Current Pain and Headache Reports最新文献

{"title":"Efficacy of Intra-Articular Platelet-Rich Plasma Injections in Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis.","authors":"Alan D Kaye, Jolie A Boullion, Mariem Abdelsalam, Melanie A Green, Angela Nguyen, Ellie M MacDonald, Mehdi Dastgah, Corrado Ballaera, Shahab Ahmadzadeh, George Mychaskiw Ii, Sahar Shekoohi, Christopher L Robinson","doi":"10.1007/s11916-024-01320-9","DOIUrl":"10.1007/s11916-024-01320-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Knee osteoarthritis (OA) is a gradual deterioration of articular cartilage characterized by pain and physical dysfunction. Although analgesic pharmacological agents are the first-line treatment for knee OA, they are not effective for all patients. In this study, we evaluate the efficacy of an intra-articular injection treatment using platelet-rich plasma (PRP) in reducing pain and improving functional ability.</p><p><strong>Recent findings: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review and meta-analysis (SR/MA) provides an updated overview for the role of PRP in knee OA treatment. Ten articles, published between 2016 and 2023, met the inclusion criteria and compared PRP treatment to a placebo control at six-month follow-up. A total of 9,409 potential studies were identified from a review of four different databases: PubMed (n = 4595), Cochrane (n = 4252), VHL (n = 112), and OpenSigle (n = 450). After the titles and abstracts and inclusion and exclusion criteria were considered, a total of 10 studies were analyzed. Although a significant improvement among PRP-treated groups in some studies was found, there was variability such as where the aforementioned scores appeared to worsen and some only demonstrated trends. Overall, PRP may be a promising treatment for symptomatic knee OA. However, further research is necessary to determine the efficacy of PRP in treating knee OA, with specific considerations for times at follow-up, frequency and dosage of injections, and comorbidities, which were unaccounted for in this SR/MA.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"13"},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932249","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":"Influence of Obesity, Race and Gender on Radiation Exposure for Epidural Procedures.","authors":"Laxmaiah Manchikanti, Alan D Kaye, Mahendra R Sanapati, Vidyasagar Pampati, Sahar Shekoohi, Joshua A Hirsch","doi":"10.1007/s11916-024-01327-2","DOIUrl":"10.1007/s11916-024-01327-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>This retrospective, case controlled, comparative evaluation review of radiation exposure during epidural procedures in interventional pain management assessed variations in radiation exposure based on obesity, race, and gender.</p><p><strong>Recent findings: </strong>Numerous publications have shown increasing radiation exposure based on body mass index (BMI). However, the influence of race and gender have not been studied. A recent study assessing radiation exposure for epidural procedures with mandated 2 views, compared to a single view or optional 2 views, showed an increase in exposure time of 21%, with radiation dose increases of 133%. The influence of obesity, has been studied, but potential influence of race, and gender on radiation exposure for epidural procedures has not been studied. The present review shows a prevalence of total obesity with BMI of 30 or above of 50.9%, with a higher prevalence in patients below the age of 45, female gender, and African Americans. Mean fluoroscopy time and dose increased significantly from 6.9 s to 0.925 milligray (mGy) for all epidural procedures for those who are underweight to 10.0 s and 6.7 mGy for those with Class 3 obesity above BMI of 40. However, after adjusting for body mass index, no significant differences were noted in race for both fluoroscopy time and radiation dose across multiple epidural procedures. Fluoroscopy time and radiation dose increased in males in cervical interlaminar and lumbar transforaminal procedures.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"12"},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932848","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":"Sexual Dimorphism in Migraine. Focus on Mitochondria.","authors":"Michal Fila, Lukasz Przyslo, Marcin Derwich, Elzbieta Pawlowska, Janusz Blasiak","doi":"10.1007/s11916-024-01317-4","DOIUrl":"https://doi.org/10.1007/s11916-024-01317-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Migraine prevalence in females is up to 3 times higher than in males and females show higher frequency, longer duration, and increased severity of headache attacks, but the reason for that difference is not known. This narrative review presents the main aspects of sex dimorphism in migraine prevalence and discusses the role of sex-related differences in mitochondrial homeostasis in that dimorphism. The gender dimension is also shortly addressed.