Current Pain and Headache Reports最新文献

Purpose of review: Cervical transforaminal epidural steroid injections (CTFESIs) are widely used for the treatment of radicular pain caused by cervical spine pathology, including disc herniations and foraminal stenosis. This review aims to analyze the risks and benefits of CTFESIs, address their efficacy and safety profile, improve clinical decision-making, and educate interventional pain medicine physicians.

Recent findings: CTFESIs have demonstrated benefits such as pain relief, functional improvement, and the potential to avoid surgical interventions. However, their use is limited by safety concerns due to the proximity of vascular structures in the cervical spine. Complications, including neurological injuries, infections, and vascular injuries, though rare, can be severe. Recent studies emphasize the importance of using advanced procedural techniques, such as fluoroscopic guidance and non-particulate corticosteroids, to minimize risks. CTFESIs remain a valuable tool for managing cervical radiculopathy in selected patients. While they provide substantial therapeutic and diagnostic benefits, careful patient selection and adherence to safety protocols are crucial to minimizing serious complications. This review compiles current evidence to assist clinicians in evaluating the risks and benefits of CTFESIs in clinical practice.

Purpose of review: Chronic non-cancer pain in children and adolescents represents a significant public health issue, affecting physical, psychological, and social well-being. Defined as pain persisting for over three months, this condition is influenced by developmental, socioeconomic, and cultural factors. However, its prevalence remains uncertain and debated. A comprehensive literature search was conducted across electronic databases, including Medline, Embase, CINAHL, PsycINFO, and the Cochrane Library. Eligible systematic reviews were critically appraised using the AMSTAR-2 tool to assess methodological quality. This overview synthesises evidence from existing systematic reviews to provide an updated understanding of the epidemiology and burden of paediatric non-cancer chronic pain.

Recent findings: Findings revealed substantial variability in the reported prevalence of specific pain types: headaches (4-83%), abdominal pain (4-53%), musculoskeletal pain (4-40%), and back/low-back pain (14-24%). Prevalence was generally lower in low- and middle-income countries, likely due to barriers in healthcare access. Methodological heterogeneity was observed across studies, and AMSTAR-2 assessment identified critical limitations in some systematic reviews, impacting the reliability of findings. This overview highlights the urgent need for standardised research methodologies to accurately monitor the prevalence of paediatric non-cancer chronic pain. Standardisation is essential for informing policies aimed at mitigating the long-term impact of chronic pain in children and adolescents. Addressing these issues, particularly in resource-limited settings, is crucial for improving health outcomes and reducing societal and economic burdens.

Background: Accidental dural puncture during epidural lead insertion for Spinal Cord Stimulation (SCS) is a recognized surgical complication that may lead to cerebrospinal fluid (CSF) leakage and subsequent postdural puncture headache (PDPH). The optimal technical approach to prevent CSF leakage remains controversial. This study aimed to evaluate a simple and efficient intraoperative technique for managing accidental dural puncture during SCS lead placement.

Materials and methods: A retrospective review was conducted of the medical records and imaging studies of all patients who underwent SCS procedures between January 2020 and April 2024. Signs or symptoms associated with dural puncture were recorded, including subcutaneous fluid collections, pseudomeningocele formation, PDPH, wound infection, and meningitis.

Results: Among 107 patients who underwent SCS implantation, involving a total of 194 lead insertions, 4 cases (3.7%) of intraoperative CSF leakage due to iatrogenic dural puncture were identified. Each case was managed by injecting fibrin glue through the introducer needle into the epidural space, directly over the dural lesion.

Conclusions: Prophylactic application of fibrin glue following dural puncture appears to be highly effective in sealing the damage and preventing CSF leakage. This technique offers a valuable intraoperative solution for surgeons to immediately address dural injuries during SCS lead placement, potentially minimizing postoperative complications and improving patient outcomes.

Purpose of review: This systematic review aimed to compare the efficacy and safety of thoracic epidural block (TEB) and thoracic paravertebral block (TPB) for managing postoperative pain following thoracotomy for pulmonary procedures.

