Current Pain and Headache Reports最新文献

Purpose of review: As cancer survivorship continues to rise, attention has increasingly turned to the long-term sequelae of oncologic treatment. While interventions such as chemotherapy, radiation therapy, and surgery have significantly improved survival outcomes, they are frequently associated with chronic pain syndromes that can profoundly impact quality of life. This review synthesizes current evidence and therapeutic approaches for three prevalent pain conditions in cancer survivors: chemotherapy-induced peripheral neuropathy, post-radiation pain syndromes, and post-surgical pain syndromes. Emphasis is placed on pathophysiology, diagnostic considerations, and emerging management strategies to guide clinicians in optimizing survivorship care.

Recent findings: Evidence supports the use of duloxetine for chemotherapy-induced peripheral neuropathy. Despite the wide use of gabapentinoids and tricyclic antidepressants for chemotherapy-induced peripheral neuropathy the data is limited on efficacy. For post-radiation and post-surgical pain syndromes related to cancer, current evidence supports a multimodal approach of physical therapy, injections, and pharmacologic agents. A personalized and multimodal approach is recommended for chronic pain in cancer survivors. Further investigations into the treatment for chronic pain syndromes in cancer survivors are critical to improve the long-term outcomes and quality of life for cancer survivors.

Purpose of review: Postoperative pain following shoulder surgeries, including rotator cuff repair and arthroplasty, can be severe and impede early mobilization, prolong recovery, and increase opioid consumption. Regional anesthesia has emerged as a cornerstone of multimodal pain management for these procedures, offering targeted analgesia with fewer systemic side effects. Among the various techniques, the retroclavicular approach to the brachial plexus, known as the retroclavicular brachial plexus block (RCB) or retroclavicular approach to the infraclavicular brachial plexus (RAPTIR), has gained attention for its promising efficacy and safety profile. This narrative review evaluates current evidence surrounding the retroclavicular block's clinical utility in postoperative shoulder pain control. We examine anatomical and technical considerations, analgesic efficacy, safety, and comparative advantages over traditional approaches such as the interscalene and supraclavicular blocks.

Recent findings: Literature suggests that RCB provides effective pain relief with reduced risk of phrenic nerve involvement and diaphragmatic paralysis, a critical advantage in patients with respiratory compromise. Additionally, its favorable ergonomic profile and improved needle visibility under ultrasound make it an appealing alternative in elective and emergent settings. The present investigation explores RCB's integration into multimodal analgesia protocols and applicability in obese and geriatric patients, highlighting current research's limitations. Although data remains limited, emerging evidence supports the retroclavicular block as a safe and effective option for shoulder analgesia, warranting further comparative studies and broader clinical adoption.

Purpose of review: Interventional pain physicians are routinely exposed to radiation during diagnostic and therapeutic procedures. With the commonplace use and utility of C-arm fluoroscopy, it has become increasingly important for physicians to maintain an understanding of the foundational principles and associated risks of radiation. This review highlights recent literature regarding radiation exposure to assist interventional pain physicians in their efforts to attenuate occupational risk.

Recent findings: Recent studies continue to call attention to the importance of radiation safety awareness and adherence to established protective measures. The literature emphasizes variability in exposure based on technique, procedure type, and use of shielding. Safety protocols and the principles that guide these recommendations are reviewed, with attention to the ALARA principle, or keeping radiation exposure "as low as reasonably achievable." There are many variables that affect the amount of radiation a given provider is exposed to and numerous ways to limit dose and associated risk. The use of protective equipment, proper technique, and clinical instruction remain essential to reducing exposure. This review underscores the value of physician adherence to safety protocols and the continued need for research in the field of radiation safety and risk reduction.

This paper applies institutional theory to palliative pain care in low resource nations (LRNs), suggesting that three interdependent pillars shape access: regulative (laws and rules), normative (professional standards and values), and cultural-cognitive (shared beliefs). Biomedical solutions alone are insufficient. Lasting progress requires coordinated legal reform, professional accountability, and culturally sensitive engagement. RECENT FINDINGS: Restrictive regulations, stigmatizing policy language, and administrative bottlenecks limit access to essential analgesics, while the inverse care law magnifies inequity. Effective regulative responses include a balanced opioid policy and pooled procurement, local analgesic production, and task-shifting to non-physicians. Normative levels such as pain competencies in training/licensure, stewardship with audit/monitoring, and quality indicators improve delivery. Capacity building with Project ECHO (Extension for Community Healthcare Outcomes) shows knowledge and practice gains. Cultural strategies that design education with community leaders and traditional healers, reframing opioids as compassionate care, and routine pain assessment all shift beliefs and behaviors positively. CONCLUSION: A sociological, three pillar approach reframes pain relief as a health system obligation and human right. Multi-pronged interventions such as simplifying policies and financing, mandated competencies and stewardship, and culturally grounded engagement can transform pain care from a neglected option to an expected standard across LRNs.

