Macie A Serio, Rachael Bartolina, Sanjana Sudini, Ellie M MacDonald, Austin S Thomassen, Sahar Shekoohi, Azem A Chami, Alan D Kaye
{"title":"Clinical Efficacy and Risks of Intradiscal Orthobiological Injections: A Narrative Review.","authors":"Macie A Serio, Rachael Bartolina, Sanjana Sudini, Ellie M MacDonald, Austin S Thomassen, Sahar Shekoohi, Azem A Chami, Alan D Kaye","doi":"10.1007/s11916-025-01414-y","DOIUrl":"https://doi.org/10.1007/s11916-025-01414-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic discogenic low back pain (LBP) is a common cause of disability worldwide. Current management options include conservative, surgical, and minimally invasive interventional injections. Intradiscal orthobiological injections of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cells (MSCs) have been introduced as regenerative treatment options.</p><p><strong>Recent findings: </strong>Many studies have demonstrated improvements in patients' reported outcomes (PROMs) measuring the areas of pain, disability, function, and satisfaction. The results are promising with statistical improvements shown throughout various studies. Adverse events such as increased pain and infection have been reported with these injections; however, the complication rate has yet to be delineated. Numerous studies report no adverse events in their sample size. The present investigation summarizes recent evidence for the efficacy and risks of PRP, BMAC, and MSC injections.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"99"},"PeriodicalIF":3.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621086","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}
Alan D Kaye, Harrison D Cooper, Sydney A Mashaw, Ahmed I Anwar, Alex V Hollander, Austin S Thomassen, Anushka Singh, Sahar Shekoohi
{"title":"Clinical Implications of Antidepressants and Associated Risk of Bleeding: A Narrative Review.","authors":"Alan D Kaye, Harrison D Cooper, Sydney A Mashaw, Ahmed I Anwar, Alex V Hollander, Austin S Thomassen, Anushka Singh, Sahar Shekoohi","doi":"10.1007/s11916-025-01412-0","DOIUrl":"https://doi.org/10.1007/s11916-025-01412-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are widely prescribed for mental health disorders. These medications, however, are linked to increased bleeding risks related to inhibition of serotonin reuptake, which impairs platelet aggregation. The present investigation explores the pharmacodynamics of antidepressants, clinical evidence of bleeding complications, and strategies to manage these risks.</p><p><strong>Recent findings: </strong>While SSRIs and SNRIs pose the highest risk, tricyclic and atypical antidepressants show comparatively lower bleeding incidences. The concomitant use of anticoagulants, NSAIDs, or antiplatelet agents significantly amplifies bleeding risk. Current guidelines stress individualized risk assessment, alternative drug selection, and preventive measures, such as gastroprotective agents. Future research may offer novel approaches to mitigate bleeding while maintaining therapeutic efficacy, ensuring the safety of antidepressants in clinical practices.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"97"},"PeriodicalIF":3.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486818","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}
Vinicius Tieppo Francio, Logan Leavitt, Christopher Radlicz, Benjamin Gill, Dawood Sayed
{"title":"Lumbar Radiofrequency Ablation (LRFA)- Myths and Facts: A Narrative Review of the Literature.","authors":"Vinicius Tieppo Francio, Logan Leavitt, Christopher Radlicz, Benjamin Gill, Dawood Sayed","doi":"10.1007/s11916-025-01413-z","DOIUrl":"https://doi.org/10.1007/s11916-025-01413-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lumbar radiofrequency ablation (LRFA) is an interventional procedure that utilizes thermal energy to selectively ablate the lumbar medial branch nerves (LMBN) to provide relief from facet-mediated chronic axial low back pain. While LRFA is widely performed, considerable variability exists in its technical execution. This review aims to synthesize the current literature on key device- and procedure-related factors that influence radiofrequency lesioning and to clarify common misconceptions regarding LRFA.