Current Pain and Headache Reports最新文献

Purpose of review: The purpose of this review is to provide an update on recent developments in the field of regenerative medicine, specifically focusing on emerging data related to biologics, including platelet-rich plasma and mesenchymal cells, for the treatment of discogenic back pain.

Recent findings: There has been a notable surge of interest in biologics, as evidenced by a wealth of recent reviews and studies. While serious adverse events are generally uncommon, considerable heterogeneity exists in study designs. More robust investigations are warranted to thoroughly evaluate the safety and efficacy of biologics in treating discogenic back pain. Continued research and funding are needed to better understand the underlying mechanisms of disc degeneration and to develop targeted therapies that can alleviate and reduce the burden of this debilitating condition. Biologics may offer effective treatments for discogenic pain; however, more multi-center, prospective, double-blinded, randomized placebo-controlled trials are essential to further establish their effectiveness.

Purpose of review: This review assesses the role of wearable technologies in pain management, emphasizing their capability to transcend subjective pain evaluations with objective functional outcome tracking. We explore the types and veracity of health metrics wearable devices track, illustrating how this technological evolution can significantly enhance patient care in the context of chronic pain prevention and management.

Recent findings: The advancements in modular wearable technology offer new avenues to track a variety of health outcomes, including aerobic capacity, physical activity, stress, and sleep quality. This provides objective measurements that can aid in the management of chronic conditions and can offer a more comprehensive assessment of a patient's pain and function. Although the initial approach to pain management that emphasized pain as the fifth vital sign had unintended devastating consequences, leveraging wearable technology for objective outcomes tracking presents an opportunity to optimize pain management strategies. Wearable technologies capture functional metrics that provide insight into many aspects of the biopsychosocial model of pain. Utilizing function as the key performance indicator has the potential to improve treatment outcomes and, ultimately, patient care.

Purpose of review: To discuss the importance of the consenting process for patients undergoing spinal cord stimulation (SCS) therapy and understanding related complications and effects.

Recent findings: Litigation for SCS/DRG related complications can be very costly, with the mean average settlement in cases relating to SCS being $303,173 dollars in the USA. According to the US Anaesthesia Closed Claims Project database, 10,546 claims related to pain medicine were made between 1990 and 2013; 43 of which were associated with SCS complications. This article will further explore consenting and complications within the context of SCS. Consenting for SCS is a crucial and very important step which potentially reflect on patients' expectations and outcomes.

Objectives: This study aims to review the societal, economic, and racial factors that impact the usage of spinal cord stimulation for chronic pain. Our working hypothesis is that patients of ethnic minority groups or of lower socioeconomic status (SES) status may have lower implantation rates and usage of spinal cord stimulation (SCS).

Materials and methods: Our study sourced publications from PubMed, Embase, and Cochrane Library on December 21st, 2023 for SCS for the purposes of pain management. Articles were excluded from the review if the study was not USA based, did not involve SCS for the purpose of pain or did not allow for the subgroup analysis. There were 1028 reports that resulted after the initial search with 184 duplicates which were removed. Six reports met the inclusion and exclusionary criteria and were included in the review.

Results: Several trends were able to be extrapolated from the pooled reviews. Orhurhu et al. found that Black and Hispanic minorities had a higher utilization rate of SCSs than their White and Asian counterparts in the inpatient setting. Jones and Missios et al. found that in the outpatient setting, White and privately insured patients were more likely to utilize SCS. Ovrom et al. observed an increased cost associated with Hispanic ethnicity and inpatient SCS utilization. Wondwossen et al. found that in the US military system White patients were more likely to receive SCS earlier in their care than Black patients. Labaran et al. concluded the Southern US completed more SCS implants, particularly in White patients with Medicare insurance.

Conclusions: White patients are recipients of SCS earlier and more frequently than minority patients in the outpatient setting. There is mixed evidence regarding inpatient SCS and how household income relates to SCS usage. Insurance type and coverage may be more accurately predictive than simple household income for SCS utilization.

Introduction: Central Post-Stroke Pain (CPSP) is a debilitating condition with a significant prevalence in stroke survivors. Set apart by its refractory to treatment neuropathic pain, it appears to arise from lesions in the spino-thalamo-cortical pathways, particularly in the thalamus. Despite advances in neuroimaging techniques, the pathophysiology of CPSP remains poorly understood, with limited diagnostic criteria and therapeutic approaches.

Objective: This systematic review aims to identify neuroimaging markers associated with CPSP, establish correlations between brain lesions and CPSP development, and explore the utility of neuroimaging techniques for diagnosis and prognosis. Secondary objectives involve establishing a link between CPSP and secondary brain area lesions and what type of pain patients with CPSP are more likely to experience.

Methods: A systematic review was conducted following PRISMA guidelines. Relevant articles were sourced from PubMed, Embase, and Web of Science, using a predefined search strategy targeting CPSP and neuroimaging studies (MRI, PET, SPECT). Studies involving adult CPSP patients with post-stroke neuroimaging were included. Data from 14 studies was analyzed, focusing on lesion locations, neuroimaging findings, and functional connectivity. Risk of bias was assessed using the QUADAS-2 tool.

Results: Key findings highlighted the association of CPSP with lesions in the ventral posterolateral and the ventral medial nuclei of the thalamus, spinothalamic pathway, and cortical areas like the insula and operculum. Functional connectivity studies highlighted the role of disrupted neural networks in pain perception. Limitations in the reviewed studies included small sample sizes, selection bias, and heterogeneity in study designs.

Conclusions: Neuroimaging findings confirm the significance of thalamic and spinothalamic pathway lesions in CPSP pathophysiology. Despite these insights, gaps in research underline the need for larger, multicenter trials to identify reliable biomarkers for diagnosis and therapeutic targets. Advanced neuroimaging combined with machine learning could be the key to understanding and managing CPSP.

