Current Pain and Headache Reports最新文献

Purpose of review: This narrative review explores the expanding applications of neuromodulation beyond pain management, focusing on its use in treating non-painful conditions such as heart failure, renal failure, spinal cord injuries, overactive bladder syndrome, and cognitive impairment in neurodegenerative diseases.

Recent findings: Neuromodulation techniques, including dorsal root ganglion stimulation, sacral neurostimulation, and deep brain stimulation, have shown promising results in various non-painful medical conditions: Heart and Renal Failure: Dorsal root ganglion stimulation induces diuresis in diuretic-resistant patients, offering a novel approach to managing fluid overload. Spinal Cord Injuries: Epidural spinal cord stimulation and brain-spine interfaces have demonstrated the potential to restore motor function, enhancing mobility and quality of life for paralyzed individuals. Overactive Bladder Syndrome: Sacral neurostimulation and tibial nerve stimulation have proven effective in improving urinary continence and reducing symptoms in patients unresponsive to conventional treatments. Cognitive Impairment in Neurodegenerative Diseases: Techniques such as deep brain stimulation and transcranial magnetic stimulation are being investigated for their ability to enhance cognitive and motor functions in conditions like Parkinson's and Alzheimer's disease. The review highlights the transformative potential of neuromodulation in non-painful conditions, demonstrating its ability to address complex medical issues beyond its traditional scope. Continued research and optimization of these techniques may lead to broader therapeutic applications and improved patient outcomes.

Purpose of review: The purpose of this article is to provide a comprehensive review of the ganglia of the head and neck and their role in the interventional management of chronic headaches and facial pain disorders.

Recent findings: Interventions targeting the sphenopalatine, stellate and gasserian ganglia are well described in the literature for headaches and facial pain disorders. There is a growing body of evidence supporting use of these techniques for clinical conditions outside of pain such as post-traumatic stress disorder and Long COVID symptoms. These findings increase the potential applications of such procedures, making them more relevant to the interventional physician tasked with managing symptoms in difficult to treat medical conditions. Nerve blocks of the head and neck are used for diagnostic and therapeutic purposes in the management of headaches and facial pain disorders. Headaches, whether acute or chronic, are common pain conditions with a wide-range of etiologies and are often difficult to treat. Chronic facial pain can have a variety of underlying causes, including direct or indirect nerve damage, infection, inflammation, and muscle dysfunction. Traditional pain management strategies such as medications and physical therapy often fail or are associated with significant adverse effects. Interventions such as nerve blocks and neuroablative procedures have shown promise in managing headaches and facial pain by directly targeting the underlying causes. This review article summarizes the most recent evidence regarding the efficacy, safety, applications and limitations of these interventional pain management techniques.

Background: Nebulized ketamine, an innovative route of drug delivery, has gained interest for its potential effectiveness in challenging clinical scenarios. The objective of this systematic review is to provide insights into the safety and effectiveness of nebulized ketamine in pain management.

Method: A systematic search was performed on online databases including WOS, Cochrane, Scopus, and PubMed, using a specific search strategy. Our review focused on primary studies about the utilization of nebulized ketamine in various contexts regarding pain management. Additionally, we incorporated relevant secondary research, such as reviews presenting diverse perspectives.

Results: Nebulized ketamine in pain management included nine studies.

Conclusion: The advantages of nebulized ketamine over other forms of administration include its rapid absorption and effective delivery. The smaller volume required for nebulization can result in fewer side effects and enhanced patient compliance thereby facilitating efficient drug delivery while minimizing the systematic impact. Emerging evidence supports the administration of nebulized ketamine as a safe and efficacious treatment for acute pain. However, further investigations are needed for a better understanding of its pharmacokinetics, optimal dosing and efficacy across different populations.

Purpose of review: Managing pain after hip surgery can be challenging, especially with the need to balance effective relief and early movement. Traditional pain management methods, such as opioids and nerve blocks, have been demonstrated to be efficacious but come with risks, including side effects, potential for opioid dependency, and the possibility of delays in mobility.

