Current pain and headache reports
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Curr Pain Headache Rep · Apr 2003
ReviewCognitive impairment in patients with chronic pain: the significance of stress.
This review article examines the role of emotional distress and other aspects of suffering in the cognitive impairment that often is apparent in patients with chronic pain. Research suggests that pain-related negative emotions and stress potentially impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral component of the neural system that mediates the impact of pain-related distress on cognitive functions, such as the allocation of attentional resources. A maladaptive physiologic stress response is another plausible cause of cognitive impairment in patients with chronic pain, but a direct role for dysregulation of the hypothalamic-pituitary-adrenocortical axis has not been systematically investigated.
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Curr Pain Headache Rep · Apr 2003
ReviewThe psychiatric management of end-of-life pain and associated psychiatric comorbidity.
Involvement by psychiatrists in the care of patients who are terminally ill has been limited historically; however, psychiatrists increasingly are participating in the care of these people who are facing the most challenging times of their lives. Pain management is considered to be an area of subspecialization for psychiatrists beyond their traditional role of being psychopharmacologists and psychotherapists. Biologically focused psychiatrists are able to address neuropsychiatric disorders, including pain and depression in the medically ill, and actively improve the quality of life for dying patients and their family members. ⋯ Beginning with an example of the scientific aspects of cancer-related treatment from a patient's perspective, and into the major treatment considerations, this article addresses pain, its recognition, and management challenges when the end of life approaches. The prompt recognition of frequently overlooked and underestimated concomitant depressions, delirium, dementia, and other mental disorders is important for mental health specialists. The importance of psychiatric care for patients who are terminally ill and the role of psychiatrists in the phase of care also are discussed.
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Cluster headaches are characterized by unilateral paroxysmal attacks of severe pain with associated symptoms. The headaches occur during particular sleep stages and are associated with other chronobiologic factors. Several sleep disorders have been associated with the occurrence of cluster headache; multiple hormonal influences affect the relationship between sleep and headache. ⋯ This article examines the relationship between the various sleep disorders and cluster headache, and reviews current research. Normal and abnormal sleep and details of treatments for specific sleep disorders that may decrease the frequency and severity of cluster headaches also are discussed. The relationship between obstructive sleep apnea, which is the most common sleep disorder, and cluster headache is discussed in detail.
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Curr Pain Headache Rep · Feb 2003
ReviewTargeted topical peripheral analgesics in the management of pain.
The term "targeted peripheral analgesics" has been developed to describe analgesics whose mechanism of action appears to be primarily through reducing pain transmission within the peripheral nervous system. Key differences between targeted peripheral and systemic analgesics and the difference between topical and transdermal analgesics are discussed. A review of the clinical conditions that have reportedly responded to targeted peripheral analgesics is described in detail in this article.
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Curr Pain Headache Rep · Feb 2003
Review Comparative StudyAnticonvulsants for the treatment of neuropathic pain syndromes.
This article is an evidence-based summary of randomized clinical trials published in peer-reviewed journals regarding the efficacy of anticonvulsants for the treatment of neuropathic pain.