Recent findings: A comprehensive search of PubMed, Embase, Web of Science, and Google Scholar identified randomized controlled trials (RCTs) published prior to April 10, 2024. Studies were eligible if they compared TEB and TPB in adult patients undergoing thoracotomy for pulmonary procedures and reported outcomes on postoperative pain, opioid consumption, hemodynamic parameters, or complications. Two reviewers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias tool. The review adhered to PRISMA guidelines. From 1,114 records screened, 7 RCTs comprising 429 patients met the inclusion criteria. TEB demonstrated superior pain relief in the immediate postoperative period, particularly when continuous infusions with opioids were utilized. TPB, however, provided greater hemodynamic stability, with significantly lower rates of hypotension and more stable mean arterial pressure and heart rate during the first 24 h. Beyond 24 h, both techniques offered comparable pain relief and opioid consumption. While the incidence of nausea, vomiting, and urinary retention was similar between groups, TPB was associated with fewer respiratory complications. Both TEB and TPB are effective for postoperative pain management following thoracotomy, each with distinct advantages. TEB provides optimal early pain control, making it suitable for patients with significant early postoperative pain. TPB, with its superior hemodynamic profile, is better suited for patients at risk of hypotension or cardiovascular instability. Tailoring analgesic strategies to patient-specific needs can optimize outcomes. Future large-scale RCTs are necessary to confirm these findings across broader thoracic surgical populations.

Registration and protocol: This review was registered with PROSPERO prior to initiation (Registration Number: CRD42024578768).

Purpose of review: Psychological practices have emerged as promising treatments for coping with chronic pain (CP) as a psychological resilience (PR) enhancer mechanism. These practices contain cognitive, behavioral and emotional modulation of pain. In this regard, classical cognitive-behavioral therapy (CBT) and current trends in CBT, including acceptance and commitment therapy and mindfulness-based practices may demonstrate significant improvements in pain perception, physical functioning, catastrophic beliefs and fear-avoidance behaviors among patients with CP. However, understanding the neurocognitive mechanisms of these practices includes challenges, such as the need to identify associated brain regions with PR to CP. Our review explored psychological practices to enhance PR as a dynamic neurocognitive process (e.g., changing affect) rather than only being a static trait.

Recent findings: Psychological practices have promising results in improving positive outcomes for CP sufferers. To illustrate, along with superior PR scores, higher positive affect, adaptive pain beliefs, and physical functioning were reported after these practices. Conversely, lower pain catastrophizing, pain-related fear-avoidance, and self-reported pain ratings were seen as PR factors. Moreover, enhanced PR process may be associated with increased activity of the brain regions, including prefrontal cortex and orbitofrontal cortex, whereas diminished activity, reactivity, and functional connectivity in the anterior cingulate cortex, amygdala and insula. This review discusses the neurocognitive modulation of CP through psychological practices and highlights the role of enhancing the PR process for individuals with CP. As the field continues to evolve, understanding the importance of psychological practices to develop PR-related factors is crucial for increasing pain management outcomes.

Purpose of review: This review synthesizes the latest updates in the literature on the connection between fasting and migraine, examining both clinical outcomes and underlying pathophysiological mechanisms.

Recent findings: Although no studies have specifically explored fasting as a therapeutic intervention for migraine, various retrospective analyses suggest that fasting might worsen migraine symptoms in the short term. On the other hand, recent investigations, including several randomized controlled trials, have shown that ketogenic diets significantly reduce the number of migraine days and decrease inflammation markers. Additional research has shown improvements in disability assessments, as indicated by VAS, MIDAS, and HIT-6 scores. These benefits are not replicated by merely administering ketone bodies. Furthermore, genetic studies have found a link between glycemic processing and the occurrence of migraine. There is accumulating evidence that ketogenesis can reduce both the frequency and disability associated with migraine, likely through the reduction of systemic inflammatory markers and diminished cortical excitability. However, the potential benefits of intermittent fasting on migraine prevention remain underexplored and warrant further investigation.

Background: The term "mixed pain" is frequently used in clinical practice to describe the coexistence of nociceptive, neuropathic, and nociplastic pain mechanisms. However, its inconsistent use and lack of a formal definition warrant further investigation. This bibliometric analysis aims to explore publication trends, research networks, and key themes in mixed pain literature.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection. The search was performed in February 2024, with journal rankings obtained from Journal Citation Reports™ 2022 (Clarivate Analytics). Extracted data included publication trends, citation analysis, co-authorship networks, and keyword mapping.

Results: A total of 229 publications were identified, demonstrating an increasing trend in both publication volume and citations. Most studies were published in high-ranking Q1 journals as research (77%) and review articles (19%). The USA (21%), Italy (15%), and Germany (12%) were the leading contributors, yet global collaboration was weak, with limited co-authorship connections except within the USA. The keyword analysis revealed five major research clusters, with "neuropathic pain," "management," and "quality of life" emerging as central themes.

