Current Pain and Headache Reports最新文献

Purpose of review: Hip osteoarthritis constitutes a prevalent condition among individuals aged 55 and above, serving as one of the primary triggers for joint discomfort and impairment, and marking a substantial origin of chronic pain particularly affecting the elderly population. Our article provides an exhaustive summary of the mechanisms of action, therapeutic efficacy, and potential adverse consequences associated with novel therapeutic modalities including glucocorticoids, hyaluronic acid, platelet-rich plasma, mesenchymal stem cells, and stromal vascular fraction. Concurrently, we conducted a comprehensive evaluation of the clinical efficacy and potential applications of various medications.

Recent findings: In comparison to physical therapy, oral analgesics, and other nonsurgical modalities, intra-articular injection therapy is characterized by enhanced safety and greater efficacy. Moreover, when contrasted with surgical intervention, intra-articular injection demonstrates a lower degree of invasiveness and incurs fewer adverse reactions. Intra-articular treatments have shown excellent local efficacy while significantly minimizing adverse reactions in patients. These methods hold significant potential for development but require comprehensive research and thorough discussion within the academic community.

Introduction: Post-amputation pain, including residual limb pain (RLP) and phantom limb pain (PLP), can affect the outcome of surgery and have an impact on quality of life. Effective management of acute post-amputation pain requires a multidisciplinary approach with collaboration among the surgical and anesthesia teams to optimize pain management. A systematic-narrative hybrid review was conducted to assess and report the effectiveness of various interventions in perioperative pain management for amputation surgery.

Methods: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov databases were searched for studies evaluating interventional and/or pharmacological approaches to managing perioperative pain in major extremity amputation surgery. The data collected included treatment options, average dosage and/or duration of treatments, and reported pain outcomes.

Results: Of the 27 studies evaluating interventions, 8 addressed neuraxial or perineural analgesia, 16 focused on peripheral nerve blocks (PNB), 2 examined peripheral nerve stimulators (PNS), and 1 investigated transcutaneous electrical nerve stimulation. Preoperative epidural analgesia was associated with a reduced incidence of postoperative pain. PNS, PNB, and catheter-based infusions were found to be effective in managing postoperative pain. The role of ketamine in treating post-amputation pain yielded mixed results, while other pharmacological agents, such as valproic acid and gabapentin, demonstrated limited efficacy.

Conclusions: While numerous pain interventions are available, no single approach has been shown to be superior. A multimodal strategy, incorporating PNBs, preoperative pain control, and potentially ketamine, appears to provide the most comprehensive pain management strategy. Further long-term prospective studies are required to refine and optimize pain management techniques for major extremity amputation surgery.

Level of evidence: III-Systematic reviews.

Purpose of review: This review evaluates the effectiveness of sacroiliac joint injections of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) for treating low back and lower extremity pain. A systematic analysis was conducted to assess the impact of PRP and MSC injections on managing these conditions.

Recent findings: In recent years, several cell-based therapies, including the injection of MSCs and PRP into the sacroiliac joints, have been proposed for the management of low back pain. Emerging clinical evidence supporting their use appears promising. The present systematic review identified 2 randomized controlled trials (RCTs) and 3 observational studies that met inclusion criteria based on strict methodological quality and bias assessments. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and qualitative analysis synthesis determined evidence levels as IV (limited) with a weak recommendation.

Purpose of review: Intrathecal drug delivery systems (IDDS) are integral to managing chronic pain and spasticity, especially in oncology patients who may also require radiation therapy (RT). Concerns regarding the potential effects of ionizing radiation on IDDS functionality have been raised, with limited but growing evidence on device resilience. This review summarizes the current literature on radiation-induced IDDS malfunctions, identifies key risk factors, and discusses mitigation strategies.

Recent findings: Although most IDDS remain functional during RT, isolated cases of radiation-induced pump failure have been reported. Factors such as radiation dose, proximity to the treatment field, and shielding methods influence device susceptibility to failure. Case studies and retrospective reviews have suggested that cumulative doses above 10 Gy may increase malfunction risks, though some devices have withstood doses as high as 36 Gy without failure. Advances in RT, including proton therapy and stereotactic techniques, may reduce exposure to IDDS. Current recommendations emphasize preemptive planning, shielding strategies, and close post-radiation monitoring to mitigate these potential risks. RT presents unique challenges for patients with IDDS, requiring a multidisciplinary approach to balance cancer treatment efficacy with device integrity. While modern IDDS demonstrate resilience to radiation exposure, careful consideration of radiation dose thresholds, device placement, and shielding is needed. Given the lack of standardized guidelines, more research is needed to establish evidence-based protocols to optimize patient safety and device performance during RT.

Purpose of review: This review aims to assess the effectiveness of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) injections in treating axial spinal pain originating from the facet joints. A systematic evaluation of available evidence on these biological therapies was conducted to determine their clinical utility.

