Current Pain and Headache Reports最新文献

Purpose of review: Migraine is a complex neurological disorder characterized by recurrent attacks superimposed on an underlying state of persistent susceptibility. The interictal state, which is the time between acute episodes, is associated with symptoms that affect cognitive, functional, psychological, interpersonal, and socioeconomic domains. The objectives of this review are to define the interictal state of migraine, distinguish trigger subtypes, and investigate the transition from the interictal state to a migraine attack.

Recent findings: Studies using assessment tools such as the Migraine Interictal Burden Scale (MIBS-4) have documented severe interictal burden in a majority of patients in several large-scale studies; however, the interictal burden has traditionally received limited attention despite its substantial impact on patients. By highlighting gaps in current research and clinical management, this work underscores the need to address both ictal and interictal states, aiming to improve patient outcomes and enhance awareness of this underrecognized aspect of migraine.

Purpose of review: Chronic back pain is highly prevalent and closely associated with opioid misuse, particularly in patients undergoing spine surgery. Optimizing opioid prescribing practices and advancing alternative treatment modalities is critical to reduce opioid-related morbidity and mortality.  RECENT FINDINGS: Despite their well-documented risks-including misuse, adverse effects, and detrimental impacts on postsurgical outcomes-opioids remain the most commonly prescribed analgesics for back pain. Spine surgery, meanwhile, is frequently followed by intense postoperative pain due to central sensitization, which often necessitates opioid use and complicates pain management. This review provides an overview of current literature on opioid prescribing trends and alternative therapies for patients undergoing spine surgery. Following spine surgery, non-opioid pharmacologic agents and nutraceuticals can enhance analgesia and reduce opioid consumption. While erector spinae plane blocks and neuraxial techniques offer transient pain relief, their efficacy is limited by duration and potential risks. Spinal cord stimulation may benefit selected patients with back pain, although its opioid-sparing effects remain uncertain. Opioid prescribing should be limited to breakthrough pain and integrated into structured tapering strategies. Optimizing postoperative analgesia in spine surgery requires a multimodal approach, interdisciplinary collaboration, and individualized prescribing-potentially guided by emerging tools such as pharmacogenomic testing.

Purpose of review: This systematic review aims to evaluate procedural interventions for chronic tendinopathy, with a focus on neurogenic mechanisms such as nerve ingrowth and neovascularization. Tendinopathy affects both athletes and the general population significantly, with up to 45% of cases eventually requiring surgical intervention despite conventional treatments. Recent advances highlight neurogenic mechanisms, such as nociceptive and autonomic fiber proliferation, as central to the pathology of chronic tendon pain, shifting focus toward targeted procedural interventions. The present investigation evaluates the efficacy and safety of interventions targeting chronic tendon neurogenesis, considered to be a major regulator of chronic tendon pain. The study focuses on procedural treatments, encompassing both percutaneous and surgical approaches, to manage tendinopathy effectively.

Recent findings: A systematic review included eleven clinical studies investigating interventions targeting nerve ingrowth, such as high-volume injections (HVIs; including high-volume distension injection [HVDI] and high-volume image-guided injection [HVIGI]), sclerosing injections, radiofrequency microtenotomy, minimally invasive stripping, electrocoagulation therapy, and surgical procedures. These studies demonstrated moderate methodological quality, with MINORS scores ranging from 10 to 13. The pooled analysis of outcomes showed a mean reduction in VAS pain scores of 33.15 mm (SD: 17.70 mm), indicating significant pain relief. Functional improvement was also notable, with a pooled mean change in VAS function scores of 29.28 mm (SD: 23.64 mm). In addition, the pooled mean improvement in VISA scores was 23.90 points (SD: 18.98 points), while the pooled mean change in disability levels was 3.20 (SD: 25.0), highlighting the positive impact of these interventions in reducing functional impairment. Collectively, these findings support the efficacy of procedural treatments targeting neurogenic mechanisms in the management of chronic tendinopathy. This review included eleven clinical studies evaluating six types of interventional procedures. Interventions focusing on nerve ingrowth mechanisms demonstrated promising outcomes for chronic tendinopathy, significantly reducing pain and enhancing functional capabilities. Despite promising results, the variability in study quality, particularly in blinding, underscores the need for more robust trials. This study supports integrating neurogenic targeting strategies into clinical practice, which could potentially revolutionize treatment paradigms in tendinopathy within pain medicine.

