Current pain and headache reports
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The objective of this review is to describe recent updates in the understanding of dialysis headache. These recent findings will be placed in a historical context that reviews the clinical features, classification, epidemiology, pathophysiology, and treatment of dialysis headache. ⋯ There is something intrinsic to the dialysis procedure itself that leads to headaches in susceptible individuals. Proposed mechanisms include fluid and electrolyte shifts, blood pressure parameters, the release of neuroinflammatory particles, and the mechanics of the dialysis procedure. Recent findings quantify the potential roles of CGRP and substance P in dialysis headache pathophysiology. Advances in dialysis techniques, like online hemodiafiltration, have also been found to vastly reduce headache incidence. Caffeine, which has anecdotally been considered potentially therapeutic for dialysis headache, may not actually provide benefit. Dialysis headache significantly impairs quality of life in many individuals on hemodialysis, a procedure which is itself already burdensome. A clearer understanding of the pathophysiology of dialysis headache has the potential to drive therapeutic advances.
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Curr Pain Headache Rep · Jan 2025
ReviewPost-laparoscopic Shoulder Pain Management: A Narrative Review.
Post-laparoscopic shoulder pain (PLSP) can slow patient recovery and extend hospital stays, making its management crucial for patients undergoing laparoscopic surgery. Current consensus guidelines say little about how to prevent or manage PLSP. In this context, a multimodal approach to PLSP management that maybe extend beyond the pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to analgesics. In this review, we explore the potential causes of PLSP. Additionally, by searching relevant databases and reviewing existing literature, we provide a comprehensive summary of current PLSP management strategies excluding analgesics. ⋯ A total of 30 articles were reviewed. The review identified a number of different treatments for PLSP, including trendelenburg position, discharge of residual gas, pulmonary recruitment manoeuvre, low-pressure pneumoperitoneum and phrenic nerve block, among others. However, the inconsistencies in the study designs resulted in disparate conclusions. While the current studies provide valuable insights, there is a clear need for further research in this area.
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Curr Pain Headache Rep · Jan 2025
ReviewCryoneurolysis for Post Operative Pain Following Chest Surgery: Contemporary Evidence and Future Directions.
Management of acute and chronic pain following surgery remains a critical patient management challenge, with poor pain management associated with negative patient satisfaction, increased opioid consumption and a high incidence of adverse events. Chest surgery specifically carries a high incidence of significant early and chronic post operative pain. The high incidence, prolonged duration of pain, and adverse effects associated with chronic opioid analgesia, has given rise to the need for non-opioid pain management strategies. ⋯ While cryoneurolysis was first developed over fifty years ago, its utilization was limited by technical implementation challenges and limitations in identifying target structures percutaneously. Advances both in cryoneurolysis delivery devices as well as ultrasound have reinvigorated interest in the technique, with recent studies highlighting the advantages of cryoneurolysis, including its favorable side effect profile, long duration of efficacy and relative technical simplicity. The purpose of this review is to examine techniques for cryoneurolysis, and explore recent evidence for safety and efficacy of the technique following different surgical procedures.
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Curr Pain Headache Rep · Jan 2025
ReviewStructural Magnetic Resonance Imaging of Post-Traumatic Headache: A Systematic Review.
To evaluate the available studies on structural magnetic resonance imaging (MRI) of post-traumatic headache (PTH). ⋯ A systematic search of PubMed and Embase databases (from inception to February 1, 2024) identified nine relevant structural MRI studies. These studies included adult participants diagnosed with acute or persistent PTH in adherence with any edition of the International Classification of Headache Disorders. Eight studies focused on PTH attributed to mild traumatic brain injury (TBI), while one examined PTH after whiplash injury. The comparison groups consisted of healthy individuals, people with mild TBI (without PTH), and/or individuals with migraine. The eligible studies assessed brain morphometry (n = 7), both cortical morphometry and diffusion tensor imaging (n = 1), or used structural brain images for machine learning (n = 1). The main findings indicated alterations in brain regions involved in affective pain processing and cognitive functions. However, the results were largely incongruent, likely due to small sample sizes and methodologic issues. Structural MRI has shown alterations in the brains of people with PTH, particularly in regions responsible for affective pain processing, cognitive control, and visual processing. These findings align well with the clinical features commonly observed in PTH. Nevertheless, most findings were inconsistent across studies, highlighting the need for methodologic standardization and investigations with larger sample sizes.
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The purpose of this review is to provide the most recent update and summary on the consideration, benefits and application of regional anesthesia in the ICU setting, as it pertains to the management of perioperative pain. ⋯ Regional anesthesia and analgesia have become ubiquitous in the perioperative setting, with numerous indications and benefits. As integral part of the multimodal analgesia approach, various regional blocks have been increasingly utilized in critically ill patients. We focus this review on various regional techniques employed for critically ill patients after cardiac, thoracic, and major abdominal surgery, including neuraxial and novel truncal blocks. Effective pain management in critically ill patients poses many challenges and is extremely important. Regional anesthesia, in combination with other analgesia modalities, while still under-utilized, can help reduce acute perioperative pain, stress response, opioid use and related side effects and expedite recovery and improve clinical outcomes.