Cannabis and Migraine: It ’s Complicated
AbstractPurpose of ReviewThe use of cannabis for the treatment of migraine has become an area of interest with the legalization of medical cannabis in the USA. Understanding the mechanisms of cannabinoids, available studies, and best clinical recommendations is crucial for headache providers to best serve patients.Recent FindingsPatients utilizing medical cannabis for migraine have reported improvement in migraine profile and common comorbidities. Reduction in prescription medication is also common, especially opioids. Side effects exist, with the majority being mild. Not enough data is available for specific dose recommen...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

Exercise in Treatment of Migraine Including Chronic Migraine
AbstractPurpose of ReviewWith this review, we aimed to investigate the effect of exercise on migraine and explored the possibility of exercise as a treatment option for migraine.Recent FindingsA close association of physical activity and exercise with migraine has been reported in clinical and population-based studies. Recent randomized controlled trials investigating the effect of aerobic exercise as a migraine-preventive treatment have revealed a notable improvement in migraine symptoms. Data on the effect of anaerobic exercise and exercise for flexibility, coordination, and relaxation on migraine are currently insuffici...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain
AbstractPurpose of ReviewThis is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain.Recent FindingsSeveral definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6  months in the pelvis, with an overwhelming majority ...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

Ketamine Use in the Surgical Patient: a Literature Review
AbstractPurpose of ReviewWhile ketamine is an established anesthetic, its role in the management of acute surgical pain is less certain. Therefore, a literature review is warranted to examine the role of ketamine in acute pain management.Recent FindingsThe use of ketamine appears to be most efficacious in larger procedures that lead to increased systemic inflammation or extensive tissue damage. In addition, ketamine seems to be most successful when administered consistently throughout a procedure, such as by an infusion instead of a single bolus, in order to have adequate dosing for an analgesic effect.SummaryTherefore, th...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

Diabetic Neuropathy: a Critical, Narrative Review of Published Data from 2019
AbstractPurpose of ReviewThis manuscript is a systematic, narrative review that compiles and describes all data available from 2019 related to epidemiologic, diagnostic, and therapeutic advances in diabetic neuropathy (DN).Recent FindingsEpidemiology of DN is discussed. Diagnostic modalities include predictive models, electrodiagnostics, imaging, and biomarkers. A majority of studies on the treatment of diabetic peripheral neuropathy (DPN) involve pharmacotherapy, but complementary and alternative medicine, exercise, modalities, psychological, interventional, and surgical options are also explored.SummaryDN is a highly pre...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

Posterior Reversible Encephalopathy Syndrome
AbstractPurpose of ReviewThis review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion.Recent FindingsCOVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1 &n...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

Tapentadol, Buprenorphine, and Levorphanol for the Treatment of Neuropathic Pain: a Systematic Review
The objective of this systematic review is to present the available evidence for the utilization of the atypical opioids tapentadol, buprenorphine, and levorphanol for the treatment of neuropathic pain.Recent FindingsIn total, 1619 articles were retrieved of which 10 studies were included. Of 5 included studies pertaining to tapentadol, 4 studies show tapentadol monotherapy to be effective for the treatment of diabetic peripheral neuropathy or chronic, radiating low back pain. Of the 3 studies included for buprenorphine, only one was a randomized controlled trial found not to have a statistically significant reduction in p...
Source: Current Pain and Headache Reports - February 25, 2021 Category: Neurology Source Type: research

Review of the Current State of Urine Drug Testing in Chronic Pain: Still Effective as a Clinical Tool and Curbing Abuse, or an Arcane Test?
AbstractPurpose of ReviewTherapeutic use, misuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain remain a major concern for physicians, the government, payers, and patients. The challenge remains finding effective diagnostic tools that can be clinically validated to eliminate or substantially reduce the abuse of controlled prescription drugs, while still assuring the proper treatment of those patients in pain. Urine drug testing still remains an important means of adherence monitoring, but questions arise as to its relevance and effectiveness. This review examines the role of UDT, determi...
Source: Current Pain and Headache Reports - February 17, 2021 Category: Neurology Source Type: research

A Comprehensive Review and Update of Post-surgical Cutaneous Nerve Entrapment
AbstractPurpose of ReviewThis is a comprehensive review of the literature regarding post-surgical cutaneous nerve entrapment, epidemiology, pathophysiology, and clinical presentation. It focuses mainly on nerve entrapment leading to chronic pain and the available therapies.Recent FindingsCutaneous nerve entrapment is not an uncommon result (up to 30% of patients) of surgery and could lead to significant, difficult to treat chronic pain. Untreated, entrapment can lead to neuropathy and damage to enervated structures and musculature, and significant morbidity and financial loss. Nerve entrapment is defined as pressure neurop...
Source: Current Pain and Headache Reports - February 5, 2021 Category: Neurology Source Type: research