</p><p><strong>Recent findings: </strong>Emerging evidence suggests that several device-related parameters-including cannula and needle size, active tip length, temperature settings, lesioning duration, and needle angulation-affect lesion size and clinical outcomes. However, the impact of adjunctive steroid administration on lesion characteristics and therapeutic efficacy remains inconclusive. Furthermore, while some concerns have been raised regarding the potential for LRFA to accelerate spinal degeneration, definitive evidence is lacking. There is, however, a plausible association between LRFA and multifidus atrophy. The use of motor testing prior to ablation is warranted. Current data support the safety of LRFA in patients with posterior spinal instrumentation and implantable devices. Device- and procedure-specific variables may significantly influence LRFA lesion characteristics and clinical outcomes. While the safety profile of LRFA is generally favorable, potential complications exist, underscoring the need for a nuanced understanding of optimal procedural techniques. Despite its widespread adoption, misconceptions persist regarding optimal approaches, safety considerations, and determinants of efficacy. This review critically evaluates the existing literature to address these controversies and provide an evidence-based perspective on LRFA.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"98"},"PeriodicalIF":3.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486819","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}
Alan D Kaye, Gabrielle Cassagne, Brennan M Abbott, Alexandra M Dubuisson, Jasmine J Fagan, Isabella Indovina, Deniz Gungor, Anusha Kallurkar, Adam M Kaye, Sahar Shekoohi
{"title":"Emerging Clinical Roles of Gabapentin and Adverse Effects, Including Weight Gain, Obesity, Depression, Suicidal Thoughts and Increased Risk of Opioid-Related Overdose and Respiratory Depression: A Narrative Review.","authors":"Alan D Kaye, Gabrielle Cassagne, Brennan M Abbott, Alexandra M Dubuisson, Jasmine J Fagan, Isabella Indovina, Deniz Gungor, Anusha Kallurkar, Adam M Kaye, Sahar Shekoohi","doi":"10.1007/s11916-025-01410-2","DOIUrl":"10.1007/s11916-025-01410-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gabapentin, introduced in the 1990s as an anticonvulsant and anti-epileptic drug, has become a cornerstone treatment for various neurological and pain-related conditions. Its approved uses include seizure disorders, postherpetic neuralgia, and restless leg syndrome, while off-label applications commonly include diabetic neuropathy, fibromyalgia, post-traumatic stress disorder, and insomnia. The efficacy of gabapentin stems from its ability to modulate voltage-gated calcium channels, reducing excitatory neurotransmitter release in the central nervous system. However, its pharmacological versatility is accompanied by significant risks, including weight gain and combination additive and/or synergistic opioid-related respiratory depression.</p><p><strong>Recent findings: </strong>Weight gain, affecting up to 25% of patients, is primarily attributed to secondary effects such as altered gastrointestinal function and peripheral edema. This adverse effect can negatively impact treatment adherence, especially in patients with chronic conditions requiring long-term therapy. Patients with preexisting metabolic disorders face heightened risks, necessitating strategies like dietary counseling and tailored treatment adjustments to mitigate weight gain. In multimodal pain management, gabapentin mediated additive and/or synergistic effects with opioids enable reduced opioid doses but increase the risk of respiratory depression and overdose. These dose-dependent interactions amplify sedative effects, particularly in vulnerable populations such as the elderly. To optimize therapeutic benefits while minimizing risks, healthcare providers must adopt individualized treatment plans, carefully adjust dosages, and educate patients. Further research is essential to better understand mechanisms of action, improve safety profiles, and develop prescribing practices that balance efficacy with reduced adverse outcomes.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"95"},"PeriodicalIF":3.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334361","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}