Conclusions: Despite the progressive increase in mixed pain articles in highly ranked journals, this bibliometric analysis highlighted the absence of a well-structured collaborative network among authors and a lack of clear connections between keywords. Given the critical clinical implications of mixed pain, further high-quality studies on this topic and enhanced international collaborations are recommended.

Purpose of review: Total knee replacement (TKR) is a common procedure to alleviate pain in patients with severe osteoarthritis of the knee after failed conservative treatment. While generally safe, postoperative pain is a significant issue many patients experience following surgery.

Recent findings: To control postoperative pain, numerous treatments may be administered which may be given preoperatively, intraoperatively, or postoperatively. These treatments include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. Additionally, peripheral nerve blocks (PNB) may be performed prior to total knee replacement to limit pain after the surgery. A specific type of PNB done prior to total knee replacement is the genicular nerve block (GNB) which targets five genicular nerves that innervate different parts of the knee joint. This type of block is designed to prevent pain impulses from being sent to the central nervous system from the knee without affecting movement of the lower extremity by sparing efferent nerves innervating muscles. PubMed was used to identify the studies found in this review that are less than 5 years old using the search term "genicular nerve block clinical studies." Most studies compared GNB alone compared to other blocks, however some used GNB in combination with other blocks, most at a maximum of 48 h postoperative. GNB is typically performed by anesthesiologists under ultrasound guidance to ensure accurate placement of the block. Clinical studies have shown that GNB is effective in controlling pain following TKR leading to lower pain scores following surgery as well as a reduced level of opioid consumption. Additionally, GNB has shown reduced motor weakness following TKR compared to other types of PNBs allowing earlier mobilization of patients. However, more studies are needed to further investigate the efficacy of GNB compared to other PNBs to treat postoperative pain following TKR.

Purpose of review: Hip osteoarthritis constitutes a prevalent condition among individuals aged 55 and above, serving as one of the primary triggers for joint discomfort and impairment, and marking a substantial origin of chronic pain particularly affecting the elderly population. Our article provides an exhaustive summary of the mechanisms of action, therapeutic efficacy, and potential adverse consequences associated with novel therapeutic modalities including glucocorticoids, hyaluronic acid, platelet-rich plasma, mesenchymal stem cells, and stromal vascular fraction. Concurrently, we conducted a comprehensive evaluation of the clinical efficacy and potential applications of various medications.

Recent findings: In comparison to physical therapy, oral analgesics, and other nonsurgical modalities, intra-articular injection therapy is characterized by enhanced safety and greater efficacy. Moreover, when contrasted with surgical intervention, intra-articular injection demonstrates a lower degree of invasiveness and incurs fewer adverse reactions. Intra-articular treatments have shown excellent local efficacy while significantly minimizing adverse reactions in patients. These methods hold significant potential for development but require comprehensive research and thorough discussion within the academic community.

Introduction: Post-amputation pain, including residual limb pain (RLP) and phantom limb pain (PLP), can affect the outcome of surgery and have an impact on quality of life. Effective management of acute post-amputation pain requires a multidisciplinary approach with collaboration among the surgical and anesthesia teams to optimize pain management. A systematic-narrative hybrid review was conducted to assess and report the effectiveness of various interventions in perioperative pain management for amputation surgery.

Methods: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov databases were searched for studies evaluating interventional and/or pharmacological approaches to managing perioperative pain in major extremity amputation surgery. The data collected included treatment options, average dosage and/or duration of treatments, and reported pain outcomes.

Results: Of the 27 studies evaluating interventions, 8 addressed neuraxial or perineural analgesia, 16 focused on peripheral nerve blocks (PNB), 2 examined peripheral nerve stimulators (PNS), and 1 investigated transcutaneous electrical nerve stimulation. Preoperative epidural analgesia was associated with a reduced incidence of postoperative pain. PNS, PNB, and catheter-based infusions were found to be effective in managing postoperative pain. The role of ketamine in treating post-amputation pain yielded mixed results, while other pharmacological agents, such as valproic acid and gabapentin, demonstrated limited efficacy.

Conclusions: While numerous pain interventions are available, no single approach has been shown to be superior. A multimodal strategy, incorporating PNBs, preoperative pain control, and potentially ketamine, appears to provide the most comprehensive pain management strategy. Further long-term prospective studies are required to refine and optimize pain management techniques for major extremity amputation surgery.

Level of evidence: III-Systematic reviews.