{"title":"Nervus Intermedius Neuralgia.","authors":"Jennifer Robblee","doi":"10.1007/s11916-024-01335-2","DOIUrl":"https://doi.org/10.1007/s11916-024-01335-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review discusses the diagnosis and treatment of nervus intermedius neuralgia (NIN) and identifies gaps in the literature.</p><p><strong>Recent findings: </strong>The nervus intermedius is a branch of the facial nerve. NIN presents as a rare neuralgia of this nerve, causing deep ear pain, which may radiate to the auditory canal, auricle, mastoid, soft palate, temple, and angle of the jaw. NIN most commonly presents in middle-aged women; neurovascular compression involving the anterior inferior cerebellar artery is the most common etiology described. Despite its diagnostic criteria in the International Classification of Headache Disorders, 3rd edition (ICHD-3), NIN may lack a trigger zone and may manifest as achy or neuralgiform pain instead of the typically described sharp or shooting pain. Like trigeminal neuralgia, NIN can be divided into classic, idiopathic, secondary, or painful neuropathy. Although there are no established guidelines for treating NIN, many possible treatments are used. Experience from treating trigeminal neuralgia suggests that carbamazepine or oxcarbazepine can be considered first-line. Patients with medically refractory NIN may benefit from neurosurgery referral for microvascular decompression or nerve sectioning. More research is needed to elucidate the range of clinical presentations in patients with NIN. Current data are limited and suggest that symptoms may diverge from the ICHD-3 diagnostic criteria. Although various treatments have been attempted, they often lack solid evidence and are typically derived from approaches used for other neuralgias. Proper diagnosis is crucial, particularly when considering surgical referral, due to the potential overlap of NIN with other neuralgias affecting the head and neck.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"32"},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025543","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}
David S Jevotovsky, Whitman Oehlermarx, Tommy Chen, Christopher Chiodo Ortiz, Annie Liu, Sidharth Sahni, Jason L Kessler, Joseph J Poli, Richard Lau
{"title":"Weathering the Pain: Ambient Temperature's Role in Chronic Pain Syndromes.","authors":"David S Jevotovsky, Whitman Oehlermarx, Tommy Chen, Christopher Chiodo Ortiz, Annie Liu, Sidharth Sahni, Jason L Kessler, Joseph J Poli, Richard Lau","doi":"10.1007/s11916-025-01361-8","DOIUrl":"10.1007/s11916-025-01361-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic pain is highly prevalent and involves a complex interaction of sensory, emotional, and cognitive processes, significantly influenced by ambient temperature. Despite advances in pain management, many patients continue to experience inadequate pain relief. This review aims to consolidate and critically evaluate the current evidence on the impact of ambient temperature on chronic pain conditions such as fibromyalgia (FM), multiple sclerosis (MS), complex regional pain syndrome (CRPS), and osteoarthritis (OA).</p><p><strong>Recent findings: </strong>Patients with FM often report pain exacerbations due to temperature changes, with studies showing lower thresholds for heat and cold-induced pain compared to healthy controls. In MS, the Uhthoff phenomenon, characterized by temperature-induced neurological deterioration, underscores the significance of ambient temperature in pain management. CRPS patients exhibit heightened pain sensitivity to temperature changes, with both warm and cold stimuli potentially aggravating symptoms. OA patients frequently report increased pain and rigidity associated with lower temperatures and higher humidity. Understanding the mechanisms through which temperature influences pain can enhance pain management strategies. This review highlights the need for further research to elucidate these mechanisms and develop targeted interventions, ultimately improving the quality of life for individuals with chronic pain conditions.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"31"},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025471","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}
Rodney A Gabriel, Brian H Park, Chun-Nan Hsu, Alvaro A Macias
{"title":"A Review of Leveraging Artificial Intelligence to Predict Persistent Postoperative Opioid Use and Opioid Use Disorder and its Ethical Considerations.","authors":"Rodney A Gabriel, Brian H Park, Chun-Nan Hsu, Alvaro A Macias","doi":"10.1007/s11916-024-01319-2","DOIUrl":"10.1007/s11916-024-01319-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Artificial intelligence (AI) offers a new frontier for aiding in the management of both acute and chronic pain, which may potentially transform opioid prescribing practices and addiction prevention strategies. In this review paper, not only do we discuss some of the current literature around predicting various opioid-related outcomes, but we also briefly point out the next steps to improve trustworthiness of these AI models prior to real-time use in clinical workflow.