</p><p><strong>Recent findings: </strong>The imbalance between energy production and demand in the brain susceptible to migraine is an important element of migraine pathogenesis. Mitochondria are the main energy source in the brain and mitochondrial impairment is reported in both migraine patients and animal models of human migraine. However, it is not known whether the observed changes are consequences of primary disturbance of mitochondrial homeostasis or are secondary to the migraine-affected hyperexcitable brain. Sex hormones regulate mitochondrial homeostasis, and several reports suggest that the female hormones may act protectively against mitochondrial impairment, contributing to more effective energy production in females, which may be utilized in the mechanisms responsible for migraine progression. Migraine is characterized by several comorbidities that are characterized by sex dimorphism in their prevalence and impairments in mitochondrial functions. Mitochondria may play a major role in sexual dimorphism in migraine through the involvement in energy production, the dependence on sex hormones, and the involvement in sex-dependent comorbidities. Studies on the role of mitochondria in sex dimorphism in migraine may contribute to precise personal therapeutic strategies.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"11"},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932779","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":"Ethical Considerations in the Use of Artificial Intelligence in Pain Medicine.","authors":"Marco Cascella, Mohammed Naveed Shariff, Omar Viswanath, Matteo Luigi Giuseppe Leoni, Giustino Varrassi","doi":"10.1007/s11916-024-01330-7","DOIUrl":"https://doi.org/10.1007/s11916-024-01330-7","url":null,"abstract":"<p><p>Although the integration of artificial intelligence (AI) into medicine and healthcare holds transformative potential, significant challenges must be necessarily addressed. This technological innovation requires a commitment to ethical principles. Key issues concern autonomy, reliability, and bias. Furthermore, AI development must guarantee rigorous data privacy and security standards. Effective AI implementation demands thorough validation, transparency, and the involvement of multidisciplinary teams to oversee ethical considerations. These issues also concern pain medicine where careful assessment of subjective experiences and individualized care are crucial. Notably, in this rapidly evolving technological landscape, politics plays a pivotal role in establishing rules and regulations. Regulatory frameworks, such as the European Union's Artificial Intelligence Act and recent U.S. executive orders, provide essential guidelines for the responsible use of AI. This step is crucial for balancing innovation with rigorous ethical standards, ultimately leveraging the incredible AI's benefits. As the field evolves rapidly and concepts like algorethics and data ethics become more widespread, the scientific community is increasingly recognizing the need for specialists in this area, such as AI Ethics Specialists.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"10"},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932525","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":"Efficacy of Transcutaneous Electrical Nerve Stimulation in Management of Cancer Pain: a Meta Analysis.","authors":"Alan D Kaye, Kaitlyn E Allen, Shivam S Shah, Summer A Smith, Taylor R Plaisance, Amy E Brouillette, Dani'elle J Despanie, Tayler D Payton, Ross Rieger, Naina Singh, Shahab Ahmadzadeh, Sonja Gennuso, Sahar Shekoohi","doi":"10.1007/s11916-024-01337-0","DOIUrl":"10.1007/s11916-024-01337-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile.</p><p><strong>Recent findings: </strong>A systematic search for eligible studies from PubMed, Google Scholar, Cochrane, and Embase was performed. The present investigation elucidated any significant differences between change in numeric rating scale of average and maximum pain scores between a TENS and non-TENS group. A nonsignificant difference was reported between TENS and non-TENS, with a mean difference of - 0.393 (95% CI - 1.780, 0.993; P = 0.578). For change in maximum pain reported, a nonsignificant difference was also found, with a mean difference of 0.128 (95% CI - 1.158, 1.414; P = 0.845).</p><p><strong>Conclusion: </strong>Related to various limitations of this meta-analysis, no definitive conclusions could be concluded regarding efficacy of TENS in the treatment of cancer or chemotherapy-related pain. Additional randomized primary studies with standardized treatment protocols and pain measurements are needed for future meta-analysis and recommendations for clinical practice.