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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a 3-year period, 25 caudalis dorsal root entry zone (DREZ) operations were done for severe, facial pain. Intraoperative brainstem recordings were done before and after DREZ in all patients. Primary diagnosis included refractory trigeminal neuralgia, atypical headaches or facial pain, posttraumatic closed head injuries, postsurgical anesthesia dolorosa, multiple sclerosis, brainstem infarction, postherpetic neuralgia and cancer-related pain. At the time of discharge, good to excellent pain relief was present in 24/25 patients and fair relief in 1. At 1 month, 19/25 (76%) patients had good to excellent results and at 3 months following surgery, 17/25 (68%) continued to have good to excellent pain relief. One year following surgery, 18 patients could be evaluated, 12/18 (67%) still considered their relief as good to excellent, 2 fair and 4 poor. Transient postoperative ataxia was present in 15/25 patients (60%), but was largely resolved at 1 months. In 3/18 (17%) patients, a degree of ataxia was still present at 1 year although in none was it disabling. Two patients had transient diplopia, and 3 had increased corneal anesthesia with 1 later developing a keratitis. No surgical or postsurgical mortality was noted. This procedure has proven to be a satisfactory treatment for many patients with debilitating facial pain syndromes with acceptable morbidity.
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PMID:The caudalis DREZ for facial pain. 971 11

Studies on the psychological assessment and treatment of neuropathic pain conditions, including postherpetic neuralgia (PHN), diabetic neuropathy, complex regional pain syndrome, post spinal cord injury, post amputation, and AIDS-related neuropathy, are reviewed. Although limited information is currently available, the findings are consistent with the larger literature on chronic pain and indicate that the assessment of neuropathic pain needs to include measurement of multiple dimensions of quality of life. Mood, physical and social functioning, and pain-coping strategies such as catastrophizing and social support are all important domains. Clinical trials of psychological interventions have not been reported in the scientific literature. Case series of successful treatment of neuropathic pain are reported, primarily in the area of biofeedback. As with other chronically painful conditions, it is likely that cognitive-behavioral interventions will improve the quality of life in neuropathic pain conditions.
Curr Pain Headache Rep 2001 Apr
PMID:Psychological assessment and treatment of patients with neuropathic pain. 1125 46

An edited transcript of two BETA LIVE! national telephone conference calls held April 18 and April 20, 1995 is provided. Pain experts Dr. William Breitbart and Dr. Matthew Lefkowitz discuss pain management in AIDS. Jules Levin discusses protease inhibitor drug development. Pain syndromes associated with AIDS include abdominal pain, peripheral neuropathy, and oropharyngeal pain. Headache pain, post-herpetic neuralgia, and musculoskeletal pain, although lower in incidence, also affect people with AIDS. Barriers to the treatment of pain are associated with health care providers and the patients themselves. Women with HIV are twice as likely to be undertreated for their pain than men with HIV. Patients with less education and those with a history of injection drug use are also likely to be undertreated for pain. Chronic pain in patients with AIDS is complex and involves treatment that looks at the physical, psychological, and emotional aspects of pain. Jules Levin, coordinator of the Protease Inhibitor Working Groups, discusses the importance of protease inhibitors and their status. Three protease inhibitor drugs are under development by three companies--La Roche, Merck and Abbott. The Merck and Abbott drugs are entering Phase III trials. Roche is planning an expanded access program for 4,000 people for its drug, saquinavir. All three companies have indicated that they will apply for accelerated approval.
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PMID:Pain management in AIDS. Interview by Ronald Baker. 1136 50

Trigeminal neuralgia and postherpetic neuralgia are the most relevant neuralgiform facial pain syndromes. Trigeminal neuralgia is characterized by lancinating intensive pain attacks of very short duration, triggered by external cues,whereas postherpetic neuralgia consists predominantly of long-lasting burning pain. Sodium channel blocking drugs are first choice in treatment of trigeminal neuralgia, operative procedures encompass microvascular decompression,thermocoagulation and percutaneous retrogasserian glycerol rhizotomy. In the acute stage postherpetic neuralgia is treated antivirally and analgesically, in the chronic stage by tricyclic antidepressive substances. Other pain syndromes described encompass the Tolosa-Hunt-syndrome, cervicogenic headache, craniomandibular dysfunction syndrome, atypical facial pain and rarer syndromes. Therapeutic recommendations are based on evidence based medicine criteria (EBM).
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PMID:[Therapy and prophylaxis of facial neuralgias and other forms of facial pain syndromes -- revised recommendations of the German Society of Migraine and Headache]. 1257 91

Regional anesthesia of the head and neck is an effective method of obtaining surgical anesthesia for various procedures. Diagnostic and therapeutic head and neck blocks can also assist with the diagnosis and management of many chronic pain conditions, including headache, postherpetic neuralgia, and cancer pain in this region. Gamma knife surgery offers a unique approach to the management of refractory trigeminal neuralgia. Because of the proximity of so many critical structures adjacent to these nerves, a solid understanding of the anatomical basis of these nerve blocks is necessary. Appropriate patient selection, monitoring, proper injection technique, knowledge of the pharmacokinetics and pharmacodynamics of local anesthetics and vasoconstrictors, possible drug interactions, and recommended doses will ensure safe and successful application of head and neck nerve blockade.
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PMID:Regional anesthesia and invasive techniques to manage head and neck pain. 1502 17