{"title":"Low Dose Naltrexone In The Management Of Chronic Pain Syndrome: A Meta-Analysis Of Randomized Controlled Clinical Trials.","authors":"Naveen Chandrashekar Hegde, Archana Mishra, Divya V, Rituparna Maiti, Debasish Hota, Anand Srinivasan","doi":"10.1007/s11916-025-01411-1","DOIUrl":"10.1007/s11916-025-01411-1","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pain conditions are among the leading causes of years lost to disability. Low Dose Naltrexone (LDN) has anti-inflammatory and immunomodulatory properties. LDN, by blocking Toll-Like Receptors (TLR), prevents central sensitization and conversion of acute pain state to a state of chronic pain. This meta-analysis compared LDN's effectiveness in chronic pain syndromes based on published randomized trials.</p><p><strong>Method: </strong>Seven studies were included after a systematic search and screening from PubMed, Embase, Scopus, Cochrane, and clinical trial registries. The efficacy outcome analyzed was the standardized mean difference (SMD), the Cohen's d, of change in pain scores between LDN and the comparator drugs using the random-effect model. Subgroup analyses by condition type and comparator were performed to analyze the effect of LDN. Adverse events were evaluated using incidence rate ratio(IRR), publication bias by funnel plot, risk of bias by Cochrane Risk of Bias tool version 2.0, and certainty of evidence by GRADE evaluation.</p><p><strong>Results: </strong>LDN did not show a significant difference in pain response compared to control groups [d = -0.11 (95%CI -0.96 to 0.74); P = 0.31]. In fibromyalgia, LDN had improvement compared to placebo [d = -0.34 (95%CI -0.62 to -0.06); P = 0.0186]. Against active comparators, LDN had no difference [d = 0.67 (95% CI -4.69 to 6.02); P = 0.35]. Adverse events were increased with LDN compared to placebo [IRR = 1.4 (95% CI 1.12 to 1.75); P = 0.0026] but comparable to active comparators [IRR = 0.55 (95% CI 0.04 to 7.31); P = 0.65].</p><p><strong>Conclusion: </strong>LDN is better than placebo in fibromyalgia pain management, and LDN is similar to active controls in chronic pain management.</p><p><strong>Prospero registration number: </strong>CRD42024511451.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"96"},"PeriodicalIF":3.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334362","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}
Elika D Javaheri, Christopher Wie, Stephen Covington, Lopa Misra, Scott Pew, Omar Viswanath, John Freeman, Jillian Maloney
{"title":"Adverse Effects Associated With High-Dose Ketamine Infusions For Refractory Pain And Psychiatric Conditions.","authors":"Elika D Javaheri, Christopher Wie, Stephen Covington, Lopa Misra, Scott Pew, Omar Viswanath, John Freeman, Jillian Maloney","doi":"10.1007/s11916-025-01408-w","DOIUrl":"https://doi.org/10.1007/s11916-025-01408-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>As higher doses of ketamine are being used in numerous medical conditions such as Complex Regional Pain Syndrome (CRPS), it is critical to examine common adverse effects (AEs) explicitly associated with high doses of ketamine (HDK).</p><p><strong>Recent findings: </strong>HDK is often associated with psychiatric symptoms such as agitation, anxiety, and sleep disturbances. Psychiatric effects have been documented in various methods of administration of HDK, including oral, intravenous, and intranasal formulations. Emesis is a common AE of HDK and is more prevalent at higher ketamine doses. Hepatotoxicity is common after HDK, is dose-dependent, and is usually transient. HDK-induced uropathy is another potential AE. When monitored appropriately, HDK administered in a hospital setting appears safe; practitioners should be mindful that certain AEs of HDK are likely dose-dependent.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"93"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327650","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}
Elizabeth Roux, Alan D Kaye, Shivam S Shah, Sahar Shekoohi, David Hao
{"title":"Trialing Strategies Prior to Intrathecal Drug Delivery in Cancer-Related Pain: A Narrative Review.","authors":"Elizabeth Roux, Alan D Kaye, Shivam S Shah, Sahar Shekoohi, David Hao","doi":"10.1007/s11916-025-01409-9","DOIUrl":"10.1007/s11916-025-01409-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cancer-related pain poses a significant clinical challenge, especially in advanced stages where systemic analgesic therapies become insufficient or intolerable. Intrathecal drug delivery systems (IDDS) offer targeted pain control while minimizing systemic exposure. However, the optimal trialing approach before permanent IDDS implantation remains contentious. This narrative review examines literature on IDDS trialing strategies in cancer pain management. A comprehensive search was conducted of PubMed, MEDLINE, and Embase databases and identified studies published up to January 2025. The review included prospective and retrospective studies, randomized controlled trials, cohort studies, and case series on trialing techniques, clinical outcomes, safety, tolerability, and efficacy. Key strateghies assessed include single-shot intrathecal bolus, multiple intrathecal boluses, continuous epidural infusion, and continuous intrathecal infusion. The review found significant variability in trialing practices, with limited high-quality comparative data to support standardized protocols. Trial success criteria varied widely, encompassing pain reduction, side effects, and patient-reported outcomes.