Current pain and headache reports
-
Curr Pain Headache Rep · Jan 2025
ReviewAn Algorithmic Overview of Advanced Pain Therapies: A Narrative Review.
Quickly referenceable, streamlined, algorithmic approaches for advanced pain management are lacking for patients, trainees, non-pain specialists, and interventional specialists. This manuscript aims to address this gap by proposing a comprehensive, evidence-based algorithm for managing neuropathic, nociceptive, and cancer-associated pain. Such an algorithm is crucial for pain medicine education, offering a structured approach for patient care refractory to conservative management. ⋯ A comprehensive literary review with PubMed and regulatory documents from the United States Food and Drug Administration were searched for a variety of interventions. Pain syndromes were categorized into nociceptive and neuropathic pain, and an algorithm was constructed. Serving as an educational tool for patients, trainees, and non-pain specialists, and as an accessible reference for pain specialists, this algorithm bridges knowledge gaps, promotes interdisciplinary collaboration, and streamlines the learning curve for new practitioners. The strength of this algorithm lies in integrating extensive clinical data, emphasizing the latest clinical evidence, and providing a structured decision-making pathway.
-
Curr Pain Headache Rep · Jan 2025
ReviewThe Potential of Spinal Cord Stimulation in Treating Spinal Cord Injury.
In the United States, spinal cord injuries affect approximately 18,000 individuals annually, most commonly resulting from mechanical trauma. The consequent paraplegia severely impairs motor functions, creating an urgent need for innovative therapeutic strategies that extend beyond traditional rehabilitation and pharmacotherapy. This review assesses the effectiveness of Spinal Cord Stimulation (SCS) in improving motor function in patients with spinal cord injuries, with a particular focus on paraplegia. SCS, an emerging intervention, has gained attention for its ability to activate paralyzed muscles and enhance the effects of physical therapy. ⋯ Our review demonstrates that SCS can lead to significant functional improvements when optimally combined with rehabilitation strategies. The success of SCS depends largely on the precise placement of electrodes with individualized parameters and the integration of stimulation with intensive physical training. This review underscores the considerable potential of SCS to improve motor outcomes in individuals with paraplegia caused by spinal cord injury, emphasizing the need for further research to optimize SCS parameters, electrode placement, and its integration with rehabilitation protocols. This review highlights the potential of SCS as a therapeutic intervention for improving motor function in individuals with paraplegia caused by spinal cord injuries.
-
Curr Pain Headache Rep · Jan 2025
ReviewHow Painful are Lumbar Hernias? A Comprehensive Review of Intervention Strategies.
Low back pain (LBP) is considered an important issue of public health, with annual prevalence estimations almost achieving 60% of the worldwide population. Available treatments have a limited impact on this condition, although they allow to alleviate pain and recover the patient's quality of life. This review aims to go deeper on the understanding of this condition, providing an updated, brief, and concise whole picture of this common musculoskeletal problem. ⋯ Scientific literature, current clinical practice and clinical guidelines are summarized, focusing on three key aspects: classification of LBP, diagnosis of symptomatic lumbar hernia, and intervention strategies (conservative, surgical, and pharmacological). Benefits and drawbacks of each approach are tackled. The most appropriate intervention for LBP suffers is hitherto a conservative treatment based on therapeutic exercise, manual therapy and therapeutic education on the neurophysiological mechanisms of pain. Whether patient's condition is severe, does not improve with conservative treatment, or presents neurological symptoms, then surgical intervention is recommended. The efficiency of pharmaceutical approaches for LBP lacks high-quality evidence-based studies, and still needs to be in-depth explored. Current treatments help to improve symptoms and patient's perspectives. However, further research in the field of herniated discs is essential in order to seek a therapy that could definitely cure or eliminate this condition.
-
Curr Pain Headache Rep · Jan 2025
ReviewNutraceuticals and Headache 2024: Riboflavin, Coenzyme Q10, Feverfew, Magnesium, Melatonin, and Butterbur.
Nutraceuticals are not regulated by the US Food and Drug Administration, so a careful literature review is essential to make clinical decisions. Riboflavin or vitamin B2 can be recommended for migraine prevention in adults, but pediatric use is not proven. Adverse events are minimal. ⋯ However, purity of US sold melatonin is very poor. Butterbur or petasites preparations have strong evidence for efficacy and concern for hepatotoxicity. Please see the US National Center for Complementary and Integrative Health/NIH online site https://www.nccih.nih.gov/health/butterbur for up-to-date recommendations on whether to use this nutraceutical.
-
This review discusses the diagnosis and treatment of nervus intermedius neuralgia (NIN) and identifies gaps in the literature. ⋯ 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.