Current Pain and Headache Reports最新文献

{"title":"Review of Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain.","authors":"Laxmaiah Manchikanti, Alaa Abd-Elsayed, Alan D Kaye, Mahendra R Sanapati, Nebojsa Nick Knezevic, Vivekanand Manocha, Joshua A Hirsch","doi":"10.1007/s11916-025-01397-w","DOIUrl":"https://doi.org/10.1007/s11916-025-01397-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article assesses the current evidence and guidelines on peripheral nerve stimulation (PNS) and provides recommendations for its use in managing moderate to severe chronic pain.</p><p><strong>Recent findings: </strong>PNS has been utilized for over 50 years in the treatment of chronic pain. However, since 2015, the Food and Drug Administration (FDA) has approved percutaneously implanted PNS leads and neurostimulators, providing a minimally invasive, non-opioid alternative for managing persistent and refractory chronic pain. The American Society of Interventional Pain Physicians (ASIPP) has established evidence-based consensus guidelines for the clinical use of PNS systems in addressing chronic pain. ASIPP guidelines performed extensive evidence synthesis, including systematic reviews, randomized controlled trials (RCTs), and observational studies using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria or certainty of evidence, and qualitative synthesis based on the best available evidence. The evidence level and recommendations showed fair evidence with moderate strength of recommendation for implantable PNS systems following a trial or selective lumbar medial branch stimulation without a trial and for temporary PNS for 60 days. This review offers a comprehensive analysis of peripheral neuropathic pain as a cause of chronic, intractable, function-limiting, and high-impact pain. It discusses the diagnosis of peripheral nerve and neuropathic pain, evidence evaluation and synthesis, medical necessity criteria, patient education, and clinical recommendations. The goal is to enhance patient outcomes by integrating PNS technology into clinical practice.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"89"},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133327","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":"The Efficacy of Magnesium Sulfate in Perioperative Multimodal Analgesia.","authors":"Andrea A Lopez-Ruiz, Lindsey P Trinchet, Steven Morozowich, Lopa Misra","doi":"10.1007/s11916-025-01395-y","DOIUrl":"10.1007/s11916-025-01395-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients frequently report inadequate pain management following surgical procedures. Physicians must often prescribe analgesics, notably opioids, as a means of providing pain relief. Due to the addictive nature of this class of medications, improper post-surgical pain management propagates the United States opioid crisis. The administration of multimodal analgesia is a strategy implemented to decrease long-term outpatient prescription opioid use. Magnesium sulfate has recently attracted interest for its potential use as an adjunct in multimodal analgesia in addition to its other diverse uses in medicine. This review aims to highlight the most recent data validating the use of magnesium sulfate in perioperative multimodal analgesia.</p><p><strong>Recent findings: </strong>A narrative review was conducted using PubMed and Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations. Articles that examined the effects of intravenous magnesium sulfate on perioperative pain and/or recovery from 1946 to present were considered. 15 articles met the inclusion criteria and discussed the use of magnesium sulfate as an adjunct in multimodal analgesia across the following surgical specialties: cardiac surgery, general surgery, gynecologic surgery, orthopedic surgery, urologic surgery, neurosurgery, and otolaryngology surgery. The results of the cited studies indicate that magnesium sulfate is a well-tolerated multimodal analgesic agent that reduces postoperative pain, reduces opioid consumption, and increases patient satisfaction.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"88"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111770","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":"Notalgia Paresthetica: An Updated Review of Pathophysiology, Diagnosis, and Treatment Approaches.","authors":"Parker Nguyen, Seema Parikh, Caitlyn Ko, Grace Nguyen, Alan D Kaye, Ivan Urits, Jamal Hasoon","doi":"10.1007/s11916-025-01402-2","DOIUrl":"10.1007/s11916-025-01402-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia, most commonly affecting the upper back. Despite being a relatively common condition, it remains underdiagnosed and frequently mismanaged. This review covers the pathophysiology, clinical presentation, diagnostic evaluation, and treatment approaches for NP.