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  1. Article ; Online: Use of low-dose naltrexone in the management of chronic pain conditions: A systematic review.

    Hatfield, Elizabeth / Phillips, Kristine / Swidan, Sahar / Ashman, Lawrence

    Journal of the American Dental Association (1939)

    2020  Volume 151, Issue 12, Page(s) 891–902.e1

    Abstract: Background: The authors aimed to evaluate the efficacy of low-dose naltrexone in the management of chronic pain conditions and determine its potential use in orofacial pain management.: Methods: A comprehensive literature review was completed in the ... ...

    Abstract Background: The authors aimed to evaluate the efficacy of low-dose naltrexone in the management of chronic pain conditions and determine its potential use in orofacial pain management.
    Methods: A comprehensive literature review was completed in the PubMed/MEDLINE, Embase, Cumulated Index to Nursing and Allied Health Literature, Dentistry and Oral Sciences Source Library databases up through June 17, 2019, using terms such as neurogenic, inflammation, naltrexone, temporomandibular, and chronic pain. The primary outcome was reduction in pain intensity and, secondarily, improvement in quality of life.
    Results: A total of 793 studies were obtained with the initial search and 8 articles were selected for evaluation. Of these 8 articles, 4 were case reports, 3 were clinical studies, and 1 was a randomized controlled trial. Six studies included data on fibromyalgia, 2 studies included data on chronic regional pain syndrome, and 1 examined multiple diagnoses, including fibromyalgia, interstitial cystitis, and chronic pelvic pain. The primary outcome of all of the studies was pain intensity reduction.
    Conclusions and practical implications: Low-dose naltrexone provides an alternative in medical management of chronic pain disorders as a novel anti-inflammatory and immunomodulator. It can offer additional management options, as orofacial pain conditions share characteristics with other chronic pain disorders. Owing to the size and heterogeneity of the studies, more large-scale studies are needed, along with additional studies assessing orofacial pain response to low-dose naltrexone.
    MeSH term(s) Chronic Pain/drug therapy ; Fibromyalgia ; Humans ; Naltrexone/therapeutic use ; Pain Management ; Quality of Life
    Chemical Substances Naltrexone (5S6W795CQM)
    Language English
    Publishing date 2020-11-23
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 220622-5
    ISSN 1943-4723 ; 0002-8177 ; 1048-6364
    ISSN (online) 1943-4723
    ISSN 0002-8177 ; 1048-6364
    DOI 10.1016/j.adaj.2020.08.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Ul III Zs.72: Show issues Location:
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  2. Article: Elevation of CSF tumor necrosis factor alpha levels in new daily persistent headache and treatment refractory chronic migraine.

    Rozen, Todd / Swidan, Sahar Z

    Headache

    2007  Volume 47, Issue 7, Page(s) 1050–1055

    Abstract: Objective: To determine if patients with new daily persistent headache (NDPH) have elevated levels of tumor necrosis factor alpha (TNF alpha) in the CSF.: Background: NDPH is considered one of the most treatment resistant of all headache syndromes. ... ...

    Abstract Objective: To determine if patients with new daily persistent headache (NDPH) have elevated levels of tumor necrosis factor alpha (TNF alpha) in the CSF.
    Background: NDPH is considered one of the most treatment resistant of all headache syndromes. This reflects a lack of understanding of its pathogenesis. As a certain percentage of NDPH patients have their headaches start after an infection, the possibility of a persistent state of systemic or CNS inflammation comes into question. TNF alpha is a proinflammatory cytokine involved in brain immune and inflammatory activities, as well as in pain initiation. The goal of this study was to look at TNF alpha levels in the CSF of NDPH patients, to determine if CNS inflammation may play some role in the pathogenesis of this condition.
    Methods: CSF TNF alpha levels were studied in 38 patients: 20 with NDPH and a control population of 16 patients with chronic migraine (CM), and 2 with post-traumatic headache (PT).
    Results: CSF TNF alpha levels were elevated in 19 of 20 NDPH patients, 16 of 16 CM patients, and both PT patients. Serum TNF alpha levels were normal in most of the study subjects.
    Conclusion: An elevation of CSF TNF alpha levels was found in almost all NDPH patients and suggest a role for TNF alpha in the pathogenesis of this condition. Surprisingly, all CM and PT patients tested had elevated CSF TNF alpha levels. In most patients with elevated CSF levels, serum TNF alpha levels were normal. All of these syndromes may be manifestations of CNS inflammation. As most of the positive-tested patients showed minimal to no improvement during aggressive inpatient treatment, persistent elevation of CSF TNF alpha levels may be one of the causes of treatment refractory CDH.
    MeSH term(s) Adolescent ; Adult ; Biomarkers/cerebrospinal fluid ; Chronic Disease ; Female ; Headache/cerebrospinal fluid ; Headache/physiopathology ; Humans ; Inpatients ; Male ; Middle Aged ; Migraine Disorders/cerebrospinal fluid ; Migraine Disorders/physiopathology ; Reference Values ; Tumor Necrosis Factor-alpha/cerebrospinal fluid
    Chemical Substances Biomarkers ; Tumor Necrosis Factor-alpha
    Language English
    Publishing date 2007-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 410130-3
    ISSN 1526-4610 ; 0017-8748
    ISSN (online) 1526-4610
    ISSN 0017-8748
    DOI 10.1111/j.1526-4610.2006.00722.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 539: Show issues Location:
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  3. Article ; Online: Trendelenburg position: a tool to screen for the presence of a low CSF pressure syndrome in daily headache patients.