Purpose of review: Chronic pain affects over 51 million people and is associated with a poor quality of life. Meralgia Paresthetica is a chronic pain condition resulting from injury to the lateral femoral cutaneous nerve. Radiofrequency ablation (RFA) is a minimally invasive treatment option that has demonstrated efficacy for several nerve targets. However, limited research has focused on RFA targeting the lateral femoral cutaneous nerve. This is the first study to date to investigate the outcomes of cooled RFA for the treating of refractory Meralgia Paresthetica.

Recent findings: Data were retrospectively collected from the electronic medical records of patients treated with cooled lateral femoral cutaneous nerve RFA for Meralgia Paresthetica between 2014 and 2025. Eleven cases involving seven patients were included in this study. VAS scores decreased from 5.91 ± 1.22 at baseline to 3.05 ± 2.64 at follow-up (p < 0.001). Patients in nine of the eleven cases reported improvement in pain, with an average reduction of 64.8%. Duration of pain relief after cooled RFA was 6.92 ± 3.23 months for six cases with this data available. Cooled lateral femoral cutaneous nerve RFA is effective for many patients with Meralgia Paresthetica and may be offered for refractory cases.

Purpose of review: Analgesic techniques which provide sufficient post-operative shoulder pain relief while minimizing complications is crucial for helping patients achieve optimal recovery. The interscalene brachial plexus block (ISB) has long been considered the gold standard in terms of providing patients with adequate pain control following shoulder operations. However, ISB's expansive neural blockade poses several potential risks, including delayed sensorimotor rehabilitation to the upper extremity, partial blockade of the cervical sympathetic chain, and, most notably, diaphragmatic paresis, rendering this technique a potential contraindication in patients with respiratory compromise, including chronic lung disease, obesity, sleep apnea, etc. Hence, alternative regional techniques which employ a more localized blockade mechanism, such as the suprascapular nerve block (SSNB), have been examined as a means of circumventing these risks, while still providing comparable pain relief. This narrative review aims to provide an objective comparison of the functional efficacy of each analgesic technique based on parameters of post-operative pain management efficacy, opioid consumption, recovery patterns, technical functionality, and side effect profiles.

Recent findings: A comprehensive literature search was conducted and identified randomized controlled trials and meta-analyses which subjected patients to ISB or SSNB for shoulder pain relief and various metrics such as pain scores, opioid consumption, pulmonary function, adverse side effects, functional recovery, and patient satisfaction were evaluated. The consensus is that ISB is slightly more efficacious in relieving pain in the initial post-operative phase, but by 24 h post-operation any differences in pain are largely marginal. No clinically significant differences in long-term opioid consumption, patient satisfaction, or pain control were demonstrated in the world literature. Furthermore, SSNB exhibited significantly lower rates of pulmonary impairment and neurological side effects as well as quicker rates of functional recovery.

Summary: While ISB appears to be slightly more efficacious in administering pain relief in the immediate post-operative phase, SSNB appears to provide a safer side effect profile and should be considered in analgesia protocols for shoulder surgeries, especially in patient populations with pre-existing pulmonary conditions.

Purpose of review: Cingulotomy, a stereotactic neurosurgical procedure targeting the anterior cingulate cortex, has been explored for various refractory pain and neuropsychiatric conditions. However, while prior reviews have largely focused on chronic non-cancer pain, there remains a significant knowledge gap regarding its role in managing intractable cancer-related pain. This systematic review therefore aimed to evaluate the efficacy and safety of bilateral cingulotomy as a therapeutic option for cancer-associated pain, addressing a highly underexplored but clinically relevant area of neurosurgical palliation.

Recent findings: A total of six studies were included, encompassing 172 patients with intractable or metastatic cancer pain who underwent bilateral cingulotomy. Procedures were performed using radiofrequency (RF) or radiofrequency ablation (RFA)-based lesioning at temperatures of approximately 75-80 °C for 60-80 s. Across studies, pain reduction was observed in 60-80% of patients, with variability in long-term durability of relief. Despite differences in technique, lesion parameters, and assessment scales, cingulotomy consistently demonstrated clinically meaningful pain improvement with a low rate of transient cognitive or behavioral side effects. These findings suggest that RFA-guided cingulotomy provides more precise lesioning and better short-term efficacy compared with earlier mechanical or thermocoagulation methods. Bilateral cingulotomy appears to be a safe and promising neurosurgical intervention for patients with intractable cancer pain refractory to conventional therapies. Nevertheless, variations in lesion temperature, duration, and number across studies contribute to heterogeneity in reported outcomes. Future research should focus on standardizing methodology, incorporating long-term neurocognitive monitoring, and expanding multicenter data to strengthen evidence for its clinical application.

