Diagnosis and Management of Trochleodynia, Trochleitis, and Trochlear Headache

Conclusion Trochlear pain (trochleodynia) is becoming recognized as a set of disorders that can present in isolation or concomitantly with co-existing migraines, tension-type headaches, or other headache disorders, possibly explaining subpar symptom control in a small but significant number of individuals globally. Trochleodynia features unilateral periocular pain that may involve the ipsilateral hemicranium. Pain exacerbation occurs with trochlear palpation and supraduction of the affected eye especially in the adducted position. Trochleodynia may respond to oral NSAIDs if symptoms are mild and of recent onset. While oral NSAIDs may lead to remission with moderate to severe symptoms, the patient should be offered trochlear injection of corticosteroids. Bilateral manifestations could be concerning for an underlying systemic inflammatory disease, and workup could be considered (Table 1). Control of associated underlying disease almost always leads to trochleodynia remission. Nevertheless, in order to identify the optimal treatment paradigm for trochleodynia and better understand variations in response to treatment, prospective randomized control trials are required. Author Contributions All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constr...
Source: Frontiers in Neurology - Category: Neurology Source Type: research

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Source: Pain - Category: Anesthesiology Tags: Commentary Source Type: research
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Source: Pain - Category: Anesthesiology Tags: Commentary Source Type: research
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Source: Pain - Category: Anesthesiology Tags: Topical Review Source Type: research
Both persistent pain and cognitive decline prevalence increase with advancing age and are associated with functional decline. However, the association of pain and cognitive decline has not been evaluated yet by a systematic assessment of longitudinal studies. We aimed to assess the association of persistent pain as a risk factor for cognitive decline in community older adults, using data from longitudinal studies in a systematic review and meta-analysis. Publications were identified using a systematic search on PubMed, EMBASE, and Cochrane Library databases from inception to June 2019. Because heterogeneity across studies ...
Source: Pain - Category: Anesthesiology Tags: Systematic Review and Meta-Analysis Source Type: research
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Source: Pain - Category: Anesthesiology Tags: Perspectives Source Type: research
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Source: Pain - Category: Anesthesiology Tags: Perspectives Source Type: research
In conclusion, GRIP allows for high-resolution assessment and presentation of pain location and distribution with minimal use of time.
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research
This study used eye-gaze tracking to examine attentional biases to pain-related stimuli in a clinical sample of youth with chronic pain and pain-free controls. The moderating role of attentional control was also examined. Youth with chronic pain (n = 102) and pain-free controls (n = 53) viewed images of children depicting varying levels of pain expressiveness paired with neutral faces while their eye gaze was recorded. Attentional control was assessed using both a questionnaire and a behavioural task. Both groups were more likely to first fixate on high pain faces but showed no such orienting bias for moderate or low pain ...
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research
Classical Ehlers–Danlos syndrome (cEDS) is a connective tissue disorder caused by heterozygous mutations in one of the type V collagen-encoding genes, COL5A1 or COL5A2. cEDS is characterized by generalized joint hypermobility and instability, hyperextensible, fragile skin, and delayed wound healing. Chronic pain is a major problem in cEDS patients, but the underlying mechanisms are largely unknown, and studies in animal models are lacking. Therefore, we assessed pain-related behaviors in haploinsufficient Col5a1+/− mice, which clinically mimic human cEDS. Compared to wild-type (WT) littermates, 15 to 20-week-ol...
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research
This study evaluated the relative efficacy of 4 treatment sessions each of 4 nonpharmacological treatments: (1) hypnotic cognitive therapy (using hypnosis to alter the meaning of pain); (2) standard cognitive therapy; (3) hypnosis focused on pain reduction, and (4) pain education. One hundred seventy-three individuals with chronic pain were randomly assigned to receive 4 sessions of 1 of the 4 treatments. Primary (pain intensity) and secondary outcome measures were administered by assessors unaware of treatment allocation at pretreatment, posttreatment, and 3-, 6-, and 12-month follow-up. Treatment effects were evaluated u...
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research
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