Pub Date : 2024-06-01Epub Date: 2024-02-26DOI: 10.1007/s11916-024-01233-7
John Freeman, Devin Nikjou, Jillian Maloney, Stephen Covington, Scott Pew, Christopher Wie, Natalie Strand, Alaa Abd-Elsayed
Purpose of review: Bracing represents a prevalent conservative, non-surgical approach used in the management of chronic spinal conditions such as spondylosis, degenerative disc disease, and spondylolisthesis. A wide variety of orthoses are available to aid in addressing cervical, thoracic, lumbar, thoracic, and SI joint pain. In this review, we aim to comprehensively examine brace types with their current applications and implications of usage.
Recent findings: There are multiple cervical bracing options, such as soft and rigid collars, to assist in managing acute trauma and chronic degenerative conditions. The review highlights the nuanced decision-making process between hard and soft collars based on the severity of bone or ligamentous injury and neurological findings. Orthoses for low back pain are commonly used. The review highlights the challenges of chronic neck and lower back pain, emphasizing the importance of clinicians exploring all treatment strategies including braces which can improve function and reduce pain.
审查目的:矫形器是治疗脊椎病、椎间盘退行性病变和脊椎滑脱症等慢性脊椎病的常用保守非手术方法。有多种矫形器可用于辅助治疗颈椎、胸椎、腰椎、胸椎和 SI 关节疼痛。在这篇综述中,我们旨在全面研究支架类型及其当前应用和使用意义:有多种颈椎支具可供选择,如软颈圈和硬颈圈,可帮助治疗急性创伤和慢性退行性病症。这篇综述强调了根据骨骼或韧带损伤的严重程度以及神经系统的检查结果,在硬颈圈和软颈圈之间进行微妙决策的过程。矫形器是治疗腰背痛的常用工具。综述强调了慢性颈部和下背部疼痛所带来的挑战,强调了临床医生探索所有治疗策略的重要性,包括可以改善功能和减轻疼痛的矫形器。
{"title":"The Role of Orthoses in Chronic Axial Spinal Conditions.","authors":"John Freeman, Devin Nikjou, Jillian Maloney, Stephen Covington, Scott Pew, Christopher Wie, Natalie Strand, Alaa Abd-Elsayed","doi":"10.1007/s11916-024-01233-7","DOIUrl":"10.1007/s11916-024-01233-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Bracing represents a prevalent conservative, non-surgical approach used in the management of chronic spinal conditions such as spondylosis, degenerative disc disease, and spondylolisthesis. A wide variety of orthoses are available to aid in addressing cervical, thoracic, lumbar, thoracic, and SI joint pain. In this review, we aim to comprehensively examine brace types with their current applications and implications of usage.</p><p><strong>Recent findings: </strong>There are multiple cervical bracing options, such as soft and rigid collars, to assist in managing acute trauma and chronic degenerative conditions. The review highlights the nuanced decision-making process between hard and soft collars based on the severity of bone or ligamentous injury and neurological findings. Orthoses for low back pain are commonly used. The review highlights the challenges of chronic neck and lower back pain, emphasizing the importance of clinicians exploring all treatment strategies including braces which can improve function and reduce pain.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-03-21DOI: 10.1007/s11916-024-01240-8
Qing Zhao Ruan, Jason Chang, Daniel Pak, Rajesh Supra, Cyrus Yazdi, Linda Kollenburg, Erkan Kurt, David Reece, Alexandra C G Fonseca, Alaa Abd-Elsayed, Christopher L Robinson
Purpose of review: Lower extremity pain is deemed by Center for Disease Control and Prevention (CDC) to be a significant source of chronic pain in adults. If not appropriately managed, patients are subjected to risks of prolonged musculoskeletal dysfunction, disruption to quality of life, and elevated healthcare expenditures. Peripheral nerve stimulation (PNS) has shown great potential in recent years demonstrating efficacy in multiple diagnoses ranging from acute post-surgical pain to complex regional pain syndrome (CRPS). This study seeks to delineate efficacy of peripheral neuromodulation in the context of chronic lower extremity pain.
Recent findings: Prevailing clinical studies demonstrate evidence levels ranging from II to V (Oxford Centre of Level of Evidence) in lower limb PNS, attaining positive outcomes in pain scores, opioid use, and quality of life measures. Nerves most frequently targeted are the sciatic and femoral nerves with post-amputation pain and CRPS most commonly investigated for efficacy. PNS is a promising therapeutic modality demonstrated to be effective for a variety of nociceptive and neuropathic pain conditions in the lower extremity. PNS offers chronic pain physicians a powerful tool in the multi-modal management of lower limb chronic pain.
