Current pain and headache reports
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Curr Pain Headache Rep · Jan 2025
ReviewEfficacy of Immunotherapy for Complex Regional Pain Syndrome: A Narrative Review.
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. ⋯ 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.
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Curr Pain Headache Rep · Jan 2025
ReviewEfficacy of Transversus Thoracic Plane Block for Pain Management in Cardiac Surgeries.
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. ⋯ 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.
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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. ⋯ 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.
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Curr Pain Headache Rep · Jan 2025
ReviewSpinal Cord Stimulation for Low Back Pain: A Systematic Review.
Chronic low back pain (LBP) is a prevalent and debilitating condition affecting millions worldwide. Among emerging interventions, spinal cord stimulation (SCS) has gained attention as a potential alternative for managing chronic LBP, particularly when alternative approaches fail to provide adequate relief. ⋯ This systematic review focuses on both residual pain levels and ability to perform daily tasks after treatment with SCS. The present investigation includes a systematic search for studies from PubMed, Google Scholar, and Cochrane, and Embase. Sources were eligible for inclusion in the review if they were published from 2010 to present (May 1, 2024). 8 studies involving a total of 1,172 patients were evaluated. This systematic review demonstrated that SCS is superior to conventional medical management (CMM) for both short and long-term pain relief, functionality, psychological well-being, and opioid dependency. Furthermore, newer SCS approaches, such as high frequency (HF), differential target multiplexed (DTM), and multiphase SCS all demonstrated improved efficacy over traditional SCS for pain relief and functionality scores. Adverse event rates for all trials were low and represent the safety of SCS treatments. The present investigation provides insight into the capabilities of both traditional SCS and HF SCS, DTM SCS, and multiphase SCS as compared to baseline pain and functionality as well as conventional medical management (CMM). This review grants physicians a broader picture of the applicability of SCS, its safety profile, and the opportunities it offers for pain reduction and functionality over CMM.
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Curr Pain Headache Rep · Jan 2025
ReviewThe Dual Burden of Post-Traumatic Headache: Health Consequences and Economic Impact.
To review the history and impact and burden of post-traumatic headache (PTH). ⋯ PTH is a prevalent headache disorder that many healthcare providers encounter. Unlike more extensively researched primary headache disorders like migraines, PTH has not been as thoroughly studied, and there are fewer treatments specifically tested for it. A significant obstacle to conducting detailed population studies on PTH is the need for the headache to occur shortly after a traumatic event. Despite these challenges, PTH is recognized as a disabling condition with considerable effects on quality of life and economic impact. PTH is a distressing and debilitating condition. Although there have been efforts to evaluate its personal and economic effects, these studies are limited compared to the more extensive research conducted on other primary headache disorders. More comprehensive epidemiological studies are needed.