hemiplegic migraine may be familial or sporadic. Both forms share a similar spectrum of clinical presentations and genetic heterogeneity. ⋯ Sporadic cases are more difficult to diagnose and often require several investigations to rule out more ominous possibilities. Therapeutic options are limited, but future genetic research may elucidate pathophysiologic mechanisms that may, in turn, yield more specific treatments.
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Migraine is a major source of pain-related disability. Despite the personal and societal impact of this disorder, migraine continues to be misdiagnosed and undertreated even though well-established diagnostic criteria and safe and effective treatments are available. The recent revision of diagnostic criteria for headache diagnosis and consensus guidelines for migraine treatment hopefully will promote better medical care for headache sufferers. Advancements in understanding the neurobiology of migraine will guide the development of new treatments.
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Curr Pain Headache Rep · Apr 2004
ReviewHypothalamo-pituitary-adrenal axis dysfunction as a contributory factor to chronic pain and depression.
Chronic pain and depressive illness are variably resistant to treatment with current pharmacologic therapies. Pain as a reflex sensory response is accompanied by a fast autonomic and delayed neuroendocrine response mediated by the sympathoadrenal and hypothalamo-pituitary-adrenal (HPA) axis, respectively. The emotional aspect of the pain response is encoded by corticolimbic systems (including the HPA axis) to encapsulate the relationship between pain, memory, and mood. ⋯ Conversely, many chronic pain patients may suffer from depressive illness, which appears to develop as a consequence of chronic pain. A comparison of key changes in HPA function after chronic stress in animals with clinical depression in humans, reveals some striking similarities. In this article, the role of the HPA axis in the etiology of chronic pain and depression is discussed.