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

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

Spinal cord stimulation (SCS) is a reversible treatment for chronic pain that is gaining favor as a first-line therapy for many disease states. Because there are no addictive issues and no side effects systemically, the treatment is moving up the treatment continuum ladder. First used clinically in 1967, the procedure was used exclusively for failed back surgery syndrome. Over the past 30 years selection criteria, psychologic screening, and technology have improved. These advances have broadened the treatment options for many patients in pain. This review focuses on the selection, indications, techniques, new advances, complications, and outcomes involved with SCS. A review is provided for the treatment of radiculitis, failed back surgery syndrome, complex regional pain syndrome, peripheral neuropathies, pelvic pain, occipital neuralgia, angina, ischemic extremity pain, and spasticity. Technologic advances such as multi-lead and multi-electrode arrays are also discussed in regard to the impact these developments have on the clinical application of the therapy.
Curr Pain Headache Rep 2001 Dec
PMID:Current and future trends in spinal cord stimulation for chronic pain. 1167 84

Involvement of the (efferent) autonomic nervous system in the generation of pain is ongoing matter of debate. Based on clinical and experimental observations, there are good arguments that the sympathetic nervous system may be involved in pain following trauma, with and without nerve lesion, at an extremity, such as in complex regional pain syndrome type I and II. However, the mechanisms involved are in many cases still unclear. In various types of headache there is no convincing evidence that the sympathetic nervous system is involved in the generation of pain, although these pains may be accompanied by considerable autonomic reactions which are dependent on activity in sympathetic neurons. Migraine and headaches with autonomic symptoms are accompanied by autonomic reactions which are dependent on activity in cranial parasympathetic neurons. Whether parasympathetic neurons innervating cranial blood vessels are involved in activation or sensitization of trigemino-vascular afferents is discussed and needs experimental verification.
Cephalalgia 2003
PMID:Relationship between pain and autonomic phenomena in headache and other pain conditions. 1269 58

Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. Because of these various symptoms and the difficulty in identifying causative lesions, complex regional pain syndrome is difficult to treat or cure. Complex regional pain syndrome has not been systematically investigated; there are few controlled treatment trials for established complex regional pain syndrome. This article reviews the existing studies (even if preliminary) to direct clinicians toward the best options. Treatments for other neuropathic pain syndromes that may be efficacious for complex regional pain syndrome also are discussed. Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.
Curr Pain Headache Rep 2003 Jun
PMID:Complex regional pain syndrome: a review of evidence-supported treatment options. 1272 May 98

Facilitation of nociceptive systems has been implicated in Chronic-Migraine pathogenesis. Daily consumption of medication may be a contributing factor. The patient was male, aged 76 years, with history of migraine without aura. Six years ago, he presented with a mild-moderate daily pulsating headache. He was overusing analgesics and ergotamine. After withdrawing, the patient started a nonpulsating headache, diffuse and constant. During follow up, he was refractive to several symptomatic and prophylactic treatments. When we treated him with placebo capsules, the headache responded very well. At first, pain-relief occurred for 6 h and progressively, extended. Two years later, when our patient started to use transdermal patches of fentanyl for treatment of a complex regional pain syndrome type 1, his headache did not improve. Patient has maintained prolonged response to placebo. Actually, he is pain-free for 2-3 days with 1 placebo capsule. We discuss mechanisms of chronic-migraine, drug-overuse, drug-induced headache and placebo addiction. Powerful psychological mechanisms could determine response to placebo in this patient.
Cephalalgia 2005 May
PMID:Placebo response in a patient with chronic migraine and ergotic overuse. 1583 45

This review summarizes evidence, primarily from recent human studies, indirectly supporting a novel hypothesis: that the assessment of healthy individuals' responses to standardized noxious stimuli in a controlled laboratory environment has important implications for the later risk of developing a broad spectrum of chronically painful conditions. Descriptions of many chronic pain syndromes note that the disorder (e.g., fibromyalgia, headache, complex regional pain syndrome) is associated with hypersensitivity to pain and with reduced endogenous inhibition of pain, implying that an individual's processing of pain-related information changes with the onset of the syndrome. However, pain sensitivity and pain-inhibitory capacity are normally distributed along a wide continuum in the general population, and recent evidence suggests that heightened baseline pain sensitivity and reduced basal pain-inhibitory processing place individuals at greater risk for experiencing severe, acute, clinical pain (e.g., postoperative pain). More controversial is the hypothesis that such individual-difference characteristics confer risk for, or protection against, chronic pain; although only a single prospective study has been published, substantial indirect evidence supports the contention that greater basal pain sensitivity and reduced pain-inhibitory capacity may act as a diathesis for chronic pain. Long-term cohort studies are necessary to test this hypothesis; such research could yield insight into the nature of chronic pain and permit greater precision in selecting high-risk individuals for chronic pain prevention research.
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PMID:Individual differences in endogenous pain modulation as a risk factor for chronic pain. 1608 10

