Current pain and headache reports
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Curr Pain Headache Rep · Jan 2025
ReviewDiagnosis and Management of Mild Traumatic Brain Injury (mTBI): A Comprehensive, Patient-centered Approach.
The purpose of this review is to provide an update regarding recent research and recommendations in the care of mild traumatic brain injury (mTBI). ⋯ New diagnostic criteria for mTBI have recently been developed by the American Congress of Rehabilitation Medicine through the Delphi method and this will help to standardize assessment, diagnosis, and treatment. Symptoms of mTBI are diverse and can sometimes become persistent. Treatment of mTBI should be patient-centered and may require subspeciality referral and coordinated, inter-disciplinary, or multi-disciplinary treatment.
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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
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 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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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.