审查目的:美国疾病控制和预防中心(CDC)认为,下肢疼痛是成年人慢性疼痛的一个重要原因。如果管理不当,患者将面临长期肌肉骨骼功能障碍、生活质量下降和医疗支出增加的风险。近年来,外周神经刺激疗法(PNS)显示出巨大的潜力,在从急性手术后疼痛到复杂性区域疼痛综合征(CRPS)等多种诊断中都有疗效。本研究旨在确定外周神经调控对慢性下肢疼痛的疗效:目前的临床研究显示,下肢外周神经调控疗法的证据等级从 II 级到 V 级(牛津证据等级中心)不等,在疼痛评分、阿片类药物使用和生活质量测量方面取得了积极成果。最常针对的神经是坐骨神经和股神经,最常研究的疗效是截肢后疼痛和 CRPS。事实证明,PNS 是一种很有前途的治疗方式,对下肢的各种痛觉和神经病理性疼痛都很有效。PNS 为慢性疼痛医生提供了多模式治疗下肢慢性疼痛的有力工具。
{"title":"Literature Review: Mechanism, Indications, and Clinical Efficacy of Peripheral Nerve Stimulators in Lower Extremity Pain.","authors":"Qing Zhao Ruan, Jason Chang, Daniel Pak, Rajesh Supra, Cyrus Yazdi, Linda Kollenburg, Erkan Kurt, David Reece, Alexandra C G Fonseca, Alaa Abd-Elsayed, Christopher L Robinson","doi":"10.1007/s11916-024-01240-8","DOIUrl":"10.1007/s11916-024-01240-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lower extremity pain is deemed by Center for Disease Control and Prevention (CDC) to be a significant source of chronic pain in adults. If not appropriately managed, patients are subjected to risks of prolonged musculoskeletal dysfunction, disruption to quality of life, and elevated healthcare expenditures. Peripheral nerve stimulation (PNS) has shown great potential in recent years demonstrating efficacy in multiple diagnoses ranging from acute post-surgical pain to complex regional pain syndrome (CRPS). This study seeks to delineate efficacy of peripheral neuromodulation in the context of chronic lower extremity pain.</p><p><strong>Recent findings: </strong>Prevailing clinical studies demonstrate evidence levels ranging from II to V (Oxford Centre of Level of Evidence) in lower limb PNS, attaining positive outcomes in pain scores, opioid use, and quality of life measures. Nerves most frequently targeted are the sciatic and femoral nerves with post-amputation pain and CRPS most commonly investigated for efficacy. PNS is a promising therapeutic modality demonstrated to be effective for a variety of nociceptive and neuropathic pain conditions in the lower extremity. PNS offers chronic pain physicians a powerful tool in the multi-modal management of lower limb chronic pain.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-03-21DOI: 10.1007/s11916-024-01232-8
Mihir Jani, Nimesha Mehta, Sandra Yu, Ricky Ju, Ugur Yener, Alaa Abd-Elsayed, Lynn Kohan, Sayed Emal Wahezi
Purpose of review: Radiofrequency ablation (RFA) is a minimally invasive procedure for facet joint pain. The targets for the procedure are the medial branches of the dorsal spinal nerves which innervate the facet joints. Before RFA, patients undergo diagnostic meal branch blocks to ensure appropriate pain relief and confirm the utility of proceeding to RFA. The success of RFA relies heavily on procedural technique and accurate placement near the medial branch.
Recent findings: Motor testing is utilized in the lumbar region to assess the response of the multifidus and ensure proper placement of the RFA probe to prevent inadvertent damage to surrounding spinal anatomy. However, relying on motor responses in this area presents challenges given the frequency of lack of muscle twitching. Factors contributing to limited muscle twitch responses include muscle atrophy, excessive lordosis, facet arthropathy, local anesthetic use before ablation, and previous surgical neurotomy. These complexities highlight the challenges in ensuring precise motor stimulation during RFA. Despite these obstacles, accurate anatomical placement remains crucial. For RFA cases that prove challenging, relying on anatomical placement can be adequate to proceed with the procedure. Bridging knowledge gaps is vital for standardized practices and safer procedures. Further research is necessary to refine techniques, understand patient-specific factors, and enhance the efficacy of RFA in managing chronic lumbar facet joint pain.
