Acupuncture in the Management of Medication Overuse and Drug-induced Aseptic Meningitis Headache: A Case Report.

Headache disorders are burdensome, both in terms of the number of people they affect, and in terms of associated healthcare spending. This report presents a 36-year-old female admitted to a tertiary university hospital with a primary complaint of intractable headache, caused by a combination of medication overuse headache, and headache secondary to aseptic meningitis. During her hospital stay, opioid analgesic doses were initially increased without success in an attempt to control her headache. Despite multiple medication trials the patient's headache failed to improve. On day ten of her hospitalization, she underwent a thirty-minute acupuncture session which resulted in immediate relief of her headache. She received one more acupuncture treatment the following day and was discharged to an acute inpatient rehabilitation facility on a vastly reduced dose of opioids. Instructions on how to taper the remaining opioids were provided, and the patient was scheduled for outpatient acupuncture therapy sessions for further headache management. This report demonstrates the importance of recognizing acupuncture as a viable treatment option for medication overuse headache and for headache secondary to systemic diseases such as aseptic meningitis. Furthermore, acupuncture should also be considered as a nonpharmacological modality to be used when tapering a patient off of high doses of opioids.

Treatment of patients with arthritis-related pain.

Many causes of arthritic pain are encountered in clinical practice. Osteoarthritis is the most common form of arthritis in the United States, afflicting tens of millions of people. The authors review current literature on the treatment of patients with osteoarthritis. They discuss nonpharmacologic therapy such as physical therapy, weight reduction, and osteopathic manipulative treatment. Pharmacologic treatment of patients with osteoarthritis includes acetaminophen, nonsteroidal anti-inflammatory drugs, tramadol hydrochloride, and opiate analgesics in patients who failed all other treatment modalities. Patients who failed medical management should be referred for consideration for surgery.