Recent findings: The erector spinae plane block (ESPB) has recently gained attention as a newer option that may offer unique benefits. ESPB is an ultrasound-guided technique targeting nerves along the spine, providing broad and long-lasting pain relief without significant muscle weakness. This allows patients to start moving sooner, which is critical to recovery. Studies suggest ESPB can reduce opioid use and maintain motor strength better than other approaches, although more research is needed to confirm these findings across larger groups.

Conclusion: ESPB's technique, however, still needs standardization to ensure consistent results, as variations in dosage and application can impact its effectiveness. Further research focusing on larger, controlled studies could better clarify ESPB's role compared to traditional methods, especially regarding long-term recovery and quality of life. As more evidence accumulates, ESPB may become a valuable addition to pain management plans for hip surgery, especially for patients needing effective, low-risk analgesia.

Purpose of review: The present investigation evaluated the use of opioids for postoperative pain relief in spinal surgery patients.

Recent findings: Pain management is a crucial component of postoperative care that greatly impacts patient outcomes. Postoperative pain management has been shown to allow for earlier mobility, discharge, and return to normal life. Opioids are the standard treatment for postoperative pharmacologic pain relief, but they are associated with the same adverse effects that pain management strives to mitigate. Opioids are associated with a large side effect profile, including a higher risk of various postoperative complications. Opioids are potentially highly addictive and postoperative use is associated with dependence, tolerance, and the current opioid epidemic. Some studies indicate that there are similar surgical outcomes amongst patients independent of whether opioids were prescribed opioids for pain relief.

Conclusion: Opioids should only be recommended for postoperative pain management under strict guidance and supervision from physicians. All 50 states have acute pain guidelines in place limiting opioid prescribing. One of the strategies of reducing postoperative opioid consumption is the emphasis on opioid alternatives that should be actively considered and explored prior to resorting to opioids. There are pharmacological and non-pharmacological options available for pain relief that can provide similar levels of analgesia as prescription opioid without unwanted effects such as tolerance and dependency. Proper assessment of patient history and risk factors can aid physicians in tailoring a pain management regimen that is appropriate for each individual patient. More research into efficacy and safety of alternative treatments to opioids is warranted.

Purpose of review: Peripheral neuropathies and complex regional pain syndrome (CRPS) result in a similar clinical picture including shared sudomotor and vasomotor symptomatology. Chemotherapeutic agents can precipitate chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients akin to development of CRPS following trauma. Below we review the areas of overlap between CRPS and CIPN including their shared pathophysiology, clinical presentation, diagnostics, and treatment options.

Recent findings: The features of autonomic dysfunction, motor impairment, and reduced proprioception observed in both CRPS and CIPN may result from shared mechanisms include inflammatory reactions, immune dysregulation, autonomic changes, as well as central and peripheral sensitization. Both conditions are a clinical diagnosis of exclusion, and demand a personalized, multidisciplinary therapeutic approach inclusive of psychosocial interventions to reduce deleterious effects on an individual's quality of life. CIPN is recognized as a separate clinical entity albeit sharing a similar underlying pathology and clinical presentation with CRPS. It may be plausible to include CIPN on the CRPS clinical spectrum as our mechanistic understanding of its development and progression evolves.

Purposeof review: The provision of a review of current literature on the cost-effectiveness of employing SCS in the treatment of CRPS.

Recent findings: Four studies were included in this review, with authorship in the United States, Canada, Europe, and Australia. Each study individually supported the cost-effectiveness of SCS in the treatment of CRPS, with the incremental cost of one quality-adjusted life year found to be AUD 2,321 - USD 22,084, all below a willingness to pay estimated at USD 50,000. One of the four studies was rated American Academy of Neurology (AAN) Grade II, three of the four studies were rated AAN Grade III, and an overall Class C evaluation was assigned to this evidence. SCS can be cost-effective in the treatment of patients with CRPS when considering a time horizon of at least ten years. Current evidence, however, remains weak and less invasive options remain first-line.