Purpose of review: The present investigation is the first systematic review and meta-analysis assessing analgesic efficacy of erector spinae plane blocks (ESPB) in patients undergoing nephrectomies. ESPBs have shown promise in various surgeries, but their efficacy in nephrectomy has not been comprehensively evaluated. This study compares patients that underwent nephrectomies with ESPBs and general anesthesia versus patients that had general anesthesia only. We performed a systematic search for studies from PubMed, Google Scholar, Embase, and Cochrane. Sources were considered for inclusion in the review if they were randomized controlled trials published from July 2014 to present in English. Data on postoperative opioid consumption, intraoperative opioid use, pain scores, and time to first analgesic request was extracted. The data was analyzed using EndNote, Rayyan, and RevMan software.

Recent findings: Our analysis included 7 studies with a total of 352 patients. ESPBs significantly reduced postoperative opioid consumption (mean difference = -11.28 mg IV (intravenous) morphine equivalents; 95% CI (confidence interval), -15.33 to -7.22; P < 0.00001) and intraoperative opioid use (mean difference = -0.08 mg IV fentanyl equivalents; 95% CI, -0.09 to -0.08; P < 0.00001). Also, the time to the first analgesic request was significantly longer in the ESPB group (mean difference = 52.86 min; 95% CI, 50.24 to 55.48; P < 0.00001). Pain scores were consistently lower in the ESPB group at various postoperative intervals. ESPBs effectively reduce both opioid consumption and pain scores in nephrectomy patients. This approach can minimize opioid-related side effects and improve recovery.

Purpose of review: This narrative review explores the role of the erector spinae plane block (ESPB) as an alternative strategy for managing acute and chronic pain following breast surgeries. The focus is on its potential to reduce opioid consumption and the incidence of postmastectomy pain syndrome (PMPS), which remain significant postoperative concerns.

Methods: A structured literature search was conducted across PubMed, Google Scholar, Medline, and ScienceDirect using keywords including: Erector Spinae Plane Block, ESPB, postoperative analgesia, opioid reduction, breast surgery, mastectomy, and postmastectomy pain syndrome. Studies included randomized controlled trials, cohort studies, and case series published within the last 10 years. The quality of evidence was assessed based on study design, sample size, and reported outcomes.

Recent findings: ESPB has shown promise in reducing postoperative pain and opioid requirements in breast surgeries, including mastectomies, lumpectomies, reconstruction, and axillary dissections. By delivering local anesthetic into the fascial plane deep to the erector spinae muscle, ESPB provides multi-dermatomal analgesia with a favorable safety profile. Compared to other regional techniques such as pectoralis nerve blocks and paravertebral blocks, ESPB is often easier to perform and associated with comparable or improved analgesia. Some studies also report earlier ambulation and shorter hospital stays.

Conclusions: The ESPB has been shown to reduce the incidence of postmastectomy pain syndrome and opioid consumption following breast surgery. Current evidence indicates that both the ESPB and paravertebral blocks are both safe and effective in their analgesic purposes but there is no significant evidence favoring one block over the other.

Purpose of review: Rib fractures, commonly resulting from blunt thoracic trauma, contribute significantly to patient morbidity related to severe pain and associated complications, including atelectasis, pneumonia, and acute respiratory failure. Effective pain management is crucial for minimizing these complications, optimizing respiratory function, and facilitating recovery.

Recent findings: Traditional methods such as NSAIDs, systemic opioids, intercostal nerve blocks, and surgical interventions provide relief but are associated with limitations, including risks of respiratory depression, sedation, infection, and procedural complications. These risks underscore the need for alternative strategies with improved safety profiles. The serratus anterior plane block (SAPB) has emerged as a promising regional anesthesia technique for managing rib fracture pain. Administered under ultrasound guidance, SAPB has shown a low risk of complications such as infection, bleeding, or pneumothorax, enhancing its appeal as a minimally invasive approach. Research has demonstrated SAPB's efficacy in reducing pain scores, minimizing opioid requirements, and improving respiratory function and mobility. By decreasing opioid dependence, SAPB lowers the risk of opioid-related adverse effects and facilitates faster patient recovery. Its favorable safety profile and effectiveness make SAPB a valuable option in managing rib fracture pain, particularly in high-risk populations. Despite its advantages, further studies are needed to optimize SAPB techniques, establish standardized protocols, and investigate long-term outcomes. SAPB represents a significant advancement in rib fracture pain management, highlighting the growing role of regional anesthesia in modern medicine.