Current Pain and Headache Reports最新文献

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.

Purpose of review: This review aims to discuss about the potential roles of neuropsychological instruments and tasks in the evaluation of dependence behaviors shared by medication-overuse headache (MOH) and substance use disorders (SUDs).

Recent findings: Recent studies utilizing criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) for SUDs have revealed that MOH patients often exhibit impaired control over medication use, along with tolerance and withdrawal symptoms. In addition, dependence questionnaires such as the Leeds Dependence Questionnaire and the Severity of Dependence Scale have shown a strong correlation between MOH and higher dependence scores, with predictive value for treatment outcomes. Furthermore, investigations into decision-making processes with the Iowa Gambling Task have suggested potential parallels between MOH and SUDs. MOH patients exhibit biased decision-making, particularly in conditions of ambiguity, possibly predisposing them to favor immediate pain relief over long-term consequences. This suggests a potential mechanism involving emotional feedback processing in MOH. This review underscores the importance of recognizing dependence-like behaviors in MOH patients and highlights the potential utility of neuropsychological instruments and tasks in advancing the understanding of MOH pathophysiology. The findings suggest that MOH shares characteristics with substance dependence, emphasizing the need for tailored interventions in MOH management. Understanding the neurobehavioral aspects of MOH may lead to more effective therapeutic strategies aimed at mitigating dependence and improving long-term outcomes.

Purpose of review: Chronic axial spinal pain is a leading cause of disability and healthcare spending in the United States. A common source of axial spinal pain is the facet joint. Current treatments for facet joint-mediated pain include conservative treatments and interventions such as intra-articular facet joint injections (FJI), medial branch blocks (MBB), and radiofrequency ablation (RFA). While facet joint interventions are one of the most common spinal procedures, current scientific literature demonstrates conflicting results regarding the use of corticosteroids in these interventions.

Recent findings: A systematic review was conducted to determine the efficacy of local corticosteroid usage in facet joint interventions for treating chronic axial spinal pain. Separate literature searches were performed using PubMed, Google Scholar, Embase, and Cochrane Library to evaluate the use of local corticosteroids in intra-articular FJI, MBB, and for the prevention of post-neurotomy neuritis (PNN). Inclusion criteria included a randomized clinical trial (RCT) or control trial while unique inclusion criteria was used for the differing uses of local corticosteroids. The exclusion criteria for studies included (i) studies written in a non-English language; (ii) articles without full-text access or abstract-only papers; (iii) and studies focused on non-human subjects. Final literature searches were conducted in August 2024. Two studies with 131 patients, four studies with 440 patients, and two studies with 203 patients were selected for the assessment of local corticosteroid use on intra-articular FJI, MBB, and PNN, respectively. A quality assessment tool recommended by The Cochrane Collaboration was used to assess bias risk in included studies. Results were synthesized through a meta-analysis to evaluate intra-articular FJI while a literature analysis was completed to investigate MBB and PNN. This study found that the use of corticosteroid intra-articular FJI and MBB provides significant improvement in pain relief and functionality from baseline for the treatment of lower back pain and chronic axial spinal pain, respectively. However, the use of corticosteroids post-RFA has not been proven to reduce the occurrence of PNN. Limitations to the studies used included blinding bias, absence of placebo groups, subjective inclusion criteria, limited generalizability and small sample sizes.