</p><p><strong>Recent findings: </strong>Machine learning-based predictive models for identifying risk for persistent postoperative opioid use have been reported for spine surgery, knee arthroplasty, hip arthroplasty, arthroscopic joint surgery, outpatient surgery, and mixed surgical populations. Several machine learning-based models have been described to predict an individual's propensity for opioid use disorder and opioid overdose. Natural language processing and large language model approaches have been described to detect opioid use disorder and persistent postsurgical opioid use from clinical notes. AI holds significant promise in enhancing the management of acute and chronic opioids, which may offer tools to help optimize dosing, predict addiction risks, and personalize pain management strategies. By harnessing the power of AI, healthcare providers can potentially improve patient outcomes, reduce the burden of opioid addiction, and contribute to solving the opioid crisis.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"30"},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025516","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}
Saurabh Kataria, Made Agus Mahendra Inggas, Utsav Patel, Jeremiah Hilkiah Wijaya, Kevin Yabut, Muhammad Abubakar Ayub, Pankti Maniyar, Nihar Upadhyay, Beso Davitashvili, Jayshil Patel, Siddhi Shah, Tawfiq Turjman, Hisham Turjman, Sahar Shekoohi, Alan D Kaye
{"title":"A Systematic Review and Meta-Analysis of Stem Cell Therapies for Pain in Diabetic Neuropathy, Osteoarthritis, and Spinal Cord Injuries.","authors":"Saurabh Kataria, Made Agus Mahendra Inggas, Utsav Patel, Jeremiah Hilkiah Wijaya, Kevin Yabut, Muhammad Abubakar Ayub, Pankti Maniyar, Nihar Upadhyay, Beso Davitashvili, Jayshil Patel, Siddhi Shah, Tawfiq Turjman, Hisham Turjman, Sahar Shekoohi, Alan D Kaye","doi":"10.1007/s11916-024-01331-6","DOIUrl":"https://doi.org/10.1007/s11916-024-01331-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>The use of stem cell therapy is a rapidly evolving and progressing frontier of science that has been used to treat illnesses such as malignancies, immunodeficiencies, and metabolic syndromes. This review aims to give an overview of the use of stem cell therapy in the treatment of pain caused by diabetic neuropathy, osteoarthritis, and other spinal cord pathologies.</p><p><strong>Recent findings: </strong>Pain is defined as a generalized or localized feeling of distress related to a physical or emotional stimulus and can be caused by a multitude of pathologies. The field of pain management has explored many strategies such as gene therapies, neuromodulation, platelet-rich plasma, and numerous pharmacotherapies. The approach to the delivery of these strategies has varied, with the method of stem cell therapy delivery being the focus of this present investigation. In addition, we combined several different studies to analyze the effects of stem cell therapies and improvement in pain scores quantified by the visual analog scale (VAS). The overall results showed a mean difference of -2.58, suggesting that the stem cell treatment group had a lower VAS score at 6 months compared to the control group. The use of different types of stem cells, such as pluripotent and mesenchymal stem cells, play a critical role in the care of cases suffering from pain. Effective delivery methods are evolving and can transform treatment options in the future, for which large cohort studies are warranted.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"29"},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015659","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}
Isabella Henderson, Ronnie Elsaadany, Gabriel Chan, Vikram Bajaj, Diana Duarte, Sadie Goodman, Michael Grunstein, Nehal P Vadhan, Robert A Duarte
{"title":"Exploring the Potential of Psychedelics in the Treatment of Headache Disorders: Clinical Considerations and Exploratory Insights.","authors":"Isabella Henderson, Ronnie Elsaadany, Gabriel Chan, Vikram Bajaj, Diana Duarte, Sadie Goodman, Michael Grunstein, Nehal P Vadhan, Robert A Duarte","doi":"10.1007/s11916-024-01321-8","DOIUrl":"https://doi.org/10.1007/s11916-024-01321-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Exploration of the potential of serotonergic psychedelic drugs, such as psilocybin and LSD, as potential treatments for headache disorders. This review addresses the need for well-informed physician guidelines and discusses mechanisms, safety, and efficacy of these treatments. Further research, including the consideration of combination with psychotherapy, is needed.