Purpose of review: The purpose of this review is to evaluate the current knowledge and recent findings on different pain and headache presentations associated with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) disease.

Recent findings: MOGAD is an inflammatory autoimmune disease affecting mostly the central nervous system, presenting with optic neuritis, transverse myelitis and other forms of inflammatory demyelination. Pain and headache in MOGAD have been recognized more recently and acute and chronic forms of pain can occur in both the adult and pediatric population. An important recent observation is that MOGAD can affect the peripheral nervous system, which can contribute to pain symptoms. Acute and chronic forms of pain have been described in MOGAD, including ocular pain, different types of headaches and neuropathies, involving the central and peripheral nervous system. Awareness of these types of pain in both the pediatric and adult population is crucial, to ensure timely diagnosis and treatment.

Purpose of review: The purpose of this study was to review the literature on the relationship between migraine, anxiety and related disorders, anxious symptomology and related behaviors.

Recent findings: Generalized anxiety, other anxious disorders and migraine are comorbid. In addition, anxious symptomology and behaviors are common in people with migraine even if they do not meet diagnostic criteria or threshold. Anxiety including diagnosed disorders such as generalized anxiety, phobias, panic disorder, as well as behaviors such as catastrophizing, avoidance behaviors, and higher fear of headache/migraine or anxiety sensitivity are comorbid and/or common in migraine. Anxiety is associated with negative outcomes such as migraine progression, medication overuse, stigma and migraine-related disability. The association between migraine, anxiety, and fear and avoidance behaviors has an extensive empirical basis. Awareness of the high prevalence of comorbidity and symptomology as well as the negative outcomes associated with anxiety and related symptoms and behaviors is important in the comprehensive management of people with migraine. Better understanding the relationship between migraine and anxiety symptoms and behaviors and their effects on outcomes is essential to provide more effective treatment for people with migraine. The review emphasizes the necessity of screening and more comprehensive evaluation in patients with migraine using psychological diagnostic tools. Thus, prevention and management of anxiety, fear, and anxiety-related behaviors in the context of migraine management may be considered an essential treatment goal and strategies may include non-pharmacological and pharmacological approaches.

Background: Migraine is a highly prevalent and incapacitating neurological disorder mostly characterised by recurring attacks of moderate to severe throbbing and pulsating pain on one side of the head. The role of estrogen in migraine has been well documented. Although genetic variations in the ESR1 gene have been associated with an increased risk of developing migraine, the findings are inconsistent. We performed a meta-analysis of previously published articles considering four important single nucleotide polymorphisms in the ESR1 gene (rs1801132, rs2228480, rs2234693, and rs9340799) to explore their possible association with the development of migraine and its clinical phenotypes.

Materials and methods: We thoroughly searched literature databases, including PubMed, Science Direct, and Scopus until March 14, 2024, to identify the relevant reports. We utilized GPower software v.3 to assess the power of each report included in the meta-analysis and Comprehensive Meta-analysis v4 for all meta-analysis-related analyses. We employed funnel plots and Egger's regression test to identify publication biases within each genetic comparison model. We used Cochrane Q statistics, probability value, and I² to assess heterogeneity.

Results: After applying predefined criteria, a meta-analysis was conducted with 11 relevant studies comprising 3835 cases of migraine and 3655 healthy individuals. The analysis indicated a strong correlation between ESR1 polymorphisms (rs2228480 and rs9340799) and the likelihood of developing migraine. Furthermore, the subgroup analysis showed that rs2228480 is associated with susceptibility to migraine in both Caucasians and Asians. Additionally, rs2234693 variants were found to be linked with the development of migraine with aura. However, the trial sequential analysis suggested that more case-control studies are necessary to establish the definitive role of ESR1 variants in migraine.

Conclusions: ESR1 variants (rs2228480, rs2234693, and rs9340799) are associated with an increased risk of migraine and related phenotypes. However, further studies are needed to establish a definitive conclusion.

Purpose of review: Trigeminal neuralgia (TN) is a highly heterogeneous condition with a wide choice of successful treatment options. However, differences between subtypes are poorly understood and it remains unknown which patients will respond to different treatments. This review aims to summarize the current state of the TN field and explore the problem of predicting surgical outcomes.

Recent findings: Attempts have been made to standardize classification, outcome reporting, and treatment guidelines. Identification of risk factors for poor surgical treatment outcomes has led to the development of prognostic scoring systems to predict outcomes and guide management. Advances in imaging techniques including diffusion tensor imaging show promise in better understanding the underlying pathophysiology and predicting surgical outcomes. Progress is hampered by lack of understanding of the pathophysiology in TN and differences between disease subtypes. Further work needs to be done to create accurate prediction tools for widespread use, including use of advanced imaging and computing tools, multicenter collaboration, and prospective validation.

Purpose of review: This paper aims to review pudendal neuralgia pathophysiology, risk factors, diagnosis, and treatment options.

Recent findings: Conservative and pharmacologic options are first line treatments for the treatment of pudendal neuralgia. Interventional treatment such as, pudendal nerve blocks can be tried if first line treatments feel to provide adequate analgesia. If pudendal nerve blocks provide sufficient relief but have a short duration, decompressive surgery may be considered. Neuromodulation is also a viable option. Emerging techniques such as pulsed radiofrequency ablation, cryotherapy, lipofilling, and repetitive transcranial magnetic stimulation are promising; however, more studies are needed to evaluate safety and effectiveness. Current study data is generally poor, and unstandardized. Further research is needed to identify the optimal treatment approach and evaluate the effects of pudendal neuralgia on mental health and quality of life.