Current Pain and Headache Reports最新文献

Purpose of the review: Our review discusses the pharmacologic profile of buprenorphine, then dives into the current literature regarding buprenorphine's use to treat chronic pain, opioid use disorder, and acute postoperative pain. We aim to focus on how that literature may influence the perioperative management of patients on buprenorphine and prompt reconsideration of buprenorphine as a frontline opioid analgesic.

Recent findings: Buprenorphine has been used effectively for both acute and chronic pain management, for the treatment of opioid withdrawal, and for the treatment of opioid use disorder due to its unique pharmacological profile. Historically, there has been controversy over the best practice recommendations for buprenorphine use in the perioperative setting, though the data now overwhelmingly refutes the full discontinuation of buprenorphine preoperatively. It has also been seen in recent times that buprenorphine is at least as effective as usual care opioids for acute pain management, with important safety advantages. Expanding our analgesic toolkit to more thoroughly understand the unique mechanism of action and properties of buprenorphine is paramount in our treatment of perioperative pain in both opioid-naïve and opioid-tolerant patients.

Purpose of review: Despite the scarce literature regarding the matter, this current article identifies the most important factors that lead to the best outcomes in the therapeutic approach of trigeminal neuralgia and hemifacial spasm. However, notwithstanding the central focus lies on the neurosurgical perspective, the authors also integrate insights from adjacent medical specialties. Thus, the main objective of this comprehensive narrative review is to enhance understanding of the factors that can dramatically influence the course of these conditions.

Recent findings: This article provides a state-of-the-art perspective regarding the therapeutic management of trigeminal neuralgia and hemifacial spasm. Preoperative diagnosis has the first pivotal role in managing this condition, and 3D multimodal image fusion based on Time-Of-Flight Magnetic Resonance Angiography (TOF MRA) with high-resolution T2-weighted imaging has been proven to be the most effective and accurate method. Focusing on the correct therapeutic approach is the second pivotal factor, given that the therapeutic options comprise various approaches ranging from oral medication to neurosurgical microvascular decompression. It has been concluded that microvascular decompression remains the most effective treatment for drug-resistant trigeminal neuralgia and hemifacial spasm. Pain freedom is achieved in around 76-84% of patients, and long-term durability remains substantial, with 64-73% still pain-free at ten years, particularly when the compression is arterial rather than venous. The endoscopic approaches demonstrated efficacy in selected cases, while combined procedures such as MVD with partial sensory rhizotomy may increase numbness without improving long-term results. Systematic reviews concluded that radiosurgery and percutaneous procedures can provide pain relief in many patients, but with less durable outcomes. Altogether, these findings support MVD as the cornerstone surgical therapy while underlining the importance of careful patient selection and modern adjuncts to maximize success. When the neurosurgical intervention represents the treatment option for trigeminal neuralgia or hemifacial spasm, several pivotal factors must be taken into account in order to provide the best clinical results with minimal to no complications.

Purpose: The purpose of this review is to present an updated overview of the literature concerning the safe and effective management of perioperative pain in NORA settings. The increasing demand for minimally invasive procedures, driven by advancements in technology, has led to the growing utilization of non-operating room anesthesia (NORA) across multiple medical disciplines.

Recent findings: Despite the growing utilization, there is a notable dearth of literature regarding the outcomes of NORA cases, particularly regarding pain management. NORA environments, such as bronchoscopy suites, magnetic resonance imaging (MRI) facilities, interventional cardiology suites, and gastrointestinal (GI) endoscopic units managing conditions like masses, cancers, and bleeding, present distinct challenges for effective pain control. Anesthesiology providers must exhibit adept familiarity and attentiveness, and be vigilant and prepared for diverse NORA settings, some of which may suffer from understaffing, inadequate infrastructure, or remote accessibility, potentially compromising patient outcomes. Further investigation into pain management strategies for NORA patients is imperative. The adaptation and progression of pain services within the dynamic healthcare landscape of NORA, characterized by continual evolution and shifting paradigms, are essential to meet the evolving demands of patient care effectively.