</p><p><strong>Recent findings: </strong>Psychedelics demonstrate promising outcomes as treatments for headache disorders. Recent findings indicated that some patients who underwent brief periods of treatment with psychedelics experienced a reduction in headache attack frequency, severity, or duration. When prescription medications are ineffective at treating headache disorders, or are habit-forming, patients often turn to alternative options. There is anecdotal evidence that psychedelic drugs like LSD and psilocybin can effectively treat and prevent pain in patients with headache disorders, such as migraine or cluster headache. It is vital that physicians treating patients who self-treat with psychedelics be well-informed about the mechanisms and their effects to best advise their patients and coordinate their care well. This is a review assessing the literature on the mechanisms, safety, and efficacy of psychedelic drugs as a headache management intervention. We believe there is evidence that may support further investigation into the clinical use of psychedelic medications to treat cluster headache and migraine, including the consideration of use in conjunction with other interventions like cognitive behavioral therapy or acceptance and commitment training.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"28"},"PeriodicalIF":3.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015660","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}
Rune H Christensen, Haidar M Al-Khazali, Afrim Iljazi, Edina Szabo, Håkan Ashina
{"title":"Functional Magnetic Resonance Imaging of Post-Traumatic Headache: A Systematic Review.","authors":"Rune H Christensen, Haidar M Al-Khazali, Afrim Iljazi, Edina Szabo, Håkan Ashina","doi":"10.1007/s11916-024-01351-2","DOIUrl":"https://doi.org/10.1007/s11916-024-01351-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>To evaluate existing functional magnetic resonance imaging (fMRI) studies on post-traumatic headache (PTH) following traumatic brain injury (TBI).</p><p><strong>Recent findings: </strong>We conducted a systematic search of PubMed and Embase databases from inception to February 1, 2024. Eligible fMRI studies were required to include adult participants diagnosed with acute or persistent PTH post-TBI in accordance with any edition of the International Classification of Headache Disorders. We identified five eligible fMRI studies: two on acute PTH and three on persistent PTH. These studies assessed resting-state functional connectivity involving comparisons with one or more of the following groups: people with migraine, those with mild TBI but no PTH, and healthy controls. In acute PTH, studies focused exclusively on functional connectivity between the periaqueductal gray or hypothalamus and other brain regions. In persistent PTH, evidence of altered functional connectivity was identified primarily within cingulate, sensorimotor, and visual regions, indicating a hypersensitivity to sensory stimuli in PTH. Despite these insights, the fMRI data remains sparse and is limited by inconsistent results and small samples. The paucity of fMRI studies on PTH limits our understanding of its neurobiological basis. The available evidence suggests that alterations in functional connectivity occur within brain areas involved in emotional and sensory discriminative aspects of pain processing. However, inconsistent results and small sample sizes underscore a critical need for larger, more rigorous fMRI studies. Future studies should also consider using task-based fMRI to investigate possible hypersensitivity to different sensory stimuli in PTH after TBI.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"27"},"PeriodicalIF":3.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985472","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, Brynne E Tynes, Coplen D Johnson, Bryan C Strong, Brennan M Abbott, Jelena Vučenović, Omar Viswanath, Charles J Fox, Shahab Ahmadzadeh, Sam N Amarasinghe, Saurabh Kataria, Sahar Shekoohi
{"title":"Ketamine Infusion for Complex Regional Pain Syndrome Treatment: A Narrative Review.","authors":"Alan D Kaye, Brynne E Tynes, Coplen D Johnson, Bryan C Strong, Brennan M Abbott, Jelena Vučenović, Omar Viswanath, Charles J Fox, Shahab Ahmadzadeh, Sam N Amarasinghe, Saurabh Kataria, Sahar Shekoohi","doi":"10.1007/s11916-025-01360-9","DOIUrl":"https://doi.org/10.1007/s11916-025-01360-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Complex Regional Pain Syndrome (CRPS) is a neuropathic pain disorder characterized by pain disproportionate to the inciting event that is constant for an extended duration. Numerous treatment options for this condition have been explored with unsatisfactory results in many cases. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist typically used as an anesthetic and analgesic, presents a promising potential treatment for CRPS in patients who fail to respond to traditional therapies.</p><p><strong>Recent findings: </strong>Numerous studies report significant improvement in the degree of pain, mobility of extremities, and other parameters after ketamine infusion in patients with CRPS. Although adverse effects were not reported often, some subjects experienced nausea, vomiting, headache or psychotropic or psychomimetic symptoms which could be mitigated with cessation of the drug. Although more research is needed to determine optimal dosing and duration, ketamine seems to be a safe and effective treatment for refractory cases of CRPS.</p><p><strong>Conclusion: </strong>The present investigation summarizes existing knowledge and research surrounding ketamine infusions for CRPS to provide a well-rounded depiction of advantages and disadvantages for physicians who may be considering it for patients with this challenging and complex condition.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"26"},"PeriodicalIF":3.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980597","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}