Dexmedetomidine as an Adjunct for Regional Anesthetic Nerve Blocks
This article will review current evidence related to the use of dexmedetomidine as an adjuvant for regional anesthesia.Recent FindingsAdjuvants, frequently used during regional anesthesia, act synergistically with local anesthetics thus enhancing the quality of regional anesthesia while minimizing adverse effects. These adjuvants may be administered via different routes including topical, perineural, neuraxial, and systemic.SummaryRecent studies indicate that dexmedetomidine prolongs the duration of intravenous regional anesthesia, peripheral nerve blocks, and spinal analgesia. Controversy regarding potential neurotoxicity...
Source: Current Pain and Headache Reports - February 3, 2021 Category: Neurology Source Type: research

Comprehensive Review of Topical Analgesics for Chronic Pain
This article reviews the various topical analgesics, their mechanisms of action, and their efficacy.Recent FindingsStudies have found topical NSAIDs are useful in treating acute musculoskeletal pain syndromes (strains and sprains) and show some efficacy in treating hand and knee osteoarthritis (Derry et al. Cochrane Database Syst Rev 5:CD008609,2017). Topical capsaicin 8% has been shown to be efficacious in the treatment of postherpetic neuralgia, painful diabetic peripheral neuropathy, and HIV-neuropathy (Derry et al. Cochrane Database Syst Rev 1:CD007393,2017). Topical lidocaine has been widely studied and found to reduc...
Source: Current Pain and Headache Reports - February 3, 2021 Category: Neurology Source Type: research

Interventional Modalities to Treat Complex Regional Pain Syndrome
This article reviews the interventional treatments for pain resulting from CRPS.Recent FindingsSympathetic nerve blocks (stellate ganglion and lumbar sympathetic) are the first-line interventional treatment options for patients with CRPS of the upper and lower extremities, respectively. Fluoroscopic techniques for lumbar sympathetic blocks have not significantly changed throughout the years. However, both novel fluoroscopic and ultrasound approaches to stellate ganglion blockade have arisen. In addition, novel neuromodulation therapies to treat CRPS have been developed to include new waveforms with dorsal column stimulatio...
Source: Current Pain and Headache Reports - February 3, 2021 Category: Neurology Source Type: research

Neuromodulation in Treating Pelvic Pain
AbstractPurpose of ReviewChronic pelvic pain (CPP) is a complex condition that can be multifactorial, disabling, and difficult to treat. It is important to understand the various diagnoses and pathways that can be involved and have an understanding of the available treatment options.Recent FindingsThere is a complex innervation of the pelvic region which makes its treatment very challenging. There are pathophysiological similarities of CPP to disease states like complex regional pain syndrome and sympathetically driven pain.SummaryCPP is poorly understood and includes psychological, psychosocial, cultural, and economic inf...
Source: Current Pain and Headache Reports - February 3, 2021 Category: Neurology Source Type: research

Treatment and Management of Loin Pain Hematuria Syndrome
AbstractPurpose of ReviewLoin pain hematuria syndrome (LPHS) is rare and seldom diagnosed, yet it has a particularly significant impact on those affected. This is a review of the latest and seminal evidence of the pathophysiology and diagnosis of LPHS and presents the typical clinical presentation and treatment options available.Recent FindingsLPHS is typically found in young women with characteristic symptoms, including severe recurrent flank pain and gross or microscopic hematuria. The majority of patients will experience crippling pain for many years without effective therapy, often requiring frequent use of narcotic me...
Source: Current Pain and Headache Reports - January 25, 2021 Category: Neurology Source Type: research

CSF-Venous Fistula
AbstractPurpose of ReviewTo provide an update on recent developments in the understanding, diagnosis, and treatment of CSF-venous fistula (CVF).Recent FindingCVF is a recently recognized cause of spontaneous intracranial hypotension (SIH), an important secondary headache, in which an aberrant connection is formed between the spinal subarachnoid space and an adjacent spinal epidural vein permitting unregulated loss of CSF into the circulatory system. CVFs often occur without a concurrent epidural fluid collection; therefore, CVF should be considered as a potential etiology for patients with SIH symptomatology but without an...
Source: Current Pain and Headache Reports - January 21, 2021 Category: Neurology Source Type: research

Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers
AbstractPurpose of ReviewWith the widespread growth of ambulatory surgery centers (ASCs), the number and diversity of operations performed in the outpatient setting continue to increase. In parallel, there is an increase in the proportion of patients with a history of chronic opioid use and misuse undergoing elective surgery. Patients with such opioid tolerance present a unique challenge in the ambulatory setting, given their increased requirement for postoperative opioids. Guidelines for managing perioperative pain, anticipating postoperative opioid requirements and a discharge plan to wean off of opioids, are therefore n...
Source: Current Pain and Headache Reports - January 14, 2021 Category: Neurology Source Type: research

Recent Applications of Virtual Reality for the Management of Pain in Burn and Pediatric Patients
AbstractPurpose of ReviewVirtual reality, via integration of immersive visual and auditory modalities, offers an innovative approach to pain management. The purpose of this review is to investigate the clinical application of virutal reality  as an adjunct analgesic to standard of care, particularly in pediatric and burn patients.Recent FindingsAlthough relatively new, virtual reality has been successfully implemented in a wide range of clinical scenarios for educational, diagnostic, and therapeutic purposes. Most recent literature supports the use of this adjunct analgesic in reducing pain intensity for pediatric and...
Source: Current Pain and Headache Reports - January 14, 2021 Category: Neurology Source Type: research