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"5"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928692","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":"Efficacy, Indications, and Safety of Intrathecal Baclofen Pump: A Narrative Review.","authors":"Alan D Kaye, Se Yun Cheon, Morgan H Roque, Caroline Gibbs, Karlee R Mott, Alex M Wandler, Syeda T Munir, Junyu Lin, Shahab Ahmadzadeh, Harish Siddaiah, Sarah H Myers, Kristin Nicole Bembenick, Sahar Shekoohi","doi":"10.1007/s11916-024-01310-x","DOIUrl":"10.1007/s11916-024-01310-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Baclofen, a muscle relaxant that reduces the release of excitatory neurotransmitters in the pre-synaptic neurons stimulating inhibitory neuronal signals in post-synaptic neurons, has been around for over 5 decades. Baclofen is used primarily for spasticity and since 1982, has had a role as an intrathecal agent. In the present investigation, we review research trends and updates on safety and efficacy of intrathecal baclofen (ITB) pumps.</p><p><strong>Recent findings: </strong>Evaluation of safety and efficacy of ITB pumps in spasticity and relevant conditions was evaluated in the present investigation. PubMed and ClinicalTrials.gov were used to review appropriate related literature. Commonly reported aspects regarding ITB efficacy include comparison with alternative treatments, maintenance efficacy, and long-term outcomes. Safety considerations and risk factors associated with ITB include postoperative complications, withdrawal symptoms, tolerance issues, long-term management, and contraindications. In summary, the present investigation reveals that ITB is efficacious for muscle spasticity; however, efforts should be made to enhance safety and efficacy by providing improved best practice guidelines on maximum safe dose with the least amount of risk with individualized treatments.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"9"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928707","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":"Efficacy of Immunotherapy for Complex Regional Pain Syndrome: A Narrative Review.","authors":"Alan D Kaye, Angela Nguyen, Jolie Boullion, Mary-Elizabeth F Blue, Dillion W Hopson Allen, Rucha A Kelkar, Aya Mouhaffel, Andrew T Ro, Shahab Ahmadzadeh, Sahar Shekoohi, Christopher L Robinson","doi":"10.1007/s11916-024-01329-0","DOIUrl":"10.1007/s11916-024-01329-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportional pain typically affecting an extremity. Management of CRPS is centered around specific symptomatology, which tends to be a combination of autonomic dysfunction, nociceptive sensitization, chronic inflammation, and/or motor dysfunction. Targeting the autoimmune component of CRPS provides a way to both symptomatically treat as well as minimize progression of CRPS.</p><p><strong>Recent findings: </strong>Understanding the physiology of CRPS and strategies for treating and targeting immunophysiology behind CRPS allows examination of the efficacy of such treatments. IL-1 receptor antagonism, glucocorticoid administration, IVIG infusion, and TNFα inhibitors are treatments that target the immune response and decrease inflammation, thereby reducing pain and enhancing function in patients with CRPS. IL-1 receptor antagonism is thought to inhibit the inflammatory effects of IL-1, a key player in the inflammatory process in CRPS. Glucocorticoids have anti-inflammatory properties and can reduce inflammation in affected tissues. IVIG infusion involves administering immunoglobulins, which may modulate the immune response and reduce autoimmunity in CRPS. TNFα inhibitors block the action of TNFα, a pro-inflammatory cytokine associated with CRPS development. These therapies are further discussed at the extent of mechanism of action as well as advantages and limitations of such therapies. The present investigation provides a detailed summary of the mechanism of action, advantages, and limitations of novel immunomodulatory therapies and recent studies and trials that investigated these therapies for CRPS. Future studies are warranted related to the role of immunomodulators in the treatment of CRPS.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"4"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928687","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":"Efficacy of Transversus Thoracic Plane Block for Pain Management in Cardiac Surgeries.","authors":"Alan D Kaye, Carliss M Sampognaro, Shivam S Shah, Drake P Duplechin, Grant C Curry, Victoria A Rodriguez, Shahab Ahmadzadeh, Jibin Mathew, Zachary R Palowsky, Sahar Shekoohi","doi":"10.1007/s11916-024-01357-w","DOIUrl":"https://doi.org/10.1007/s11916-024-01357-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Effective pain management in cardiac surgery presents as a continuous challenge related to the intensity of postoperative pain and reliance on opioid therapy. The dependance of opioid-based therapies is concerning, as these therapies carry risk future addiction and potential severe side effects. The transversus thoracic plane block (TTPB) has emerged as a promising regional anesthesia technique that blocks the anterior branches of the intercostal nerves in the chest wall, potentially providing improved analgesia for cardiac surgery patients. The present investigation evaluates the efficacy of TTPB in reducing opioid consumption, decreasing postoperative pain scores, and enhancing recovery outcomes in patients undergoing cardiac surgeries.