Ramana K Naidu, Leonardo Kapural, Sean Li, Caitlin Tourjé, Joseph Rutledge, David Dickerson, Timothy R Lubenow
{"title":"A Review of the Prospera Spinal Cord Stimulation System with Multiphase Stimulation and Proactive Care.","authors":"Ramana K Naidu, Leonardo Kapural, Sean Li, Caitlin Tourjé, Joseph Rutledge, David Dickerson, Timothy R Lubenow","doi":"10.1007/s11916-024-01318-3","DOIUrl":"10.1007/s11916-024-01318-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to describe the development and key features of the Prospera™ Spinal Cord Stimulation (SCS) System, as well as the clinical evidence supporting its use. Prospera delivers therapy using a proprietary multiphase stimulation paradigm and is the first SCS system to offer proactive care through automatic, objective, daily, remote device monitoring and remote programming capabilities.</p><p><strong>Recent findings: </strong>Results from the recently published BENEFIT-02 trial support the short-term safety and efficacy of multiphase stimulation in patients with chronic pain. BENEFIT-03 is an ongoing, multicenter, single-arm study with 24-month follow-up; interim analyses suggest that multiphase therapy is safe and effective and that patients and clinicians have positive experiences with remote device management. Preliminary evidence suggests that the Prospera SCS System represents an opportunity to improve patient care by combining an effective multiphase stimulation paradigm with an efficient proactive care model.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"25"},"PeriodicalIF":3.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973047","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":"Pain Management Services Can Be a Cost-Effective Option over Surgery for the Treatment of Chronic Pain.","authors":"Alaa Abd-Elsayed, Max Y Jin","doi":"10.1007/s11916-025-01359-2","DOIUrl":"https://doi.org/10.1007/s11916-025-01359-2","url":null,"abstract":"<p><strong>Purpose of commentary: </strong>The number of facilities and physicians that offer pain management services has grown significantly since the 1970s. Despite the rise in prevalence of individuals with chronic pain during that time, interventional pain physicians remain underutilized. One reason why this may be the case is a large number of patients are referred directly to surgical specialists prior to being seen by an interventional pain physician. With the rising cost of healthcare, a shift away from surgical specialists and towards pain specialists as part of a multidisciplinary care team may help reduce the cost of care for chronic pain patients.</p><p><strong>Recent findings: </strong>Through comparing the costs for patients with various types of chronic back pain, it was found that those who were treated by a pain physician rather than a surgeon saved up to over $8000 USD. Despite the cost benefits, it is important to recognize that healthcare disparities still exist which prevent patients from accessing interventional pain physicians. These disparities include patient location and insurance coverage. Overall, the treatment paradigm should start with non-invasive treatments, followed by minimally invasive procedures, with surgical interventions reserved as a last resort for when less invasive measures fail. Early incorporation of a multidisciplinary care team that includes chronic pain management services is critical for providing appropriate and cost-effective patient care.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"24"},"PeriodicalIF":3.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973048","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}
Christopher Wie, Tyler Dunn, Jeannie Sperry, Natalie Strand, Aziza Dawodu, John Freeman, Stephen Covington, Scott Pew, Lopa Misra, Jillian Maloney
{"title":"Cognitive Behavioral Therapy and Biofeedback.","authors":"Christopher Wie, Tyler Dunn, Jeannie Sperry, Natalie Strand, Aziza Dawodu, John Freeman, Stephen Covington, Scott Pew, Lopa Misra, Jillian Maloney","doi":"10.1007/s11916-024-01348-x","DOIUrl":"10.1007/s11916-024-01348-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to understand the foundations of cognitive behavioral therapy (CBT) and biofeedback, their indications for therapy, and evidence-based support.</p><p><strong>Recent findings: </strong>Both CBT and biofeedback are noninvasive therapy options for patients who are suffering from a variety of chronic pain conditions, including chronic low back pain, headache, fibromyalgia, and temporomandibular disorder (TMD). CBT has been shown to be effective in treating multiple chronic pain conditions.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"23"},"PeriodicalIF":3.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958330","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}