ABSTRACT
PURPOSE OF REVIEW: Loin pain hematuria syndrome (LPHS) is rare and seldom diagnosed, yet it has a particularly significant impact on those affected. This is a review of the latest and seminal evidence of the pathophysiology and diagnosis of LPHS and presents the typical clinical presentation and treatment options available. RECENT FINDINGS: LPHS is typically found in young women with characteristic symptoms, including severe recurrent flank pain and gross or microscopic hematuria. The majority of patients will experience crippling pain for many years without effective therapy, often requiring frequent use of narcotic medication. However, the lack of conclusive pathophysiology, in conjunction with the rarity of LPHS, has prohibited the development and trial of definitive treatment options. Nevertheless, in order to combat this rare but severe disease, management strategies have continued to evolve, ranging from conservative measures to invasive procedures. This review presents an overview of the current hypotheses on the pathophysiology of LPHS in addition to summarizing the management strategies that have been utilized. Only 30% of LPHS patients will experience spontaneous resolution, whereas the majority will continue to face chronic, crippling pain. Several methods of treatment, including invasive and non-invasive, may provide an improved outcome to these patients. Treatment should be individually tailored and multi-disciplinary in nature. Further research is required to further elucidate the pathophysiology and develop new, specific, treatment options.
Subject(s)
Flank Pain/therapy , Hematuria/therapy , Age Distribution , Analgesics, Opioid/therapeutic use , Anesthetics, Local/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Bupivacaine/administration & dosage , Capsaicin/administration & dosage , Denervation , Electric Stimulation Therapy , Flank Pain/complications , Flank Pain/epidemiology , Flank Pain/physiopathology , Ganglia, Spinal , Hematuria/complications , Hematuria/epidemiology , Hematuria/physiopathology , Humans , Hypnosis , Infusions, Spinal , Kidney/innervation , Nephrectomy , Neuromuscular Agents/therapeutic use , Pulsed Radiofrequency Treatment , Renal Dialysis , Sensory System Agents/administration & dosage , Sex Distribution , Splanchnic Nerves , Sympathectomy , Syndrome , Transplantation, Autologous , UreterABSTRACT
Migraine is a debilitating neurological condition with symptoms typically consisting of unilateral and pulsating headache, sensitivity to sensory stimuli, nausea, and vomiting. The World Health Organization (WHO) reports that migraine is the third most prevalent medical disorder and second most disabling neurological condition in the world. There are several options for preventive migraine treatments that include, but are not limited to, anticonvulsants, antidepressants, beta blockers, calcium channel blockers, botulinum toxins, NSAIDs, riboflavin, and magnesium. Patients may also benefit from adjunct nonpharmacological options in the comprehensive prevention of migraines, such as cognitive behavior therapy, relaxation therapies, biofeedback, lifestyle guidance, and education. Preventative therapies are an essential component of the overall approach to the pharmacological treatment of migraine. Comparative studies of newer therapies are needed to help patients receive the best treatment option for chronic migraine pain.