{"title":"Mitigating Factors in L4 and L5 Medial Branch Motor Stimulation During Radiofrequency Ablation.","authors":"Mihir Jani, Nimesha Mehta, Sandra Yu, Ricky Ju, Ugur Yener, Alaa Abd-Elsayed, Lynn Kohan, Sayed Emal Wahezi","doi":"10.1007/s11916-024-01232-8","DOIUrl":"10.1007/s11916-024-01232-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Radiofrequency ablation (RFA) is a minimally invasive procedure for facet joint pain. The targets for the procedure are the medial branches of the dorsal spinal nerves which innervate the facet joints. Before RFA, patients undergo diagnostic meal branch blocks to ensure appropriate pain relief and confirm the utility of proceeding to RFA. The success of RFA relies heavily on procedural technique and accurate placement near the medial branch.</p><p><strong>Recent findings: </strong>Motor testing is utilized in the lumbar region to assess the response of the multifidus and ensure proper placement of the RFA probe to prevent inadvertent damage to surrounding spinal anatomy. However, relying on motor responses in this area presents challenges given the frequency of lack of muscle twitching. Factors contributing to limited muscle twitch responses include muscle atrophy, excessive lordosis, facet arthropathy, local anesthetic use before ablation, and previous surgical neurotomy. These complexities highlight the challenges in ensuring precise motor stimulation during RFA. Despite these obstacles, accurate anatomical placement remains crucial. For RFA cases that prove challenging, relying on anatomical placement can be adequate to proceed with the procedure. Bridging knowledge gaps is vital for standardized practices and safer procedures. Further research is necessary to refine techniques, understand patient-specific factors, and enhance the efficacy of RFA in managing chronic lumbar facet joint pain.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose of review: This systematic review and network meta-analysis aims to compare the efficacy of different mind-body exercise (MBE) interventions, including Yoga, Pilates, Qigong, and Tai Chi, in managing chronic non-specific neck pain (CNNP). We searched randomized controlled trials in PubMed, Embase, Web of Science and Cochrane Library. After screening eligible studies and extracting relevant data, risk of bias of included studies was assessed by the Cochrane Risk of Bias assessment tool, and network meta-analysis was performed by the Stata software version 16.0.
Recent findings: Of the 1019 studies retrieved, 18 studies with 1442 subjects were included. Fourteen studies were graded as high quality. Yoga plus hot sand fomentation was the most effective in reducing pain intensity and functional disability, and improving the quality of physical life in patients with CNNP. Yoga achieved the most improvement in cervical mobility. And Pilates was the best MBE intervention for improving the quality of mental life. Overall, Yoga, Pilates, Qigong, and Tai Chi demonstrated considerable effectiveness in improving pain intensity, functional disability, cervical mobility, and quality of life in patients with CNNP. Yoga or Yoga plus heat therapy was the most effective method for patients with CNNP. Additional high-quality, large-scale, multi-center, long-term follow-up studies are necessary to fully understand the comparative effectiveness of different MBE interventions for CNNP, and to recognize the potential benefits of each MBE intervention and the need for individualized treatment approaches.
{"title":"Comparative Efficacy of Mind-Body Exercise for Treating Chronic Non-Specific Neck Pain: A Systematic Review and Network Meta-Analysis.","authors":"Qian Gao, Xinmin Li, Mengyang Pan, Jing Wang, Fangjie Yang, Pengxue Guo, Zhenfei Duan, Chunlin Ren, Yasu Zhang","doi":"10.1007/s11916-024-01218-6","DOIUrl":"10.1007/s11916-024-01218-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>This systematic review and network meta-analysis aims to compare the efficacy of different mind-body exercise (MBE) interventions, including Yoga, Pilates, Qigong, and Tai Chi, in managing chronic non-specific neck pain (CNNP). We searched randomized controlled trials in PubMed, Embase, Web of Science and Cochrane Library. After screening eligible studies and extracting relevant data, risk of bias of included studies was assessed by the Cochrane Risk of Bias assessment tool, and network meta-analysis was performed by the Stata software version 16.0.</p><p><strong>Recent findings: </strong>Of the 1019 studies retrieved, 18 studies with 1442 subjects were included. Fourteen studies were graded as high quality. Yoga plus hot sand fomentation was the most effective in reducing pain intensity and functional disability, and improving the quality of physical life in patients with CNNP. Yoga achieved the most improvement in cervical mobility. And Pilates was the best MBE intervention for improving the quality of mental life. Overall, Yoga, Pilates, Qigong, and Tai Chi demonstrated considerable effectiveness in improving pain intensity, functional disability, cervical mobility, and quality of life in patients with CNNP. Yoga or Yoga plus heat therapy was the most effective method for patients with CNNP. Additional high-quality, large-scale, multi-center, long-term follow-up studies are necessary to fully understand the comparative effectiveness of different MBE interventions for CNNP, and to recognize the potential benefits of each MBE intervention and the need for individualized treatment approaches.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-04-01DOI: 10.1007/s11916-024-01249-z
Sage V Hebert, Melanie A Green, Sydney A Mashaw, William D Brouillette, Angela Nguyen, Kylie Dufrene, Anitha Shelvan, Shilpadevi Patil, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D Kaye
Purpose of review: Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges.
