Current Pain and Headache Reports最新文献

Purpose of review: To evaluate the available studies on structural magnetic resonance imaging (MRI) of post-traumatic headache (PTH).

Recent findings: A systematic search of PubMed and Embase databases (from inception to February 1, 2024) identified nine relevant structural MRI studies. These studies included adult participants diagnosed with acute or persistent PTH in adherence with any edition of the International Classification of Headache Disorders. Eight studies focused on PTH attributed to mild traumatic brain injury (TBI), while one examined PTH after whiplash injury. The comparison groups consisted of healthy individuals, people with mild TBI (without PTH), and/or individuals with migraine. The eligible studies assessed brain morphometry (n = 7), both cortical morphometry and diffusion tensor imaging (n = 1), or used structural brain images for machine learning (n = 1). The main findings indicated alterations in brain regions involved in affective pain processing and cognitive functions. However, the results were largely incongruent, likely due to small sample sizes and methodologic issues. Structural MRI has shown alterations in the brains of people with PTH, particularly in regions responsible for affective pain processing, cognitive control, and visual processing. These findings align well with the clinical features commonly observed in PTH. Nevertheless, most findings were inconsistent across studies, highlighting the need for methodologic standardization and investigations with larger sample sizes.

Purpose of review: Chronic pain affects approximately 1.5 billion people worldwide, representing the leading cause of disability and a significant financial burden on healthcare systems. Conventional treatments, such as opioids and non-steroidal anti-inflammatory drugs, are frequently linked to adverse effects, including dependency and gastrointestinal issues, and often offer limited long-term relief. This review explores the potential of psychedelics, including psilocybin, LSD, and ketamine, as alternative therapeutic agents in chronic pain management.

Recent findings: These substances modulate pain perception through actions on serotonergic and glutamatergic systems and may promote neuroplasticity, offering novel pathways for pain relief. Specifically, the review details the pharmacologic actions of psychedelics, their effects on chronic pain syndromes such as cancer pain, migraines, and neuropathic pain, and their clinical implications. The safety profiles, patient responses, and analgesic properties of these compounds are examined, highlighting the need for further research to validate their efficacy and optimize their therapeutic use in pain management.

Purpose of review: Management of primary headache disorders during pregnancy is limited due to known teratogenicity or unknown safety of many currently available pharmaceutical therapies. Here, we explore the safety and efficacy of non-invasive neuromodulatory devices as another treatment modality for pregnant patients.

Recent findings: There are six FDA-cleared, non-invasive neuromodulatory devices currently available for the management of headache that include remote electrical neuromodulation (REN), noninvasive vagal nerve stimulation (nVNS), external trigeminal nerve stimulation (eTNS), single-pulse transcranial magnetic stimulation (sTMS), and external concurrent occipital and trigeminal neurostimulation (eCOT-NS). Neuromodulatory devices are a safe, effective, and well tolerated non-pharmacological option for migraine and other primary headache disorders. Although evidence of safety and tolerability use in pregnancy is limited, they may serve as a therapeutic alternative or adjunct to improve the care of our pregnant patients.

Purpose of review: Knee osteoarthritis (OA) is a gradual deterioration of articular cartilage characterized by pain and physical dysfunction. Although analgesic pharmacological agents are the first-line treatment for knee OA, they are not effective for all patients. In this study, we evaluate the efficacy of an intra-articular injection treatment using platelet-rich plasma (PRP) in reducing pain and improving functional ability.

Recent findings: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review and meta-analysis (SR/MA) provides an updated overview for the role of PRP in knee OA treatment. Ten articles, published between 2016 and 2023, met the inclusion criteria and compared PRP treatment to a placebo control at six-month follow-up. A total of 9,409 potential studies were identified from a review of four different databases: PubMed (n = 4595), Cochrane (n = 4252), VHL (n = 112), and OpenSigle (n = 450). After the titles and abstracts and inclusion and exclusion criteria were considered, a total of 10 studies were analyzed. Although a significant improvement among PRP-treated groups in some studies was found, there was variability such as where the aforementioned scores appeared to worsen and some only demonstrated trends. Overall, PRP may be a promising treatment for symptomatic knee OA. However, further research is necessary to determine the efficacy of PRP in treating knee OA, with specific considerations for times at follow-up, frequency and dosage of injections, and comorbidities, which were unaccounted for in this SR/MA.

Purpose of review: This retrospective, case controlled, comparative evaluation review of radiation exposure during epidural procedures in interventional pain management assessed variations in radiation exposure based on obesity, race, and gender.

Recent findings: Numerous publications have shown increasing radiation exposure based on body mass index (BMI). However, the influence of race and gender have not been studied. A recent study assessing radiation exposure for epidural procedures with mandated 2 views, compared to a single view or optional 2 views, showed an increase in exposure time of 21%, with radiation dose increases of 133%. The influence of obesity, has been studied, but potential influence of race, and gender on radiation exposure for epidural procedures has not been studied. The present review shows a prevalence of total obesity with BMI of 30 or above of 50.9%, with a higher prevalence in patients below the age of 45, female gender, and African Americans. Mean fluoroscopy time and dose increased significantly from 6.9 s to 0.925 milligray (mGy) for all epidural procedures for those who are underweight to 10.0 s and 6.7 mGy for those with Class 3 obesity above BMI of 40. However, after adjusting for body mass index, no significant differences were noted in race for both fluoroscopy time and radiation dose across multiple epidural procedures. Fluoroscopy time and radiation dose increased in males in cervical interlaminar and lumbar transforaminal procedures.

