Current pain and headache reports
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Although possessing a long history of use, the therapeutic use of epidural steroid injections still needs substantiation. Refinements in our understanding of the pathophysiology of radicular pain and in the techniques used to deliver depo-steroids to the target tissue will lead to improved clinical outcomes and fewer technique and drug-related side effects. Administration of epidural steroids at lumbar spine sites is more common than at cervical spine levels, although the same pain management concepts are applicable. Comparative studies are necessary to clearly define the advantages and disadvantages of the use of fluoroscopy and the transforaminal technique.
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Despite no clear explanation of the mechanism underlying chronic daily headache, sensitization of central nociceptive neurons is one possibility. Either prolonged activation of peripheral nociceptors or any factors that can alter the endogenous pain control system can trigger this process. ⋯ It was also shown that chronic analgesic exposure led to changes in the serotonin content and the density of the 5-HT(2A) receptor in the cerebral cortex. The plasticity of the serotonin-dependent pain control system may facilitate the process of sensitization and results in the development of chronic daily headache.
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Chronic daily headache (CDH), an almost continual headache in the absence of organic pathology, is an exceptionally challenging type of headache to treat in children and adolescents. CDH has different expressions in children and adults; the different expressions may reflect several different etiologies or a developmental continuum. Although a positive family history predisposes children to develop headache, many environmental, biological, and psychological processes may share a role in the etiology. ⋯ Although many drug and nondrug therapies are available for treating children's headache, we lack data about which therapies are best for children with CDH or its subtypes. The current principles guiding our management of CDH in children and adolescents are extrapolated from the existing literature on childhood headache, CDH in adults, and our clinical experience. A child-centered focus is particularly important in the treatment of CDH because it is not caused by an underlying disease or disorder.
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Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and movement against inertia. However, when exposed to single or recurrent episodes of biomechanical overloading, muscle injury may occur. ⋯ Techniques for evaluation of the muscular components of a pain syndrome involve palpation, strength testing, range of motion, and assessment of muscle endplay. Management of acute injuries may necessitate imaging and surgery consultation for lacerations or hemorrhage. Treatment of acute syndromes consists of cryotherapy and reduced activity, whereas chronic syndromes may require multiple therapeutic approaches, applied together or sequentially.
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Curr Pain Headache Rep · Oct 2001
ReviewInterventional approaches to the management of myofascial pain syndrome.
Interventional therapies are a valuable addition to our armamentarium when treating myofascial pain syndromes. When combined with other therapies, interventional techniques can be an effective adjunct in the multidisciplinary management of pain. ⋯ More recent advances, such as the use of botulinum toxin, are also discussed. In addition, other techniques such as acupuncture and the use of laser therapy are mentioned.