Recent findings: Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.
{"title":"Assessing Risk Factors and Comorbidities in the Treatment of Chronic Pain: A Narrative Review.","authors":"Sage V Hebert, Melanie A Green, Sydney A Mashaw, William D Brouillette, Angela Nguyen, Kylie Dufrene, Anitha Shelvan, Shilpadevi Patil, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D Kaye","doi":"10.1007/s11916-024-01249-z","DOIUrl":"10.1007/s11916-024-01249-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges.</p><p><strong>Recent findings: </strong>Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-02-19DOI: 10.1007/s11916-024-01222-w
David L Chang, Benjamin Mirman, Neel Mehta, Daniel Pak
Purpose of review: The purpose of this review is to evaluate and summarize the literature investigating cryoneurolysis in the treatment of various chronic pain pathologies.
Recent findings: There is an increasing amount of interest in the use of cryoneurolysis in chronic pain, and various studies have investigated its use in lumbar facet joint pain, SI joint pain, post-thoracotomy syndrome, temporomandibular joint pain, chronic knee pain, phantom limb pain, neuropathic pain, and abdominal pain. Numerous retrospective studies and a more limited number of prospective, sham-controlled prospective studies suggest the efficacy of cryoneurolysis in managing these chronic pain pathologies with a low complication rate. However, more blinded, controlled, prospective studies comparing cryoneurolysis to other techniques are needed to clarify its relative risks and advantages.
{"title":"Applications of Cryoneurolysis in Chronic Pain Management: a Review of the Current Literature.","authors":"David L Chang, Benjamin Mirman, Neel Mehta, Daniel Pak","doi":"10.1007/s11916-024-01222-w","DOIUrl":"10.1007/s11916-024-01222-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to evaluate and summarize the literature investigating cryoneurolysis in the treatment of various chronic pain pathologies.</p><p><strong>Recent findings: </strong>There is an increasing amount of interest in the use of cryoneurolysis in chronic pain, and various studies have investigated its use in lumbar facet joint pain, SI joint pain, post-thoracotomy syndrome, temporomandibular joint pain, chronic knee pain, phantom limb pain, neuropathic pain, and abdominal pain. Numerous retrospective studies and a more limited number of prospective, sham-controlled prospective studies suggest the efficacy of cryoneurolysis in managing these chronic pain pathologies with a low complication rate. However, more blinded, controlled, prospective studies comparing cryoneurolysis to other techniques are needed to clarify its relative risks and advantages.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-02-22DOI: 10.1007/s11916-024-01227-5
Saurabh Kataria, Utsav Patel, Kevin Yabut, Jayshil Patel, Rajkumar Patel, Savan Patel, Jeremiah Hilkiah Wijaya, Pankti Maniyar, Yukti Karki, Moinulhaq P Makrani, Omar Viswanath, Alan D Kaye
Purpose of review: This manuscript summarizes novel clinical and interventional approaches in the management of chronic, nociceptive, and neuropathic pain.
Recent findings: Pain can be defined as a feeling of physical or emotional distress caused by an external stimulus. Pain can be grouped into distinct types according to characteristics including neuropathic pain, which is a pain caused by disease or lesion in the sensory nervous system; nociceptive pain, which is pain that can be sharp, aching, or throbbing and is caused by injury to bodily tissues; and chronic pain, which is long lasting or persisting beyond 6 months. With improved understanding of different signaling systems for pain in recent years, there has been an upscale of methods of analgesia to counteract these pathological processes. Novel treatment methods such as use of cannabinoids, stem cells, gene therapy, nanoparticles, monoclonal antibodies, and platelet-rich plasma have played a significant role in improved strategies for therapeutic interventions. Although many management options appear to be promising, extensive additional clinical research is warranted to determine best practice strategies in the future for clinicians.