Purpose of review: Chronic low back pain is one of the top three causes of diminished quality of life in well-developed countries. There are many etiologies of lower back pain, and sometimes, the pain is of true spinal pathology. However, this is not always the case, and sacroiliac joint (SIJ) pain has been described as an etiology in 15-30% or more of patients who are experiencing low back pain. Overlooking SIJ dysfunction as the cause of low back pain has considerable consequences on the patient's quality of life and healthcare-associated costs. SIJ dysfunction has been gaining recognition through well-described algorithms and reports on how to diagnose and differentiate types of low back pain.

Recent findings: When conservative management fails in patients with SIJ dysfunction, fusion of the SIJ is a possibility. SIJ fusion was introduced as an open procedure but was often seen as a "last resort" related to the high complication rates and intensity of the procedure consistent with long operative time, high blood loss, and extended hospital stays. Minimally invasive surgical techniques for SIJ fusion were developed and have produced quality relief for some patients. Most minimally invasive SIJ fusion procedures are performed through a lateral approach. However, newer studies have shown evidence of a posterior or posterior oblique approach that may be more desirable for patients. The posterior approach to SIJ fusion has demonstrated a shorter operative time, smaller incision, and quicker return to activities of daily living. This narrative review aims to highlight up to date evidence on the efficacy and safety posterior minimally invasive SIJ fusion.

Aim: Diabetic peripheral neuropathy (DPN) affects up to half of all patients with diabetes mellitus. Acupuncture is often used to manage chronic pain, but its' effects on DPN are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to assess the effectiveness of acupuncture for DPN.

Methods: We searched databases from inception to September 30, 2024. Paired reviewers independently extracted data and assessed risk of bias. We used random effects models for all meta-analyses and the GRADE approach to assess the certainty of evidence.

Results: We included 14 RCTs (1,169 participants, 45% female). Low certainty evidence suggests that, compared to sham, acupuncture may reduce pain (weighted mean difference [WMD] -1.44 cm on a 10 cm VAS, 95%CI -1.72 to -1.15; modelled risk difference [RD] for achieving the minimally important difference [MID] of 1.5 cm: 45%, 95%CI 35-54%). Comparted to sham or usual care, low certainty evidence suggests that acupuncture may reduce overall neurological symptom severity (WMD - 1.22 [95%CI -1.85, -0.59] on the 19-point Toronto Clinical Scoring System [TCSS]), and provide little to no difference in physical functioning, mental functioning, or adverse events. Low certainty evidence suggests that, compared to amitriptyline or pregabalin, acupuncture may reduce pain associated with DPN.

Conclusions: Acupuncture for DPN may reduce pain when compared to sham acupuncture and may reduce neurologic symptom severity and result in little to no difference in physical functioning, mental functioning or adverse events, when compared with sham acupuncture or usual care.

Background: Neuropathic pain represents a significant public health concern due to its complex pathophysiology and the disability it can cause. Despite advancements in understanding its underlying mechanisms and potential treatments, challenges persist in achieving effective management. This bibliometric analysis aims to offer a comprehensive overview of research trends, key contributors, and existing gaps in the literature on neuropathic pain, providing valuable insights to guide future studies and enhance clinical approaches.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection (WoSCC) database. Key metrics, including publication trends, citation patterns, co-authorship networks, and keyword co-occurrence, were evaluated. Statistical analyses included average annual percentage change (APC) assessments and trend forecasting with an Auto Regressive Integrated Moving Average (ARIMA) model.

Results: A total of 9,974 studies published between 2005 and 2024 were included. Publications peaked between 2021 and 2022 but showed a slight decline thereafter, with forecasts predicting a steady increase from 2025 to 2030. Most papers were published in high-impact Q1 journals, reflecting the quality of research. Co-authorship analysis revealed central hubs of collaboration in the USA and China, with limited integration of smaller countries into the global research network. Keyword analysis identified multiple thematic clusters, including "chronic pain," "molecular mechanisms," and "clinical management." Specific gaps were noted in understanding personalized therapeutic approaches, and non-pharmacological interventions.

Conclusions: This analysis underscores the critical need for continued research to address gaps in diagnosis, treatment, and management of neuropathic pain. Strengthening international collaborations and fostering multidisciplinary efforts will be pivotal in advancing this field.