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Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.
Learn More >Pain that lingers beyond the early weeks after the acute postoperative period is an important risk factor for chronic postsurgical pain. This study examined the hypothesis that patients' expectations about their postsurgical pain would be independently associated with lingering postsurgical pain.
Learn More >Mechanical stress to the TMJ is an important factor in cartilage degeneration, with both clinical and pre-clinical studies suggesting that repeated TMJ overloading could contribute to pain, inflammation, and/or structural damage in the joint. However, the relationship between pain severity and early signs of cartilage matrix microstructural dysregulation is not understood, limiting advancement of diagnoses and treatments for TMJ-OA. Changes in the pericellular matrix (PCM) surrounding chondrocytes may be early indicators of osteoarthritis. A rat model of TMJ pain induced by repeated jaw loading (1 hr/day for 7 days) was used to compare the extent of PCM modulation for different loading magnitudes with distinct pain profiles (3.5N – persistent pain, 2N – resolving pain, or unloaded controls – no pain) and macrostructural changes previously indicated by Mankin scoring. Expression of PCM structural molecules, collagen VI and aggrecan NITEGE neo-epitope, were evaluated at day 15 by immunohistochemistry within TMJ fibrocartilage and compared between pain conditions. Pericellular collagen VI levels increased at day 15 in both the 2N (p=0.003) and 3.5N (p=0.042) conditions compared to unloaded controls. PCM width expanded to a similar extent for both loading conditions at day 15 (2N, p<0.001; 3.5N, p=0.002). Neo-epitope expression increased in the 3.5N group over levels in the 2N group (p=0.041), indicating pericellular changes that were not identified in the same groups by Mankin scoring of the pericellular region. Although remodeling occurs in both pain conditions, the presence of pericellular catabolic neo-epitopes may be involved in the macrostructural changes and behavioral sensitivity observed in persistent TMJ pain. This article is protected by copyright. All rights reserved.
Learn More >More than hurt feelings: The wear and tear of day-to-day discrimination in adults with chronic pain.
To examine the extent to which self-reported experiences of discrimination are associated with pain interference among men and women with chronic non-cancer pain.
Learn More >Up to 80% of patients with head and neck cancer undergoing ablative surgery and neck dissection develop postoperative pain with detrimental effects on quality of life that also contributes to neuropathic and chronic postoperative pain.
Learn More >This journal recently published a paper by Wager and colleagues, entitled "Long-term outcomes of children with severe chronic pain: Comparison of former patients with a community sample" (Wager et al., in press). This paper demonstrates the lasting positive effects of intensive interdisciplinary pain treatment (IIPT) in children, and adds confidence in the duration of treatment effects through its unprecedented, controlled, 7-year follow-up design. Youth treated in IIPT are those with the most impairing pain; thus, these results are particularly encouraging, with almost 60% of the clinical sample no longer experiencing chronic pain.
Learn More >The DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP).
Learn More >: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. : A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. : One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. : The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP.
Learn More >1) Compare pressure pain threshold (PPT) values between office workers with chronic neck pain and asymptomatic controls; 2) establish reference PPT values in chronic neck pain; 3) evaluate associations between PPTs, pain intensity and disability.
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