{"title":"Recent Advances in Management of Neuropathic, Nociceptive, and Chronic Pain: A Narrative Review with Focus on Nanomedicine, Gene Therapy, Stem Cell Therapy, and Newer Therapeutic Options.","authors":"Saurabh Kataria, Utsav Patel, Kevin Yabut, Jayshil Patel, Rajkumar Patel, Savan Patel, Jeremiah Hilkiah Wijaya, Pankti Maniyar, Yukti Karki, Moinulhaq P Makrani, Omar Viswanath, Alan D Kaye","doi":"10.1007/s11916-024-01227-5","DOIUrl":"10.1007/s11916-024-01227-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>This manuscript summarizes novel clinical and interventional approaches in the management of chronic, nociceptive, and neuropathic pain.</p><p><strong>Recent findings: </strong>Pain can be defined as a feeling of physical or emotional distress caused by an external stimulus. Pain can be grouped into distinct types according to characteristics including neuropathic pain, which is a pain caused by disease or lesion in the sensory nervous system; nociceptive pain, which is pain that can be sharp, aching, or throbbing and is caused by injury to bodily tissues; and chronic pain, which is long lasting or persisting beyond 6 months. With improved understanding of different signaling systems for pain in recent years, there has been an upscale of methods of analgesia to counteract these pathological processes. Novel treatment methods such as use of cannabinoids, stem cells, gene therapy, nanoparticles, monoclonal antibodies, and platelet-rich plasma have played a significant role in improved strategies for therapeutic interventions. Although many management options appear to be promising, extensive additional clinical research is warranted to determine best practice strategies in the future for clinicians.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11126447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-03-02DOI: 10.1007/s11916-024-01230-w
Paul L Durham, Sophia R Antonopoulos
Purpose of review: To provide information from preclinical and clinical studies on the biological activity and health benefits of dietary inclusion of nutraceuticals as a safe, effective, non-pharmacological approach for the treatment of migraine.
Recent findings: There is emerging evidence of the therapeutic benefit of nutraceuticals to inhibit oxidative stress, suppress inflammation, and prevent changes in the normal gut microbiome, which are implicated in migraine pathology. Nutraceuticals can be enriched in polyphenols, which act as molecular scavengers to reduce the harmful effects of reactive oxygen species and phytosterols that suppress inflammation. Nutraceuticals also function to inhibit dysbiosis and to maintain the commensal intestinal bacteria that produce anti-inflammatory molecules including short-chain fatty acids that can act systemically to maintain a healthy nervous system. Dietary inclusion of nutraceuticals that exhibit antioxidant, anti-inflammatory, and anti-nociceptive properties and maintain the gut microbiota provides a complementary and integrative therapeutic strategy for migraine.
{"title":"Benefit of Dietary Supplementation of Nutraceuticals as an Integrative Approach for Management of Migraine: Evidence From Preclinical and Clinical Studies.","authors":"Paul L Durham, Sophia R Antonopoulos","doi":"10.1007/s11916-024-01230-w","DOIUrl":"10.1007/s11916-024-01230-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide information from preclinical and clinical studies on the biological activity and health benefits of dietary inclusion of nutraceuticals as a safe, effective, non-pharmacological approach for the treatment of migraine.</p><p><strong>Recent findings: </strong>There is emerging evidence of the therapeutic benefit of nutraceuticals to inhibit oxidative stress, suppress inflammation, and prevent changes in the normal gut microbiome, which are implicated in migraine pathology. Nutraceuticals can be enriched in polyphenols, which act as molecular scavengers to reduce the harmful effects of reactive oxygen species and phytosterols that suppress inflammation. Nutraceuticals also function to inhibit dysbiosis and to maintain the commensal intestinal bacteria that produce anti-inflammatory molecules including short-chain fatty acids that can act systemically to maintain a healthy nervous system. Dietary inclusion of nutraceuticals that exhibit antioxidant, anti-inflammatory, and anti-nociceptive properties and maintain the gut microbiota provides a complementary and integrative therapeutic strategy for migraine.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-03-12DOI: 10.1007/s11916-024-01236-4
Andrea Stieger, Carolina S Romero, Lukas Andereggen, Daniel Heisenberg, Richard D Urman, Markus M Luedi
Purpose of review: Postcraniotomy headache (PCH) is a common adverse event and can lead to various complications and decreased quality of life.