    Rozen, Todd / Swidan, Sahar / Hamel, Robert / Saper, Joel

    Headache

    2008  Volume 48, Issue 9, Page(s) 1366–1371

    Abstract: Objective: To test the hypothesis that the Trendelenburg position is an accurate screening investigation for the presence of a low cerebrospinal fluid (CSF) pressure syndrome in patients with daily headache.: Background: The Trendelenburg position ... ...

    Abstract Objective: To test the hypothesis that the Trendelenburg position is an accurate screening investigation for the presence of a low cerebrospinal fluid (CSF) pressure syndrome in patients with daily headache.
    Background: The Trendelenburg position causes a rapid increase in intracranial CSF pressure. In a patient with a known CSF leak who overtime had less improvement in the supine position, being placed in Trendelenburg rapidly alleviated her daily headache. This suggested that the Trendelenburg position might be a good screening tool for low CSF pressure syndromes.
    Methods: Case reports. All patients were placed in the Trendelenburg position (10 degrees -20 degrees head-down tilt) for 5 minutes. A patient was considered to have a positive Trendelenburg test if they experienced complete pain freedom or substantial improvement in baseline head pain in the Trendelenburg position.
    Results: Case patients are presented for 3 clinical scenarios: Scenario 1: Daily headache with or without a positional component with a positive response to the Trendelenburg position and subsequent evidence of an underlying low CSF pressure syndrome. Scenario 2: Daily headache with a strong positional component but no improvement in the Trendelenburg position and a negative evaluation for a low CSF pressure syndrome. Scenario 3: Trendelenburg position proves the existence of a post-lumbar puncture headache in patients with near-daily headaches.
    Conclusion: The Trendelenburg position appears potentially useful as a clinical tool to screen for the presence of a low CSF pressure syndrome in patients with daily headache.
    MeSH term(s) Adult ; Cerebrospinal Fluid Pressure/physiology ; Female ; Head-Down Tilt ; Headache/diagnosis ; Headache/etiology ; Humans ; Intracranial Hypotension/complications ; Intracranial Hypotension/diagnosis ; Middle Aged
    Language English
    Publishing date 2008-10
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 410130-3
    ISSN 1526-4610 ; 0017-8748
    ISSN (online) 1526-4610
    ISSN 0017-8748
    DOI 10.1111/j.1526-4610.2007.01027.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 539: Show issues Location:
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  4. Article: Efficacy of intravenous diphenhydramine versus intravenous DHE-45 in the treatment of severe migraine headache.

    Swidan, Sahar Z / Lake, Alvin E / Saper, Joel R

    Current pain and headache reports

    2004  Volume 9, Issue 1, Page(s) 65–70

    Abstract: This study was conducted to compare the efficacy of intravenous diphenhydramine with dihydroergotamine mesylate (DHE-45; Novartis International AG, Switzerland) in the treatment of severe, refractory, migraine headache. A retrospective review was ... ...

    Abstract This study was conducted to compare the efficacy of intravenous diphenhydramine with dihydroergotamine mesylate (DHE-45; Novartis International AG, Switzerland) in the treatment of severe, refractory, migraine headache. A retrospective review was conducted to include eighty randomly chosen patients who were admitted to the Michigan Head Pain & Neurological Institute's inpatient program at Chelsea Community Hospital. Patients had received nine doses of diphenhydramine or nine doses of DHE-45 during a 3-day period. Patients receiving DHE-45 also received metoclopramide (Reglan; AH Robins Company, Inc., Richmond, VA) as prophylaxis for nausea. Demographics, headache diagnosis, psychiatric discharge diagnoses, abortive medications, and adverse events were recorded and assessed.
    MeSH term(s) Adolescent ; Adult ; Aged ; Analgesics, Non-Narcotic/administration & dosage ; Analgesics, Non-Narcotic/adverse effects ; Analgesics, Non-Narcotic/therapeutic use ; Antiemetics/therapeutic use ; Dihydroergotamine/administration & dosage ; Dihydroergotamine/adverse effects ; Dihydroergotamine/therapeutic use ; Diphenhydramine/administration & dosage ; Diphenhydramine/adverse effects ; Diphenhydramine/therapeutic use ; Drug Therapy, Combination ; Female ; Histamine H1 Antagonists/administration & dosage ; Histamine H1 Antagonists/adverse effects ; Histamine H1 Antagonists/therapeutic use ; Humans ; Injections, Intravenous ; Male ; Metoclopramide/therapeutic use ; Middle Aged ; Migraine Disorders/drug therapy ; Migraine Disorders/physiopathology ; Nausea/prevention & control
    Chemical Substances Analgesics, Non-Narcotic ; Antiemetics ; Histamine H1 Antagonists ; Dihydroergotamine (436O5HM03C) ; Diphenhydramine (8GTS82S83M) ; Metoclopramide (L4YEB44I46)
    Language English
    Publishing date 2004-12-27
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2055062-5
    ISSN 1531-3433
    ISSN 1531-3433
    DOI 10.1007/s11916-005-0077-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5477: Show issues Location:
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