Recent findings: Recent studies emphasize the therapeutic promise of intraarticular biologics, including MSCs, PRP, and alpha-2-macroglobulin, in managing facet joint-related axial spinal pain. Emerging evidence suggests improvements in pain relief, physical function, and quality of life following these treatments. Based on our search criteria, 20 publications were identified and considered for inclusion. Of these, 4 randomized controlled trials (RCTs) and 6 observational studies met the inclusion criteria. Among the RCTs, 3 trials involved lumbar facet joints, and one trial involved cervical facet joints using PRP. Among the observational studies, 4 studies used PRP, with 3 focusing on the lumbar spine and one study, with 2 publications, on the cervical spine, and only 2 studies evaluated stem cell treatments. The summary of evidence utilizing various criteria, including Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) evidence synthesis, the evidence for PRP injections in facet joints is Level II, or moderate, and Level IV, or limited, overall, with low certainty. For PRP, the recommendation is moderate, and for MSCs, the recommendation is weak.

Purpose of review: Herein we review recent trends in opioid prescribing, the rise in office-based surgeries, and propose a framework to minimize opioid consumption following such procedures.

Recent findings: Outpatient surgical procedures are increasing year over year in the United States. This observed increase is expected to continue due to the financial incentives to perform outpatient procedures. Office-based surgery is a setting that is expected to have tremendous growth. Still, currently there are scant safety guidelines concerning how to manage perioperative pain related to surgeries in this setting safely and effectively. Opioid abuse is rampant across the United States, and we anticipate that an increase in outpatient procedures will create a rise in opioid prescribing without appropriate discourse and planning. There are a variety of systematic factors in play to minimize opioid consumption after office-based surgery that must be considered at each operative phase. Careful planning and consideration of the multitude of factors can increase patient satisfaction while minimizing opioid prescriptions.

Purpose of review: Chronic pain affects millions worldwide, reducing quality of life and posing a major healthcare challenge. This review aims to explore advancements in neurosurgical interventions for managing chronic pain, focusing on the latest neuromodulation techniques, and addressing how these innovations may offer alternative solutions for these patients.

Recent findings: We reviewed advances in high-frequency spinal cord stimulation, dorsal root ganglion stimulation, and closed-loop neuromodulation systems, which optimize precision in pain control and reduce adverse effects. Improvements in targeted drug delivery enabled more accurate and sustained management of pain, with fewer unfavorable effects than traditional therapies. Additionally, we discussed emerging technologies, including artificial intelligence for personalized treatment adjustment, and gene therapy for addressing pain at a molecular level, innovations that also hold promise for future applications. Neurosurgical techniques have the potential to transform chronic pain management, offering improved control with fewer complications. However, challenges remain regarding accessibility, cost, and long-term efficacy. Further research is needed to refine, expand access, and enhance effectiveness.

Purpose of review: The purpose of this review is to present current evidence on the multifaceted approach required for managing pediatric migraine. This includes identifying migraine triggers, managing acute pain episodes, and implementing preventive strategies. The review focuses on non-pharmacological interventions, such as behavioral and lifestyle modifications. By exploring these aspects, the review seeks to provide a comprehensive understanding of effective migraine management in children and adolescents.

Recent findings: Non-pharmacological treatments like cognitive-behavioral therapy (CBT), relaxation techniques, and biofeedback are effective alternatives to medication. Nutraceuticals and dietary considerations, including ketogenic diet, alongside education and regular follow-ups, optimize outcomes. Integrating tools for tracking migraine patterns and training for clinicians, parents, and patients enhances treatment effectiveness. Engaging adolescents and their families through education and active participation is essential for improving their quality of life. This review presents available evidence of non-pharmacological strategies for managing episodic migraine in pediatrics. CBT and lifestyle modification are documented for their effect. Future research is required to create evidence-based, comprehensive treatment plans including these and other non-pharmacological strategies tailored to individual needs.

Purpose of review: Artificial intelligence (AI) has impacted different aspects of headache medicine, from history taking and diagnosis to drug development. AI has been shown to have predictive modeling in helping diagnose migraine and assist with patient care. Additionally, this technology has been adapted to help non-headache specialists with headache management. Similar practices have expanded to help diagnose cluster headache. AI has also been used to help streamline patient visits, and identify new drug targets.

Recent findings: Various forms of AI models have been implemented in headache medicine; these have ranged from diagnosis engines to models helping track headache triggers. Additionally, AI has been used to assist in clinical trials and to help predict placebo responses to different medications. There are still several limitations with AI in setting of headache medicine. AI and diagnosis models have a role to play in headache medicine. However, technology is still in its infancy and limitations do exist.

Purpose of review: CGRP targeting therapies have revolutionized the migraine preventive space, introducing novel migraine-specific therapies to improve headache care. Four monoclonal antibodies (mAbs) are approved for use in prevention of episodic migraines. Erenumab (AMG334), fremanezumab (TEV48125), and galcanezumab (LY2951742) are monthly subcutaneous injections, while eptinezumab (ALD403) provides an intravenous infusion option. This review aims to examine the clinical evidence for the safety and efficacy of CGRP-targeted mAbs in the prevention of episodic migraines with a focus on recent studies (2023-2024).

Recent findings: Long-term studies reveal ongoing safety and efficacy in recent literature for all 4 monoclonal antibodies. These investigations have built evidence for earlier access to CGRP treatment as they increase quality of life and reduce monthly migraine days while being better tolerated than non-specific migraine preventative therapies. These studies support the recent 2024 AHS consensus statement recommending CGRP monoclonal antibodies be considered as first-line preventive treatment in episodic migraine.