Purpose of review: Migraine prevalence in females is up to 3 times higher than in males and females show higher frequency, longer duration, and increased severity of headache attacks, but the reason for that difference is not known. This narrative review presents the main aspects of sex dimorphism in migraine prevalence and discusses the role of sex-related differences in mitochondrial homeostasis in that dimorphism. The gender dimension is also shortly addressed.

Recent findings: The imbalance between energy production and demand in the brain susceptible to migraine is an important element of migraine pathogenesis. Mitochondria are the main energy source in the brain and mitochondrial impairment is reported in both migraine patients and animal models of human migraine. However, it is not known whether the observed changes are consequences of primary disturbance of mitochondrial homeostasis or are secondary to the migraine-affected hyperexcitable brain. Sex hormones regulate mitochondrial homeostasis, and several reports suggest that the female hormones may act protectively against mitochondrial impairment, contributing to more effective energy production in females, which may be utilized in the mechanisms responsible for migraine progression. Migraine is characterized by several comorbidities that are characterized by sex dimorphism in their prevalence and impairments in mitochondrial functions. Mitochondria may play a major role in sexual dimorphism in migraine through the involvement in energy production, the dependence on sex hormones, and the involvement in sex-dependent comorbidities. Studies on the role of mitochondria in sex dimorphism in migraine may contribute to precise personal therapeutic strategies.

Although the integration of artificial intelligence (AI) into medicine and healthcare holds transformative potential, significant challenges must be necessarily addressed. This technological innovation requires a commitment to ethical principles. Key issues concern autonomy, reliability, and bias. Furthermore, AI development must guarantee rigorous data privacy and security standards. Effective AI implementation demands thorough validation, transparency, and the involvement of multidisciplinary teams to oversee ethical considerations. These issues also concern pain medicine where careful assessment of subjective experiences and individualized care are crucial. Notably, in this rapidly evolving technological landscape, politics plays a pivotal role in establishing rules and regulations. Regulatory frameworks, such as the European Union's Artificial Intelligence Act and recent U.S. executive orders, provide essential guidelines for the responsible use of AI. This step is crucial for balancing innovation with rigorous ethical standards, ultimately leveraging the incredible AI's benefits. As the field evolves rapidly and concepts like algorethics and data ethics become more widespread, the scientific community is increasingly recognizing the need for specialists in this area, such as AI Ethics Specialists.

Purpose of review: The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile.

Recent findings: A systematic search for eligible studies from PubMed, Google Scholar, Cochrane, and Embase was performed. The present investigation elucidated any significant differences between change in numeric rating scale of average and maximum pain scores between a TENS and non-TENS group. A nonsignificant difference was reported between TENS and non-TENS, with a mean difference of - 0.393 (95% CI - 1.780, 0.993; P = 0.578). For change in maximum pain reported, a nonsignificant difference was also found, with a mean difference of 0.128 (95% CI - 1.158, 1.414; P = 0.845).

Conclusion: Related to various limitations of this meta-analysis, no definitive conclusions could be concluded regarding efficacy of TENS in the treatment of cancer or chemotherapy-related pain. Additional randomized primary studies with standardized treatment protocols and pain measurements are needed for future meta-analysis and recommendations for clinical practice.

Purpose of review: Baclofen, a muscle relaxant that reduces the release of excitatory neurotransmitters in the pre-synaptic neurons stimulating inhibitory neuronal signals in post-synaptic neurons, has been around for over 5 decades. Baclofen is used primarily for spasticity and since 1982, has had a role as an intrathecal agent. In the present investigation, we review research trends and updates on safety and efficacy of intrathecal baclofen (ITB) pumps.

Recent findings: Evaluation of safety and efficacy of ITB pumps in spasticity and relevant conditions was evaluated in the present investigation. PubMed and ClinicalTrials.gov were used to review appropriate related literature. Commonly reported aspects regarding ITB efficacy include comparison with alternative treatments, maintenance efficacy, and long-term outcomes. Safety considerations and risk factors associated with ITB include postoperative complications, withdrawal symptoms, tolerance issues, long-term management, and contraindications. In summary, the present investigation reveals that ITB is efficacious for muscle spasticity; however, efforts should be made to enhance safety and efficacy by providing improved best practice guidelines on maximum safe dose with the least amount of risk with individualized treatments.

Purpose of review: Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportional pain typically affecting an extremity. Management of CRPS is centered around specific symptomatology, which tends to be a combination of autonomic dysfunction, nociceptive sensitization, chronic inflammation, and/or motor dysfunction. Targeting the autoimmune component of CRPS provides a way to both symptomatically treat as well as minimize progression of CRPS.

Recent findings: Understanding the physiology of CRPS and strategies for treating and targeting immunophysiology behind CRPS allows examination of the efficacy of such treatments. IL-1 receptor antagonism, glucocorticoid administration, IVIG infusion, and TNFα inhibitors are treatments that target the immune response and decrease inflammation, thereby reducing pain and enhancing function in patients with CRPS. IL-1 receptor antagonism is thought to inhibit the inflammatory effects of IL-1, a key player in the inflammatory process in CRPS. Glucocorticoids have anti-inflammatory properties and can reduce inflammation in affected tissues. IVIG infusion involves administering immunoglobulins, which may modulate the immune response and reduce autoimmunity in CRPS. TNFα inhibitors block the action of TNFα, a pro-inflammatory cytokine associated with CRPS development. These therapies are further discussed at the extent of mechanism of action as well as advantages and limitations of such therapies. The present investigation provides a detailed summary of the mechanism of action, advantages, and limitations of novel immunomodulatory therapies and recent studies and trials that investigated these therapies for CRPS. Future studies are warranted related to the role of immunomodulators in the treatment of CRPS.