Purposeof review: This article aims to evaluate current evidence and guidelines on anticoagulant and antiplatelet therapy for patients undergoing interventional procedures. It provides recommendations for managing these therapies with either continuation or withholding of these drugs in the perioperative period to minimize the risk of bleeding and thromboembolism in clinical practice.

Recent findings: Newly published guidelines and research underscore the crucial role of antiplatelet and anticoagulant therapy in interventional procedures, emphasizing the importance of decisions regarding whether to continue or temporarily stop these medications. Studies have categorized procedures into low-, moderate-, and high-risk groups, offering specific guidance on managing anticoagulant and antiplatelet therapy accordingly. The American Society of Interventional Pain Physicians (ASIPP) has developed consensus guidelines based on a synthesis of the best available evidence, incorporating risk stratification and practical recommendations. This review provides an in-depth analysis of medical, surgical, and interventional pain management literature. It highlights the updated ASIPP guidelines and summarizes the society's evidence-based recommendations for clinical practice.

Purpose of review: This goal of this paper is to identify the need to report adverse events (AEs) in mindfulness-based interventions (MBIs) for migraine and highlight conceptual issues related to their reporting. This paper reviews the benefits and AEs in MBIs broadly and considers their application to a migraine population.

Recent findings: Due to a lack of standardized protocol for measuring and reporting, there is little published information on AEs in MBIs for migraine. Several recent trials have reported individual cases of AEs, including one instance of posttraumatic re-experiencing. The increasing popularity of MBIs in the treatment of chronic pain conditions, including migraine, makes it necessary for providers to understand which AEs occur. Patients with migraine may be at an elevated risk of experiencing AEs in MBIs.

Purpose of review: The current literature on gamifying mobile health (mHealth) applications to address chronic pain management is evaluated in this narrative review. These approaches include utilizing wearable devices to track progress of various biomarkers, collecting digital rewards for utilizing in-app self-management educational tools, completing challenges to encourage the use of mental health resources, and leaderboards to promote shared learning and overcome social withdrawal.

Recent findings: There continues to be a growing emphasis on the collaboration between patients with chronic pain and physicians to form comprehensive management strategies to address patients' unique pharmacological, physical, and psychosocial needs. Despite the accessibility of mHealth apps, they usually fail to integrate easily into a patient's lifestyle. Moreover, there is promise for enhanced psychosocial support through mHealth apps. A small fraction of chronic pain mHealth apps have utilized principles of gamification to motivate patients to adhere to care plans. Evidence suggests that incorporating game-like elements in future mHealth app designs must be prioritized to improve user engagement and subsequently facilitate positive health behaviors and outcomes for more effective pain control.

Purpose of review: Patients' expectations are important aspects to consider for improving patients' satisfaction and willingness to return for continued care. While expectation surveys are not novel in Pain Medicine, none specifically aim to improve satisfaction. This study evaluates whether administering an expectation survey during an initial pain clinic visit improves satisfaction with treatment plans and outcomes. We hypothesized that completing the survey could increase awareness and help align expectations and satisfaction.

Recent findings: This study was conducted at an outpatient multidisciplinary pain clinic at an urban academic hospital and 100 first-time, English speaking adult patients were recruited. Fifty patients completed a pre-visit questionnaire on pain and expectations (intervention group), while 50 did not (control group). A follow-up survey was completed six months later by 85% of participants to assess satisfaction level with pain treatment, meeting of goals and expectations, and overall clinic experience. No significant differences were found between intervention and control groups for pain treatment satisfaction (3.46 ± 1.31 vs. 3.50 ± 1.28, p = 0.48), goal achievement (3.76 ± 1.14 vs. 3.49 ± 1.20, p = 0.30), or overall experience (3.83 ± 1.20 vs. 3.72 ± 1.14, p = 0.67). Dissatisfaction stemmed from inadequate pain relief, lack of follow-up, and unmet expectations. The lack of statistical significance suggests that merely assessing expectations without patient education or provider engagement may be insufficient. Future studies could explore how patient education, communication, and treatment understanding can impact satisfaction to potentially improve pain management experiences.

Purpose of the review: Nicolau's syndrome (NS) is a rare but serious drug reaction that occurs after administration of many drugs through various routes, with a broad spectrum of manifestations ranging from severe pain up to skin necrosis. In this review, we reported a case of advanced-grade NS following intravenous injection of ibuprofen. Moreover, we reviewed the existing knowledge and current practice to present in-depth any possible pathogeneses involved in this condition and highlight the specific pharmacological properties of the offending drugs that may play a role in the development of this syndrome. Eventually, we provided recommendations to prevent and treat the incidence of NS, with a focus on the therapeutic role of stellate ganglion block as a novel intervention in such cases.

Recent findings: We reported a case of Nicolau's syndrome after iatrogenic intravenous injection of ibuprofen, which caused severe upper limb ischemia. Notably, the condition was successfully managed with stellate ganglion block, representing a promising effective approach in the management of this serious complication. Early Stellate ganglion block may help in treating this condition effectively with its vasodilatory effect. To our knowledge, it is the first time stellate ganglion block has been implemented in managing this syndrome, fostering new hope in curing these cases.