This study was designed to assess the efficacy and safety of pregabalin-a novel alpha(2)-delta ligand with analgesic, anxiolytic, and anticonvulsant activity-for treating neuropathic pain in patients with post-herpetic neuralgia (PHN). Two hundred and thirty-eight patients were randomised into this multicentre, doubleblind, placebo-controlled trial to receive 150 (n=81), 300 mg/day (n=76) pregabalin, or placebo (n=81) for 8 weeks. Among the exclusion criteria was failure to respond to previous treatment for PHN with gabapentin at doses > or =1200 mg/day. Endpoint mean pain scores were significantly reduced in patients receiving 150 or 300 mg/day pregabalin compared with placebo. Efficacy was observed as early as week 1 and was maintained throughout the study. Significantly more patients in both pregabalin groups (150 mg, 26%; 300 mg, 28%) were responders (> or =50% decrease in mean pain score from baseline to endpoint) than in the placebo group (10%). Additionally, by week 1 and for the study's duration, 150 and 300 mg/day pregabalin significantly reduced weekly mean sleep interference scores. More pregabalin-treated patients than placebo-treated patients reported that they were 'much improved' or 'very much improved'. Health-related quality-of-life (HRQoL) measurements using the SF-36 Health Survey demonstrated improvement in the mental health domain for both pregabalin dosages, and bodily pain and vitality domains were improved in the 300 mg/day group. The most frequent adverse events were dizziness, somnolence, peripheral oedema, headache, and dry mouth. Pregabalin efficaciously treated the neuropathic pain of PHN. Additionally, pregabalin was associated with decreased sleep interference and significant improvements in HRQoL measures.
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PMID:Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. 1508 23

Significant improvement of neuropathic pain has been achieved with studies that have demonstrated efficacy of newer anticonvulsants in relieving this type of pain, by having a neuromodulatory effect on the hyperexcitable damaged nervous system. Two drugs from this class, gabapentin and lamotrigine, have been submitted to a number of clinical trials. Ease of use and broad therapeutic range, in addition to demonstrated efficacy, make gabapentin the drug of choice for most neuropathic pain disorders. Lamotrigine is well tolerated when it is titrated slowly, which also is the way to avoid the development of a rash. Pregabalin, the newest agent that has demonstrated efficacy in the treatment of post-herpetic neuralgia, is awaiting approval. A number of available anticonvulsants are undergoing clinical trials and many drugs with neuromodulatory properties are being considered for further development.
Curr Pain Headache Rep 2004 Jun
PMID:Neuromodulating drugs for the symptomatic treatment of neuropathic pain. 1511 40

Major depressive disorder (MDD) and anxiety disorders such as generalized anxiety disorder (GAD) are often accompanied by chronic painful symptoms. Examples of such symptoms are backache, headache, gastrointestinal pain, and joint pain. In addition, pain generally not associated with major depression or an anxiety disorder, such as peripheral neuropathic pain (e.g., diabetic neuropathy and postherpetic neuralgia), cancer pain, and fibromyalgia, can be challenging for primary care providers to treat. Antidepressants that block reuptake of both serotonin and norepinephrine, such as the tricyclic antidepressants (e.g., amitriptyline), have been used to treat pain syndromes in patients with or without comorbid MDD or GAD. Venlafaxine, a serotonin and norepinephrine reuptake inhibitor, has been safe and effective in animal models, healthy human volunteers, and patients for treatment of various pain syndromes. The use of venlafaxine for treatment of pain associated with MDD or GAD, neuropathic pain, headache, fibromyalgia, and postmastectomy pain syndrome is reviewed. Currently, no antidepressants, including venlafaxine, are approved for the treatment of chronic pain syndromes. Additional randomized, controlled trials are necessary to fully elucidate the role of venlafaxine in the treatment of chronic pain.
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PMID:Treatment of pain syndromes with venlafaxine. 1516 96

Postherpetic neuralgia (PHN) is a serious complication of herpes zoster that has a predilection for older individuals. PHN is often associated with significant morbidity, and it can cause insomnia, fatigue, depression and interference with daily activities in affected individuals. Treatment for PHN is initiated with antivirals during the acute herpes zoster outbreak. Acyclovir (Zoviraxr, GlaxoSmithKline), valacyclovir (Valtrex, GlaxoSmithKline) or famciclovir (Famvir, Novartis) can be used to treat herpes zoster, and all three have been shown to reduce the duration of the herpetic rash and zoster-associated pain. These antivirals are most effective when used within the first 72 hours of the onset of the rash. Side-effects of these antivirals are low and include nausea, vomiting, abdominal pain and headache. Other treatment options for PHN include topical analgesics, opioid analgesics, tricyclic antidepressants and gabapentin. Because of the complexity of PHN, most patients require a combination of treatment modalities for adequate pain relief.
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PMID:Treatment of postherpetic neuralgia. 1555 Sep 90

Many orofacial pain conditions occur in the elderly. Specifically,this article reviews the prevalence of general and orofacial-related pain in the elderly. The authors also describe and discuss the likely disorders and diseases that produce facial pain and burning pain in the mouth. They do not cover jaw joint pain, oral sores, or ulceration-induced pain, as these conditions are better discussed in the context of arthritis and oral pathologies of the mouth. The authors discuss oral motor disorders, myogenous pain, vascular pain, headaches, trigeminal neuralgia, trigeminal neuropathic dis-ease, postherpetic neuralgia, burning mouth syndrome, and occlusal dysesthesia.
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PMID:Orofacial pain and sensory disorders in the elderly. 1575 9


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