Current pain and headache reports
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Curr Pain Headache Rep · Feb 2004
Radiation risk management during fluoroscopy for interventional pain medicine physicians.
Because of serious radiographic-induced skin injuries that may have been caused by the inappropriate use of fluoroscopy during the performance of radiograph-guided invasive procedures, the US Food and Drug Administration (FDA) issued an advisory in 1994 suggesting that the key to preventing such unfortunate mishaps may be physician education, training, and credentialing in the safe operation of fluoroscopic equipment. The purpose of this article is to familiarize the interventional pain medicine physician with the physics of ionizing radiation and how to limit patient exposure through the optimum setting of tube current and voltage, the use of limited beam-on time, tight collimation, and the elimination of the nonessential use of the magnification mode on a fluoroscopy unit. In addition, the use of personal protection equipment and the knowledge needed to interpret the personal exposure record of each practitioner is discussed. All of this information will assist the interventional pain medicine physician in meeting the recommended FDA training and credentialing requirements.
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Chronic daily headache is a significant problem in children and adolescents. The goal of this review is to paint a picture of this malady. The epidemiology is unclear because definitions have not been uniform. ⋯ Because the disease duration and the transformation period are so different in children with this disorder, shoehorning children into adult criteria may be problematic. Nevertheless, this article presents an approach to diagnosis and treatment based on what is present in the literature, what has worked with adults, and the consensus among pediatric headache practitioners. Because there is little literature on this subject, the review ends with a series of questions for future study.
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Most neuropathic analgesic medications have been introduced initially for other medical conditions. Anticonvulsants, local anesthetics, and antidepressants later were found to be effective in the treatment of neuropathic pain. Carbamazepine and the newer anticonvulsants such as gabapentin, lamotrigine, topiramate, and oxcarbazepine are being used as first-line or adjunctive therapy. ⋯ All of the available analgesics have considerable side effects, which necessitate careful titration. Future drug research may focus on developing medications specifically for neuropathic pain. These designer agents may have more desirable action without the unwanted side effects.
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The aim of this review is to present research that has a bearing on the pathogenesis of hypersensitivity in muscle pain syndromes. Allodynia and hyperalgesia in these syndromes can be segmental or generalized and temporary or permanent. Hypersensitivity in muscle pain conditions in the clinic is best diagnosed by determining the pressure pain threshold. ⋯ Pathogenetic mechanisms for allodynia and hyperalgesia can be identified at several levels of the nociceptive system, from the nociceptors in the muscle to the cortex. Central sensitization of nociceptive neurons in the dorsal horn and a disturbed balance between inhibitory and facilitatory impulses in the descending tracts from the brain stem to the dorsal horn are the main mechanisms for pain hypersensitivity. Changes in function, biochemical make-up, and synaptic connections in the nociceptive neurons in the dorsal horn are considered to be caused by neuronal plasticity.
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Curr Pain Headache Rep · Dec 2003
ReviewEvaluation of treatments for myofascial pain syndrome and fibromyalgia.
Myofascial pain syndrome (MPS) and fibromyalgia (FM) are complex conditions and pose significant challenges to clinicians and patients. This chapter explores available treatments for MPS and FM in the context of pathophysiology, clinical evidence, and experimental support. This information may prove to be helpful in designing individualized treatment for patients with these complex syndromes. New treatments should be critically and carefully evaluated as they appear.