Current Pain and Headache Reports最新文献

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.

Purpose of review: Hip surgeries are commonly associated with significant postoperative pain, which can hinder early mobilization, prolong hospital stays, and increase healthcare costs. Effective pain management in this patient population is crucial to improving outcomes and reducing complications.

Recent findings: Traditional pain control methods, such as systemic opioids, are often associated with adverse effects, including respiratory depression, nausea, and delayed recovery. Regional anesthesia techniques, particularly the suprainguinal fascia iliaca block (SFIB), have gained attention for the potential to provide targeted, long-lasting analgesia with fewer systemic side effects.

Conclusion: This narrative review evaluates efficacy of the SFIB, an effective and safe technique for postoperative pain management in hip surgeries. The fascia iliaca block, initially described as a low-volume alternative to the lumbar plexus block, has evolved, with the suprainguinal approach demonstrating particular promise. By accessing the lumbar plexus and blocking the femoral, obturator, and lateral femoral cutaneous nerves, the SIFIB provides broad analgesia to the hip region. Recent studies have highlighted that, compared to traditional infrainguinal approaches, the suprainguinal technique offers superior spread and more consistent pain control related to its targeted proximity to the inguinal ligament. Consequently, this technique may optimize perioperative pain management and improve functional recovery in patients undergoing hip surgeries.

Background and objective: Low back pain (LBP) is one of the main health problems imposing a significant burden both personally and socially. It is estimated that 70-85% of people experience LBP during their lifetime, with nearly 20% of cases becoming chronic (CLBP). Interest in psychosocial factors and their correlations with the onset and outcome of low back pain has increased in recent years. The primary objective of this study is to demonstrate the validity and promote the adoption of psychological therapies delivered through remote platforms for the treatment and management of chronic pain related to LBP.

Methods: The clinical studies we reviewed in our research were identified from the PubMed, Web of Science, Scopus, and Cochrane Library databases. Out of the initial 11,859 studies, only 20 met the inclusion criteria.

Results: The results of our study confirm the effectiveness of psychological therapy delivered remotely in the treatment and management of chronic pain caused by low back pain. This highlights the importance of psychological intervention to improve the quality of life for these patients. Remote therapy can indeed facilitate treatment adherence and patient empowerment.

Conclusion: Living with a chronic illness requires continuous support and the development of personalized interventions where the patient is accompanied and supported daily through active intervention. This underscores the importance of expanding the availability of traditionally available psychological strategies to remote delivery to support a growing number of people affected by CLBP.

Purpose of review: Prosopagnosia is a neurological phenotype, characterized by the inability to recognize faces, typically resulting from damage or dysfunction in specific brain regions such as the fusiform gyrus. In contrast, migraine is a disease process, a complex neurological disorder with a range of symptoms including severe headache and visual disturbances.

Recent findings: The brain regions involved in migraine and prosopagnosia are located in close proximity to each other, and perhaps as an unsurprising yet rarely reported result of this, there have been several cases of migraineurs, the majority presenting with aura, who manifested prosopagnosia as a symptom during an attack. While rarely reported, the fact that prosopagnosia can occasionally manifest during migraine episodes, particularly during the aura phase, emphasizes the importance of exploring the cortical processes involved in both conditions. This review discusses migraine and prosopagnosia in the context of comorbidity, explores and summarizes current and key historical knowledge on the reported occurrences of prosopagnosia manifesting as a symptom of migraine, and emphasizes the importance of reporting this phenomenon.

Purpose of review: Allodynia is characterized by a painful response to a non-noxious stimulus. This article reviews the pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for the causes of allodynia.

Recent findings: Allodynia remains difficult to evaluate and manage. Despite ongoing research, significant progress is still needed to optimize the management of allodynia. Allodynia is a debilitating condition that can be difficult to treat. Diagnostic modalities and treatment options are limited. Advancements in diagnostic and treatment options are necessary to improve patient care.

Purpose of review: Neuromodulation techniques currently available for headache management are reviewed in this article, with a focus on recent advances in non-invasive devices for migraine and trigeminal autonomic cephalalgias.

Recent findings: The currently available FDA-cleared non-invasive devices for migraine include transcutaneous supraorbital and supratrochlear nerve stimulation, single-pulse transcranial magnetic stimulation (sTMS), external concurrent occipital and trigeminal neurostimulation (eCOT-NS), remote electrical neuromodulation (REN), and non-invasive vagal nerve stimulation (nVNS) with indications for migraine and trigeminal autonomic cephalalgias. Emerging non-invasive techniques being explored for use in migraine include transcranial direct current stimulation (tDCS), kinetic oscillation stimulation (KOS), and auricular transcutaneous vagal nerve stimulation (at-VNS). In addition to primary headache, non-invasive neuromodulation is being investigated for comorbid conditions such as depression. Non-invasive neuromodulation devices remain a safe, well-tolerated, and effective therapy for patients with primarily migraine and trigeminal autonomic cephalalgias. Ongoing research is needed to determine efficacy in other headache disorders and comorbid conditions.

Purpose of review: Osteoarthritis is a "wear and tear" injury characterized by degeneration of articular cartilage, formation of osteophytes, microfractures, and sclerosis. These physiological changes result in joint pain, stiffness, and deformity. One potential treatment for this is periosteal electrical dry needling.

Recent findings: We performed a systematic search for studies in PubMed, Google Scholar, Embase, and Cochrane. Sources published from 2014 to the present were eligible for inclusion in the review. After an initial search, 48 studies were identified, 22 of which were duplicates that were subsequently removed. The remaining 26 were filtered by title and abstract, resulting in six studies approved for final analysis. Of the six, four found significant improvement in pain and mobility after dry needling was administered as either an adjuvant or stand-alone therapy. Electrical Dry Needling is a promising treatment for Knee Osteoarthritis. More large-scale randomized control trials are needed to evaluate its efficacy as a stand-alone treatment more fully. This review demonstrates some support for dry needling in alleviating knee pain and immobility. Future studies are needed to examine the long-term effects of dry needling and its comparative efficacy to standard treatment.