</p><p><strong>Recent findings: </strong>Data from randomized controlled trials revealed that TTPB significantly reduced 24-hour opioid consumption, increased the time to first rescue analgesic, and lowered Visual Analog Scale (VAS) pain scores both at rest and with movement, particularly in the first 12 h post-surgery. Additional benefits include fewer opioid-related side effects, such as nausea and pruritus, and reductions in intensive care unit (ICU) length of stay. Studies also suggested that TTPB can support earlier extubation and accelerated recovery, contributing to higher patient satisfaction and overall improved postoperative outcomes.</p><p><strong>Conclusion: </strong>Despite these promising results, challenges in technique standardization and limited long-term data are still obstacles that prevent widespread adoption. Achieving consistent TTPB efficacy requires technical precision in ultrasound guidance, and there is little research on its effectiveness across diverse populations, such as pediatric and high-risk cardiac patients. Addressing these gaps through multi-center, long-term studies could help establish TTPB as a prominent pain management strategy in cardiac surgery to minimize opioid dependence and enhance patient comfort and recovery.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"8"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928701","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":"Rhomboid Intercostal and Subserratus Plane Block for Acute Pain Management after Abdominal Surgeries: A Narrative Review.","authors":"Alan D Kaye, Alex V Hollander, Brianna N Rogers, Austin S Thomassen, Jolie A Boullion, Gianni H Ly, Bradley Dorius, Hirni Patel, Shahab Ahmadzadeh, Sahar Shekoohi, Christopher L Robinson","doi":"10.1007/s11916-024-01356-x","DOIUrl":"https://doi.org/10.1007/s11916-024-01356-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>The rhomboid intercostal and subserratus plane (RISS) block is an effective, safer alternative for managing postoperative acute pain following abdominal surgeries. The RISS block offers several advantages over traditional approaches, including reduced incidence of puncture-related complications, lower rates of systemic opioid consumption, and more consistent analgesic coverage of lower thoracic dermatomes.</p><p><strong>Recent findings: </strong>Despite a favorable safety profile, the RISS block carries potential risks, such as pneumothorax and local anesthetic systemic toxicity, particularly when long-acting anesthetics such as bupivacaine or ropivacaine are used. Careful administration with ultrasound guidance minimizes these risks, enhancing patient safety. Compared to epidural and paravertebral blocks, RISS is associated with fewer instances of nerve damage, hemodynamic instability, and bleeding. Research suggests that RISS not only improves postoperative pain scores, but also extends duration of analgesic effect, reducing total opioid use by nearly 40%.</p><p><strong>Conclusion: </strong>Future directions include clinical trials to validate efficacy across diverse patient populations, comparative studies with other regional blocks, and evaluations of long-term outcomes. Expanding our understanding of RISS block application may help advance multimodal pain management protocols, underscoring potential to improve recovery, reduce opioid dependency, and elevate patient quality of life in postoperative settings.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"7"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928708","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":"Traumatic Brain Injury in Intimate Partner Violence.","authors":"Cali C M Callaway, Judy H Ch'ang","doi":"10.1007/s11916-024-01324-5","DOIUrl":"https://doi.org/10.1007/s11916-024-01324-5","url":null,"abstract":"<p><strong>Purposeof review: </strong>In this article, we explore the current literature on traumatic brain injury (TBI) in survivors of intimate partner violence (IPV) and evaluate the barriers to studying this vulnerable population.</p><p><strong>Recent findings: </strong>Research on TBI and IPV is limited by multiple factors including mistrust of the healthcare system by survivors, lack of awareness by community advocates, and insufficient funding by public entities. As such, most investigations are small population, retrospective, and qualitative. Quantitative research addressing the scope of TBI in IPV found reported rates ranging from 19 to 100% of survivors experiencing neurological injury at the hands of a violent partner. The principals of trauma-informed healthcare should guide both neurological care for survivors as well as future studies on TBI and IPV, with an emphasis on community-based participatory research.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":"29 1","pages":"6"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928709","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}