ABSTRACT
INTRODUCTION: A total of 83% of children report headache during a 6-month period. The estimated 1-year prevalence of chronic daily headache (CDH) in children is at least 1 to 2%. Muscle pain is associated with headache severity and chronicity. Muscle pain can be associated with active muscular trigger points, a functional concept still remaining a controversy. An integrated approach including bio-behavioral management is accepted as standard treatment but does not provide sufficient pain relief in all patients. OBJECTIVE: We report the individual clinical course of five adolescents with treatment-refractory CDH associated with focal muscle pain. We describe a concept of short-term integrative intervention including botulinum toxin (StiBo) in a personalized "follow the referred pain pattern" injection regimen with the focus on long-term follow-up. RESULTS: StiBo showed short-term efficacy on headache frequency and severity. In the long-term follow-up, CDH was not existent in any of the patients. CONCLUSION: The treatment may have enabled the patients to draw attention away from a repeated circle of muscle-triggered pain and withdrawal of daily activities toward self-driven activities, thereby potentially preventing the development of further chronification. To prove this hypothesis, a prospective, placebo-controlled study in young adolescents with CDH should be initiated including objective outcome parameters on muscular level.
Subject(s)
Botulinum Toxins/therapeutic use , Headache Disorders/drug therapy , Musculoskeletal Pain/drug therapy , Adolescent , Child , Follow-Up Studies , Headache Disorders/complications , Humans , Musculoskeletal Pain/complications , Pain Measurement , Severity of Illness Index , Treatment OutcomeABSTRACT
Visual identification of muscles and depth control of needle placement are the key features of sonography-guided injection that lead to improved targeting and safety of BoNT/A injections. This method may be especially helpful to validate already established injection techniques or when learning the correct injection technique. We recommend sonography-guided injection as a simple and painless "add-on" to the currently used standard procedure of palpation. The additional expenditure for sonography-guided injection is more than offset by the improved reliability in correct needle placement.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Botulinum Toxins, Type A/therapeutic use , Cerebral Palsy/diagnostic imaging , Cerebral Palsy/drug therapy , Injections, Intramuscular/methods , Neuromuscular Agents/administration & dosage , Neuromuscular Agents/therapeutic use , Ultrasonography/methods , Age Factors , Child , Humans , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/drug effectsABSTRACT
The effects of electrolytes in aqueous two-phase systems are investigated. It is shown that macroscopic and molecular models give a consistent view of electrolytes at interfaces. The electrostatic potential difference delta psi between coexisting phases is a common property at interfaces even though the phases are strictly electroneutral and delta psi can not be measured. It is shown how delta psi can be quantified under controlled conditions. Additionally, a molecular picture is presented based on computer simulations.