Background: Migraine is a chronic, disabling brain disorder. Melatonin, a circadian regulator with anti-inflammatory and antinociceptive actions, has been proposed for migraine prevention. We evaluated the efficacy and safety of melatonin for prophylaxis.

Methods: We systematically searched PubMed, Cochrane, Scopus, Embase, and Web of Science (September 29, 2024) for randomised controlled trials (RCTs) comparing melatonin with placebo or other active drugs. Outcomes were analysed as change from baseline to last follow-up using mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI).

Results: Nine RCTs (n = 788) were included. Versus placebo, melatonin reduced attack duration (MD -4.98 h; 95% CI -9.30 to -0.67; p = 0.02), headache days (MD -1.54 days; 95% CI -2.50 to -0.58; p < 0.01), headache severity (MD -2.08; 95% CI -2.91 to -1.26; p < 0.01), and analgesic use (MD -1.38; 95% CI -2.41 to -0.36; p < 0.01). Melatonin also increased the response rate (≥ 50% reduction in monthly headache frequency) (RR 1.38; 95% CI 1.11-1.70; p < 0.01) and improved sleep quality (PSQI: MD -1.64; 95% CI -2.85 to -0.42; p = 0.008) and disability (MIDAS: SMD - 4.07; 95% CI -5.45 to -2.69; p < 0.001). Compared with amitriptyline, melatonin was generally less effective for attack duration and severity, with no consistent advantage on analgesic use or response; however, melatonin showed a more favourable tolerability profile, including lower risk of sleepiness (RR 0.49; 95% CI 0.28-0.87; p = 0.01).

Conclusions: Melatonin demonstrates benefits over placebo for reducing migraine burden and improving patient-reported outcomes, with a favourable safety profile. While amitriptyline remains more potent for several efficacy endpoints, melatonin represents a reasonable preventive option, particularly as an adjunct during titration of first-line agents. Further head-to-head trials with standardised dosing and longer follow-up are warranted.

Purpose of review: Behavioral lifestyle factors such as physical activity, stress, sleep, and nutrition are increasingly recognized as essential contributors to chronic pain. Their influence on chronic pain highlights its widespread, modifiable nature, affecting large population segments. This reinforces chronic pain as a significant public health issue and its socioeconomic impact and need for population-level prevention strategies. Pain is inherently subjective, and pain research traditionally relies on the self-reported pain score as a common primary outcome. This provides an incomplete measure of the impact of pain interventions on these challenges.

Recent findings: Neuroimaging studies reveal structural brain changes in chronic pain generally via maladaptive synaptic plasticity. Targeting brain regions such as the anterior cingulate cortex, amygdala, and the rostral ventromedial medulla and their associated receptors offers promising new avenues for treating chronic pain, especially when emotional and stress-related components are involved. Understanding the interplay between neurological and biopsychosocial mechanisms can help us create and evaluate targeted interventions that address both neural and emotional contributors to pain. The biopsychosocial model, which considers biological, psychological, and social factors, is fundamental to chronic pain research. It emphasizes recognition of all three of these factors and the significant influence they each have on pain severity, disability, emotional distress, work status, and healthcare utilization. As a result, behavioral and cognitive-behavioral treatments have become essential components of many interdisciplinary treatment centers and behavioral medicine clinics, though access remains limited in some areas. Biopsychosocial approaches recognize pain-related behaviors are shaped by past experiences and current circumstances, with cognitive, affective, and sensory factors playing key roles-consistent with the principles of the neuromatrix theory Melzack (J Dent Educ. 2001;65:1378-82, 2001). Effective chronic pain treatment goes beyond simply reducing pain-it helps patients manage their condition in ways that support meaningful daily activities, reduce emotional distress, and promote responsible healthcare use. A comprehensive, interdisciplinary approach may be beneficial for delivering treatment that effectively helps people manage chronic pain. Herein, we highlight the multifaceted nature of chronic pain-its neurobiological foundations, behavioral influences, and social implications-underscoring the importance of integrating cognitive, affective, and sensory dimensions in understanding and treating chronic pain.