Recent findings: To reduce postcraniotomy pain and associated complications, a multimodal pain therapy including analgesics, analgesic adjuncts, and regional anesthesia is essential. The use of opioids should be minimized to facilitate prompt postoperative neurosurgical assessment. Here, we provide an update on the latest evidence regarding the role of scalp nerve blocks in the pain management of patients undergoing craniotomy procedure. Nerve blocks are effective in alleviating postoperative pain after craniotomy. Scalp blocks contribute to lower pain levels and less opioid consumption in the first 48 h following surgery. Moreover, there is a significant decrease in patients suffering from PONV among patients who receive scalp block.
{"title":"Nerve Blocks for Craniotomy.","authors":"Andrea Stieger, Carolina S Romero, Lukas Andereggen, Daniel Heisenberg, Richard D Urman, Markus M Luedi","doi":"10.1007/s11916-024-01236-4","DOIUrl":"10.1007/s11916-024-01236-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Postcraniotomy headache (PCH) is a common adverse event and can lead to various complications and decreased quality of life.</p><p><strong>Recent findings: </strong>To reduce postcraniotomy pain and associated complications, a multimodal pain therapy including analgesics, analgesic adjuncts, and regional anesthesia is essential. The use of opioids should be minimized to facilitate prompt postoperative neurosurgical assessment. Here, we provide an update on the latest evidence regarding the role of scalp nerve blocks in the pain management of patients undergoing craniotomy procedure. Nerve blocks are effective in alleviating postoperative pain after craniotomy. Scalp blocks contribute to lower pain levels and less opioid consumption in the first 48 h following surgery. Moreover, there is a significant decrease in patients suffering from PONV among patients who receive scalp block.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-03-12DOI: 10.1007/s11916-024-01226-6
Rajesh Naidu Janapala, Emilija Knezevic, Nebojsa Nick Knezevic, Rachana Pasupuleti, Mahendra R Sanapati, Alan D Kaye, Vidyasagar Pampati, Sahar Shekoohi, Laxmaiah Manchikanti
Purpose of review: To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies.
Recent findings: The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence. The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.
综述目的:通过对随机对照试验(RCT)和观察性研究进行系统回顾和荟萃分析,评估射频神经切断术治疗骶髂关节疼痛的有效性:据估计,骶髂关节疼痛的发病率约占腰痛病例的 25%,其诊断缺乏金标准。治疗方法包括运动疗法、注射、消融术和融合术,但效果不一。COVID-19 改变了包括骶髂关节手术在内的干预措施的使用模式,而这些干预措施的证据仍未确定。最近,美国联邦医疗保险(Medicare)发布了本地承保范围认定(LCD),规定骶髂关节射频神经切断术不在承保范围内。此外,最近一项关于骶髂关节注射的系统性审查显示证据等级为三级或一般。骶髂关节是连接脊柱和骨盆的重要轴向关节,是导致腰痛的原因之一。其复杂的神经支配模式因人而异。骶髂关节功能障碍导致疼痛和僵硬的原因多种多样。本系统综述和荟萃分析旨在通过应用严格的方法学,同时考虑研究性临床试验和观察性研究,评估射频神经切断术治疗骶髂关节疼痛的有效性。尽管在方法上存在差异,但在疼痛评分变化和功能改善的支持下,本综述中的证据表明射频神经切断术作为一种治疗方案具有 III 级证据,建议性尚可。该综述的优势在于其全面的方法和质量评估。然而,局限性依然存在,包括标准和技术因素的差异,这突出表明需要在现实世界中进一步开展高质量的研究。
{"title":"Systematic Review and Meta-Analysis of the Effectiveness of Radiofrequency Ablation of the Sacroiliac Joint.","authors":"Rajesh Naidu Janapala, Emilija Knezevic, Nebojsa Nick Knezevic, Rachana Pasupuleti, Mahendra R Sanapati, Alan D Kaye, Vidyasagar Pampati, Sahar Shekoohi, Laxmaiah Manchikanti","doi":"10.1007/s11916-024-01226-6","DOIUrl":"10.1007/s11916-024-01226-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies.</p><p><strong>Recent findings: </strong>The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence. The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}