</p><p><strong>Recent findings: </strong>The studies described a range of trialing strategies with varying durations, opioid dosages, and criteria for success. However, due to the lack of direct comparisons between these approaches, it is difficult to draw clear conclusions about the relative effectiveness of continuous intrathecal, continuous epidural, and bolus-based trials. Some institutions bypassed trialing, prioritizing symptom relief over procedural risks.</p><p><strong>Conclusion: </strong>This review highlights the need for individualized trialing strategies based on patient status, institutional preferences, and clinician expertise. Given the variability in current practices, further research is needed to establish evidence-based guidelines and optimize clinical decision-making.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"94"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334363","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}
Rahib K Islam, Brynne E Tynes, Victoria T Tong, Anton Pelto, Matthew Bratton, Kazi N Islam, Richard D Urman, Shahab Ahmadzadeh, Harish Siddaiah, Ross Rieger, Jeffrey Sterritt, Sahar Shekoohi, Alan D Kaye
{"title":"Persistent Opioid Use Following Major Orthopedic Surgery.","authors":"Rahib K Islam, Brynne E Tynes, Victoria T Tong, Anton Pelto, Matthew Bratton, Kazi N Islam, Richard D Urman, Shahab Ahmadzadeh, Harish Siddaiah, Ross Rieger, Jeffrey Sterritt, Sahar Shekoohi, Alan D Kaye","doi":"10.1007/s11916-025-01404-0","DOIUrl":"https://doi.org/10.1007/s11916-025-01404-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review addresses the growing public health concern of persistent opioid use following major orthopedic surgery. It aims to identify and analyze the critical factors that contribute to the transition from acute to persistent opioid consumption in this context.</p><p><strong>Recent findings: </strong>Patient-related characteristics, including pre-existing conditions and prior substance use, are critical predictors of prolonged opioid use. Additionally, surgery-related factors such as the type and duration of procedures complicate postoperative pain management. The prevalence of persistent opioid use after surgery remains high despite the emergence of effective Enhanced Recovery After Surgery protocols and patient education initiatives. Multimodal analgesia is highlighted as a vital strategy for reducing the risk of long-term opioid dependency. Persistent opioid use after orthopedic surgery poses significant challenges, including increased risks of physical and mental health complications, the development of opioid use disorder, and a substantial economic burden on healthcare systems. Targeted interventions and continuous research are essential to mitigate these risks, reduce long-term opioid dependency, and improve overall patient outcomes.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"92"},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175757","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}
{"title":"Cluster Headache in Children: Current Status, Diagnostic and Treatment Challenges and Future.","authors":"Hong Yang, WeiHong Liu, QiuYang Zou, DeJiang Li","doi":"10.1007/s11916-025-01403-1","DOIUrl":"10.1007/s11916-025-01403-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to summarize the current understanding of cluster headaches (CH) in children, focusing on epidemiology, pathophysiology, clinical characteristics, diagnostic challenges, treatment strategies, and future research directions.</p><p><strong>Recent findings: </strong>Cluster headaches in children are infrequent, with an incidence that appears to be significantly lower than that observed in adults, highlighting the need for more comprehensive studies. Pediatric patients often present with atypical symptoms, such as shorter pain duration and less pronounced autonomic features, leading to frequent misdiagnosis or delayed diagnosis. The hypothalamus plays a central role in the pathophysiology of CH, involving circadian rhythm disturbances, trigeminal nerve-vascular activation, and autonomic dysfunction. High-flow oxygen and triptan medications are effective for acute treatment in adults, but their safety and efficacy in