Arch Neurol. 2003;60:1524-1534.
Robert H. Dworkin, PhD; Miroslav Backonja, MD; Michael C. Rowbotham, MD; Robert R. Allen, MD; Charles R. Argoff, MD; Gary J. Bennett, PhD; M. Catherine Bushnell, PhD; John T. Farrar, MD; Bradley S. Galer, MD; Jennifer A. Haythornthwaite, PhD; David J. Hewitt, MD; John D. Loeser, MD; Mitchell B. Max, MD; Mario Saltarelli, MD, PhD; Kenneth E. Schmader, MD; Christoph Stein, MD; David Thompson, PhD; Dennis C. Turk, PhD; Mark S. Wallace, MD; Linda R. Watkins, PhD; Sharon M. Weinstein, MD
ABSTRACT
Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism–based approach. An evidence-based treatment approach is becoming feasible as the number of published randomized controlled trials continues to grow steadily. In this article, we discuss the diagnosis and assessment of neuropathic pain and survey recent research on pathophysiologic mechanisms. Evidence-based treatment recommendations for the pharmacologic management of chronic neuropathic pain are presented that take into account clinical effectiveness, adverse effects, influence on quality of life, and cost.
Free Full Text: http://archneur.ama-assn.org/cgi/content/full/60/11/1524
Showing posts with label differential diagnosis. Show all posts
Showing posts with label differential diagnosis. Show all posts
Friday, October 16, 2009
Wednesday, September 16, 2009
Cluster-like headache. A comprehensive reappraisal
Cluster-like headache. A comprehensive reappraisal
Cephalalgia; Published Online: 7 Sep 2009
F Mainardi 1 , M Trucco 2 , F Maggioni 3 , C Palestini 1 , F Dainese 1 & G Zanchin 3
1 Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venice, 2 Headache Centre, Department of Neurosciences, Santa Corona Hospital, Pietra Ligure, Savona and 3 Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy
Correspondence to Federico Mainardi, Headache Centre, Neurological Division, SS Giovanni e Paolo Hospital, Castello 6777 – I30122, Venice, Italy. Tel. + 39-41-529-4417,
fax + 39-41-529-4555, e-mail: federico.mainardi@ulss12.ve.it
Copyright © 2009 International Headache Society
ABSTRACT
Among the primary headaches, cluster headache (CH) presents very particular features allowing a relatively easy diagnosis based on criteria listed in Chapter 3 of the International Classification of Headache Disorders (ICHD-II). However, as in all primary headaches, possible underlying causal conditions must be excluded to rule out a secondary cluster-like headache (CLH). The observation of some cases with clinical features mimicking primary CH, but of secondary origin, led us to perform an extended review of CLH reports in the literature. We identified 156 CLH cases published from 1975 to 2008. The more frequent pathologies in association with CLH were the vascular ones (38.5%, n = 57), followed by tumours (25.7%, n = 38) and inflammatory infectious diseases (13.5%, n = 20). Eighty were excluded from further analysis, because of inadequate information. The remaining 76 were divided into two groups: those that satisfied the ICHD-II diagnostic criteria for CH, 'fulfilling' group (F), n = 38; and those with a symptomatology in disagreement with one or more ICHD-II criteria, 'not fulfilling' group (NF), n = 38. Among the aims of this study was the possible identification of clinical features leading to the suspicion of a symptomatic origin. In the differential diagnosis with CH, red flags resulted both for F and NF, older age at onset; for NF, abnormal neurological/general examination (73.6%), duration (34.2%), frequency (15.8%) and localization (10.5%) of the attacks. We stress the fact that, on first observation, 50% of CLH presented as F cases, perfectly mimicking CH. Therefore, the importance of accurate, clinical evaluation and of neuroimaging cannot be overestimated.
--------------------------------------------------------------------------------
Received 14 April 2009, accepted 20 July 2009
Cephalalgia; Published Online: 7 Sep 2009
F Mainardi 1 , M Trucco 2 , F Maggioni 3 , C Palestini 1 , F Dainese 1 & G Zanchin 3
1 Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venice, 2 Headache Centre, Department of Neurosciences, Santa Corona Hospital, Pietra Ligure, Savona and 3 Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy
Correspondence to Federico Mainardi, Headache Centre, Neurological Division, SS Giovanni e Paolo Hospital, Castello 6777 – I30122, Venice, Italy. Tel. + 39-41-529-4417,
fax + 39-41-529-4555, e-mail: federico.mainardi@ulss12.ve.it
Copyright © 2009 International Headache Society
ABSTRACT
Among the primary headaches, cluster headache (CH) presents very particular features allowing a relatively easy diagnosis based on criteria listed in Chapter 3 of the International Classification of Headache Disorders (ICHD-II). However, as in all primary headaches, possible underlying causal conditions must be excluded to rule out a secondary cluster-like headache (CLH). The observation of some cases with clinical features mimicking primary CH, but of secondary origin, led us to perform an extended review of CLH reports in the literature. We identified 156 CLH cases published from 1975 to 2008. The more frequent pathologies in association with CLH were the vascular ones (38.5%, n = 57), followed by tumours (25.7%, n = 38) and inflammatory infectious diseases (13.5%, n = 20). Eighty were excluded from further analysis, because of inadequate information. The remaining 76 were divided into two groups: those that satisfied the ICHD-II diagnostic criteria for CH, 'fulfilling' group (F), n = 38; and those with a symptomatology in disagreement with one or more ICHD-II criteria, 'not fulfilling' group (NF), n = 38. Among the aims of this study was the possible identification of clinical features leading to the suspicion of a symptomatic origin. In the differential diagnosis with CH, red flags resulted both for F and NF, older age at onset; for NF, abnormal neurological/general examination (73.6%), duration (34.2%), frequency (15.8%) and localization (10.5%) of the attacks. We stress the fact that, on first observation, 50% of CLH presented as F cases, perfectly mimicking CH. Therefore, the importance of accurate, clinical evaluation and of neuroimaging cannot be overestimated.
--------------------------------------------------------------------------------
Received 14 April 2009, accepted 20 July 2009
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