</p><p><strong>Recent findings: </strong>Recent studies support a multifactorial pathogenesis for NP, with compression or irritation of the dorsal rami of thoracic spinal nerves playing a central role. Imaging and electromyography have shown variable utility in diagnosis, while histological findings often lack specificity. Although there is no universally effective treatment, advances in topical medications, systemic oral medications, and interventional therapies may be considered. Physical therapy and postural correction remain important non-pharmacologic strategies. NP is a neuropathic condition with evolving diagnostic and therapeutic approaches. Early recognition, multidisciplinary evaluation, and individualized treatment plans are essential for improving patient outcomes. Further research is needed to establish standardized diagnostic criteria and long-term treatment efficacy.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"87"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112735","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":"The Application of Artificial Intelligence to Enhance Spinal Cord Stimulation Efficacy for Chronic Pain Management: Current Evidence and Future Directions.","authors":"John V Prunskis, Tadas Masys, Stephen T Pyles, Alaa Abd-Elsayed, Timothy R Deer, Douglas P Beall, Ramis Gheith, Sheel Patel, Dawood Sayed, Hadi Moten, Todd Hagle, Chadi I Yaacoub, Leon Anijar, Mayank Gupta, Terri Dallas-Prunskis","doi":"10.1007/s11916-025-01400-4","DOIUrl":"10.1007/s11916-025-01400-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic pain significantly impacts quality of life for millions globally, with spinal cord stimulation (SCS) as an established treatment for refractory chronic pain. However, traditional SCS therapies face limitations including inconsistent patient outcomes, challenges in patient selection, and difficulties in sustaining therapeutic efficacy. This review examines how artificial intelligence (AI) can enhance the efficacy and personalization of SCS therapy by optimizing patient selection, refining stimulation parameters, and enabling real-time adaptive adjustments.</p><p><strong>Recent findings: </strong>Recent advances demonstrate that integrating AI with SCS significantly improves patient outcomes through predictive modeling for patient selection and real-time adaptive stimulation. Predictive analytics utilizing machine learning algorithms have successfully identified patient cohorts most likely to benefit from SCS therapy, enhancing response rates and reducing suboptimal outcomes. Closed-loop AI systems incorporating physiological feedback, such as evoked compound action potentials (ECAPs), dynamically optimize stimulation parameters, resulting in sustained pain relief, decreased programming burden, and improved device longevity. Despite these promising results, critical challenges persist, particularly related to data standardization, ethical considerations, and regulatory compliance. AI holds transformative potential for spinal cord stimulation, offering increased precision, personalization, and therapeutic efficiency in managing chronic pain. Although early results are encouraging, comprehensive clinical validation and multidisciplinary collaboration remain essential. Addressing ethical, regulatory, and data management challenges will be critical for widespread adoption of AI-enhanced SCS therapies in routine clinical practice.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"85"},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111498","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":"Burden of Emotional Stress in Chronic Pain Care: A Wake-up Call for the Care Team.","authors":"Grace Kao, Jason Parmar, Saba Javed","doi":"10.1007/s11916-025-01399-8","DOIUrl":"10.1007/s11916-025-01399-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic pain management presents significant emotional challenges for clinicians due to the complex and prolonged nature of the conditions they treat. This editorial aims to explore how emotional stressors, such as compassion fatigue, emotional labor, and ethical dilemmas, impact both clinician well-being and patient outcomes. It also emphasizes the need for effective strategies to address clinician stress and enhance overall care quality.</p><p><strong>Recent findings: </strong>Healthcare professionals working in chronic pain management are particularly susceptible to emotional stress, which can lead to burnout, job dissatisfaction, and poor mental health. Research highlights the prevalence of stressors such as compassion fatigue, emotional labor, heavy workloads, and time pressures. These stressors contribute to a decline in clinician well-being, which in turn negatively impacts patient care quality. Many studies also point to the interconnection between clinician burnout and compromised patient outcomes, emphasizing the importance of addressing these issues. Addressing the emotional stress faced by clinicians in chronic pain care is crucial for improving both clinician satisfaction and patient outcomes. Effective strategies, including mindfulness practices, self-compassion, wellness programs, and flexible work schedules, have been identified as potential solutions to mitigate burnout and enhance clinician resilience. By implementing these strategies, healthcare systems can improve clinician well-being and ultimately provide higher-quality care to patients.