We investigated whether headache and family history of headache are risk factors for complex regional pain syndrome (CRPS) or not. Twenty-three CRPS patients and 69 healthy persons were interviewed whether or not they suffered from headache and had first-degree family history of headache. A headache sufferer was defined as a person who regularly suffered from headache for more than 2 days per month. Headache after an occurrence of CRPS (headache after an injury or operation in case of CRPS after an injury or operation) was excluded and just headache before an occurrence of CRPS was included. If a first-degree family had a regular headache, she or he was regarded as a headache sufferer regardless of the frequency of headache. Of the 23 patients with CRPS, 12 (52.2%) had suffered from headache before an occurrence of CRPS. Of the 69 healthy persons, 18 (26.1%) suffered from headache. Significant differences between patients and healthy persons were found. Of the 23 patients with CRPS, eight (34.8%) had a first-degree family history of headache. Of the 69 healthy persons, ten (14.5%) had a first-degree family history of headache. Significant differences between patients and healthy persons were found in a family history. The results suggest that headache and a first-degree family history of headache are risk factors for CRPS. To determine whether or not headache and first-degree family history of headache are risk factors for CRPS, further prospective studies with larger patient numbers should be carried out.
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PMID:Headache may be a risk factor for complex regional pain syndrome. 1642 40

Ziconotide intrathecal infusion was recently approved by the United States Food and Drug Administration for the treatment of intractable severe chronic pain. Patients with neuropathic pain make up a significant population among those who experience chronic pain for which there are less than optimal pharmacotherapeutic options. Published clinical trials provide a global view of ziconotide efficacy and safety. A subset of patients in clinical trials obtained complete pain relief, a remarkable finding given the history of drug treatment for neuropathic pain. To provide more information regarding those who respond to ziconotide therapy, we discuss three patients with neuropathic pain who received ziconotide infusion. Two patients with longstanding neuropathic pain, one with complex regional pain syndrome (formerly known as reflex sympathetic dystrophy) of the leg and one with lumbar radiculitis, achieved temporary but complete pain relief from single 5- and 10-microg epidural test doses. In the third case, a patient with longstanding bilateral leg and foot neuropathic pain from acquired immunodeficiency syndrome and antiretroviral drug therapy achieved considerable pain relief from a long-term continuous intrathecal infusion. The patients who received a single dose had mild central nervous system adverse effects such as sedation, somnolence, nausea, headache, and lightheadedness. The patient who received the intrathecal infusion experienced mild-to-severe adverse effects depending on the rate of infusion; these effects included sedation, confusion, memory impairment, slurred speech, and double vision. This patient could sense impending adverse effects and made rate adjustments or suspended infusion to avert untoward symptoms. In all three cases, patients achieved considerable pain relief that was long-lasting and persisted well after dose administration or suspension of infusion.
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PMID:Ziconotide infusion for severe chronic pain: case series of patients with neuropathic pain. 1650 20

Chronic pain is one of the frequently encountered clinical problems that is difficult to cure. Hyperbaric oxygen (HBO) therapy has been reported in chronic pain syndromes with promising results. In this review, we focus on the effectiveness of HBO in fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. HBO may be beneficial if appropriate patients are selected. HBO is a reliable method of treatment. However, physicians performing HBO must be aware of oxygen toxicity. Another problem regarding HBO is the scarcity of centers administering it. Further research is required focusing on the optimal treatment protocol, the cost/benefit ratio, and the safety of HBO in chronic pain management.
Curr Pain Headache Rep 2006 Apr
PMID:Hyperbaric oxygen therapy in chronic pain management. 1653 61

Caudal block with a local anesthetic through the hiatus sacralis has been performed in patients with chronic low back pain, lower limb pain, anal pain, and pelvic pain due to spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, postherpetic neuralgia, peripheral vascular disease, complex regional pain syndrome and so on. We prepar- ed an information and consent sheet on caudal block in The University of Tokyo Hospital. In the information sheet, we included disease, purpose, methods, outcome, accidental complications of caudal block, other treatments, progress on unperformed case, questions and answers, influence of rejection, and doctor's name. We experienced some cases of boring pain, deterioration of low back pain and lower limb pain, headache, nausea, hypertension, hypotension, and tachycardia as accidental complications of caudal block. In describing some accidental complications, we included boring pain, high intracranial pressure, dural puncture, nerve injury, infection, hemorrhage, embolism, allergy, and heart, lung, brain, liver, and kidney failures. Further, we could refer to the accidental complications of epidural block. However, the rate of each accidental complication has not been known in detail. We should survey the outcome and accidental complication of caudal block prospectively in multiple facilities and provide the patients with useful information.
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PMID:[Information and consent sheet of caudal block in the University of Tokyo Hospital]. 1678 90


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