children require further validation. Preventive treatments, such as verapamil, are used cautiously in pediatric patients, with close monitoring for side effects. Non-pharmacological interventions, including lifestyle adjustments and psychological support, are critical for long-term management. Cluster headaches in children are a rare but debilitating condition that poses significant diagnostic and therapeutic challenges. Current diagnostic criteria, primarily based on adult data, may not fully capture the unique clinical features of pediatric patients, leading to misdiagnosis or missed diagnosis. Treatment strategies are largely extrapolated from adult studies, with limited evidence-based data for children. Future research should focus on improving diagnostic criteria, exploring pediatric-specific pathophysiological mechanisms, and validating safe and effective treatment options. Early identification and intervention are essential to improving the quality of life and long-term outcomes for pediatric patients.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"91"},"PeriodicalIF":3.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152793","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}
Marco Mercieri, Matteo Luigi Giuseppe Leoni, Alessia Naccarato, Omar Viswanath, Samah Said Al Sarmi, Giustino Varrassi, Marco Cascella, Roberto Arcioni
{"title":"Prognostic Value of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Profiles in Predicting Outcomes of Occipital Nerve Stimulation for Refractory Chronic Migraine: A Retrospective Bias-Corrected Multivariable Analysis.","authors":"Marco Mercieri, Matteo Luigi Giuseppe Leoni, Alessia Naccarato, Omar Viswanath, Samah Said Al Sarmi, Giustino Varrassi, Marco Cascella, Roberto Arcioni","doi":"10.1007/s11916-025-01401-3","DOIUrl":"10.1007/s11916-025-01401-3","url":null,"abstract":"<p><strong>Background: </strong>Refractory chronic migraine (rCM) is characterized by debilitating headaches that do not respond adequately to conventional medical treatments, leaving patients severely disabled. In these rare cases, central cervical spinal cord stimulation or occipital nerve stimulation (ONS) may offer a potential therapeutic option. However, these techniques are not without risks, lack clear scientific evidence, and impose a significant economic burden. Therefore, it is crucial to identify parameters that can assist physicians in selecting appropriate candidates for implantation. This study aimed to investigate the role of psychological profiles in predicting outcomes for ONS in rCM patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on rCM patients treated with ONS at a second-level neuromodulation university facility. These patients were refractory to conventional medical treatments, including onabotulinumtoxin-A injections (monoclonal antibodies targeting CGRP were not yet available). The NRS for migraine intensity, the number of monthly migraine attacks, and drug consumption were assessed at 6-month and 12-month follow-ups post-implant. Psychological profiles were evaluated prior to OCN using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A multivariable logistic regression model was developed to predict ONS outcomes, incorporating MMPI-2 as a covariate. The model's accuracy and performance were assessed through non-parametric bootstrap, calibration, and discrimination analyses.</p><p><strong>Results: </strong>Twenty-three rCM patients were analysed. ONS was able to significantly reduce the pain intensity, the number of headache attacks per month, and drug consumption compared to pre-treatment levels at both 6- and 12-month follow-ups. The final multivariable logistic model at 12 months showed that the MMPI-2 Depression score was independently and negatively associated with favourable outcomes following ONS (optimism-adjusted OR 0.52, 95% CI 0.21-0.77, p = 0.03). The ROC curve indicated high model sensitivity (AUC: 0.96, 95% CI: 0.88-0.98), and the calibration plot revealed a good fit, with some improvement needed in mid-range predicted probabilities.</p><p><strong>Conclusion: </strong>ONS significantly reduced pain intensity, headache frequency, and drug use at the 12-month follow-up compared to pre-treatment levels. The MMPI-2 Depression score was an independent predictor of ONS failure, highlighting the importance of comprehensive psychological assessments in patient selection for ONS.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"90"},"PeriodicalIF":3.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144112","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}