Purpose of review: To report on the relationship between neuroinflammation and chronic pain, especially in the pediatric population. Pediatric chronic pain is prevalent, affecting about 20% of the population. Neuroinflammation is now recognized as a putative contributing factor to the development and maintenance of chronic pain. Strides have been made in understanding neuroinflammatory processes in the context of pain, as research begins to unravel the involvement of glial cells (e.g., microglia, astrocytes), pro-inflammatory markers (e.g., interleukins, Tumor Necrosis Factor-alpha [TNF-α]), and metabolic pathways (e.g., oxidative stress). In children, the vulnerability of a developing nervous system, life stressors (e.g., adjustment periods/transitions, social stress, family dynamics) and hormonal changes can further impact neuroinflammation and promote pain. Investigating this complex web of factors that contribute to pediatric pain has implications for both clinical practice and research. This review aims to summarize recent literature on the role of neuroinflammation in pediatric chronic pain, highlighting novel insights and areas for future clinical exploration. Targeting neuroinflammation shows promise for advancing pediatric chronic pain management, but pediatric-specific studies remain quite limited, and urgently needed.

Purpose of review: Chronic pelvic pain (CPP), affecting approximately 26% of women globally, is a multifactorial condition with causes including, but not limited to, gynecologic disorders, musculoskeletal disorders, and neuropathic disorders including pudendal neuralgia. A comprehensive evaluation and a multimodal treatment strategy - encompassing medical, minimally invasive non surgical, and surgical therapies - are essential for effective management. This narrative review explores current minimally invasive interventional management options for pudendal neuralgia causing CPP.

Recent findings: Pudendal nerve blocks demonstrated pain relief, but the duration of relief varied. Pulsed radiofrequency ablation revealed longer-lasting pain relief compared to pudendal nerve blocks, with several clinical trials and case reports supporting its efficacy. Additionally, neuromodulation techniques, including neuraxial and peripheral nerve neuromodulation, showed promising results in alleviating pain for patients who did not respond to conservative measures. While studies describe interventional therapy for pudendal neuralgia, there is a dearth of randomized controlled trials, which limits the ability to generalize treatment options for pudendial neuralgia. Despite this, current data suggest the possible benefit of interventional management of for pudendal neuralgia.

Introduction: Trigeminal Neuralgia (TN) patients usually experience severe facial pain, leading to a significant reduction in quality of life.

Objective: To evaluate the effect of peripheral nerve stimulation (PNS) on pain relief in patients with TN.

Methods: The databases of EMBASE, WEB OF SCIENCE, and PUBMED were searched from inception to 2024 for clinical trials of PNS for TN. The inclusion criteria consisted of any study using PNS to treat TN and reporting outcomes of pain intensity. Risk of bias was assessed using Revised Cochrane Risk of Bias 2.0 and Methodological Index of Non-Randomised Studies (MINORS) tool. Meta-analysis was conducted with RevMan 5.3 and publication bias was evaluated via Egger's test through STATA17.

Results: We identified 1,574 citations, and included 9 trials comprising 112 participants. In terms of efficacy, PNS was associated with significant pain relief compared to baseline (MD, -6.23 cm [95% CI, -7.20 to -5.26 cm], P < 0.05, I² = 89%), with the reduction closely approaching the minimal important difference (MID) threshold of 6.25 cm. Subgroup analysis showed that patients with baseline pain scores ≥ 8 experienced greater pain relief (N = 52, MD, -7.06 cm [95% CI, -8.30 to -5.82 cm], I² = 87%, p = 0.02) compared to patients with pain scores < 8(N = 60, MD, -4.75 cm [95% CI, -6.22 to -3.28 cm], I² = 89%) .

Conclusions: The meta-analysis results showed PNS leads to a statistically and clinically significant improvement in pain. PNS may be a promising approach in the management of TN.