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"86"},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112734","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":"Pecto-Intercostal Fascial Plane Block for Pain Management after Cardiothoracic Surgery.","authors":"Alan D Kaye, Christopher A Vuong, Alison M Hawkins, Macie A Serio, Drew R Dethloff, Alex V Hollander, Shahab Ahmadzadeh, Kimberly L Skidmore, Zachary R Palowsky, Sahar Shekoohi","doi":"10.1007/s11916-025-01398-9","DOIUrl":"https://doi.org/10.1007/s11916-025-01398-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac surgery is associated with significant postoperative pain. Compared to traditional analgesics, regional nerve blocks target specific anatomical areas to improve analgesia and to reduce postoperative opioid consumption.</p><p><strong>Recent findings: </strong>Pecto-intercostal fascial plane block (PIFB) is a novel analgesic technique that involves ultrasound-guided injection of anesthetic between pectoralis major and external intercostal muscles. Since PIFB is a relatively underexplored method of analgesia, to date, few manuscripts have reviewed and synthesized current literature related to PIFB.</p><p><strong>Conclusion: </strong>The present investigation focuses on relevant anatomy and physiology behind the PIFB, compares this novel technique with other traditional and novel methods of analgesia, and describes indications and contraindications for PIFB in cardiac surgery and other surgeries.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"84"},"PeriodicalIF":3.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081536","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":"Epidural Contrast Patterns and Clinical Implications: An Educational Review.","authors":"Giuliano Lo Bianco, Barnabas T Shiferaw, Max Y Jin, Alaa Abd-Elsayed","doi":"10.1007/s11916-025-01396-x","DOIUrl":"https://doi.org/10.1007/s11916-025-01396-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this educational review is to describe the contrast spread patterns that indicate accurate needle placement in the epidural space and spread patterns associated with erroneous needle insertion.</p><p><strong>Recent findings: </strong>Epidural injections are minimally invasive and commonly used for patients with acute and chronic back pain that does not respond to conservative management. Imaging with contrast is frequently used during this procedure to improve accuracy and reduce adverse events. Contrast spread patterns are an important tool that can help identify where the needle is placed and whether the placement is accurate. Despite this, there may be discrepancies in the interpretation of spread patterns which ultimately reduce the utility of contrast. Inaccurate needle placement may result in intrathecal/subarachnoid, subdural, fascial, or retrodural space of Okada injections. The correct interpretation of contrast spread patterns on imaging is crucial for confirming accurate epidural needle placement. Furthermore, understanding contrast patterns of improper needle placement can prevent adverse events that result from injection outside of the epidural space.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"83"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080704","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}

{"title":"Atypical Applications of Neuromodulation for Non-Painful Conditions.","authors":"Ashlyn Brown, Loc Lam, Billy Huh, Ryan S D'Souza, Saba Javed","doi":"10.1007/s11916-025-01389-w","DOIUrl":"https://doi.org/10.1007/s11916-025-01389-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"82"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004327","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":"The Ganglia of the Head and Neck: Clinical Relevance for the Interventional Pain Physician.","authors":"Paul W Millhouse, Robert W Bloom, Jason N Beckstrand, Matthew L McClure, Maxim S Eckmann, Kristofer J Feeko, Jeffrey J Mojica","doi":"10.1007/s11916-025-01387-y","DOIUrl":"https://doi.org/10.1007/s11916-025-01387-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"80"},"PeriodicalIF":3.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027225","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":"A Promising Route for Established Indications: A Systematic Review of Nebulized Ketamine in Pain.","authors":"Neveen A Kohaf, Tabia Imtiyaz Khan, Hamada Hamdy Elbana, Ro'a Azzam Hassouna, Mohamed Maher Abd Elfattah, Prashant Nasa, Sahar Shekoohi, Alan David Kaye, Islam Mohammad Shehata","doi":"10.1007/s11916-025-01394-z","DOIUrl":"https://doi.org/10.1007/s11916-025-01394-z","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>Nebulized ketamine in pain management included nine studies.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"81"},"PeriodicalIF":3.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055997","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}