Acupuncture for the Management of Low Back Pain
AbstractPurpose of ReviewThis evidence-based systematic review will focus on the use of acupuncture and its role in the treatment of low back pain to help better guide physicians in their practice. It will cover the background and the burden of low back pain and present the current options for treatment and weigh the evidence that is available to support acupuncture as a treatment modality for low back pain.Recent FindingsLow back pain (LBP), defined as a disorder of the lumbosacral spine and categorized as acute, subacute, or chronic, can be a debilitating condition for many patients. Chronic LBP is more typically defined...
Source: Current Pain and Headache Reports - January 14, 2021 Category: Neurology Source Type: research

Quantitative Sensory Testing to Predict Postoperative Pain
AbstractPurpose of ReviewWe  review the relevance of quantitative sensory testing (QST) in light of acute and chronic postoperative pain and associated challenges.Recent FindingsPredicting the occurrence of acute and chronic postoperative pain with QST can help identify patients at risk and allows proactive preventive management. Generally, central QST testing, such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), appear to be the most promising modalities for reliable prediction of postoperative pain by QST. Overall, QST testing has the best predictive value in patients undergoing orthopedic...
Source: Current Pain and Headache Reports - January 14, 2021 Category: Neurology Source Type: research

Brain Excitability in Tension-Type Headache: a Separate Entity from Migraine?
This study provided evidence that TTH and migraine differ in excitability profiles and the measurement of preactivatio n excitability was able to discriminate TTH from migraine.SummaryEarlier studies on brain excitability of TTH yielded negative findings or a common change shared with migraine. Future studies using strict diagnostic criteria to avoid the unwanted interference from migraine comorbidity may help decipher the “true” pathophysiology of TTH, which may pave the way to a TTH-specific brain signature and treatment. (Source: Current Pain and Headache Reports)
Source: Current Pain and Headache Reports - January 7, 2021 Category: Neurology Source Type: research

The Impact of Parental Migraine on Children
AbstractPurpose of ReviewThis review surveys our current understanding of the impact of parental migraine on children. Understanding the impact of migraine on others in a family unit is critical to describing the full burden of migraine and to developing psychosocial supportive interventions for patients and their families.Recent FindingsHaving a parent with migraine is associated with several early developmental features including infant colic. Adolescent children of parents with migraine self-report their parent ’s migraine interferes with school and activities and events. Further, migraine is perceived to impact t...
Source: Current Pain and Headache Reports - January 6, 2021 Category: Neurology Source Type: research

Review of Ilioinguinal Nerve Blocks for Ilioinguinal Neuralgia Post Hernia Surgery
AbstractPurpose of ReviewThe purpose of this review is to evaluate the current evidence on ultrasound-guided ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surgery.MethodsA literature search was performed to find all relevant case reports, case series, prospective or retrospective cohort studies, and randomized controlled trials (RCTs) where ultrasound-guided or landmark-based ilioinguinal nerve blocks were used for ilioinguinal neuralgia post-inguinal hernia surgery.Recent FindingsA total of six studies were identified with suitable data for inclusion. Three studies were retrospective, two studies were p...
Source: Current Pain and Headache Reports - December 17, 2020 Category: Neurology Source Type: research

Migraine in Children Under 7  Years of Age: a Review
The objective of this manuscript is to provide a comprehensive review of epidemiologic, clinic, and therapeutic aspects of migraine in this age.Recent findingsCurrent literature data show that migraine has some differences, especially in clinical and therapeutic terms, in this age group compared to subsequent ages. Furthermore, some evidences showing that an early onset of migraine may play an unfavorable role in its natural history, suggest an early identification and management of migraine in younger children. Moreover, we highlight the role that factors of prenatal and perinatal development can play in the predispositio...
Source: Current Pain and Headache Reports - December 16, 2020 Category: Neurology Source Type: research

Noninvasive Neuromodulation in Migraine
AbstractPurpose of ReviewThe past two decades has seen an influx of noninvasive neuromodulation devices aimed at treatment of various primary headache disorders, including cluster headache and migraine. This narrative review is to summarize the current options in noninvasive neuromodulation in migraine.Recent FindingsA variety of noninvasive neuromodulation devices have been FDA cleared and marketed for use in migraine, including single-pulse transcranial magnetic stimulation (sTMS), noninvasive vagal nerve stimulators (nVNS), and external trigeminal nerve stimulators (eTNS). Newer devices include peripheral electrical sti...
Source: Current Pain and Headache Reports - December 16, 2020 Category: Neurology Source Type: research

Latest Insights into the Pathophysiology of Migraine: the ATP-Sensitive Potassium Channels
AbstractPurpose of ReviewMigraine remains a challenging condition to treat, thus highlighting the need for a better understanding of its molecular mechanisms. This review intends to unravel a new emerging target in migraine pathophysiology, the adenosine 5 ′-triphosphate-sensitive K+ (KATP) channel.Recent FindingsKATP channel is a common denominator in the cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) mediated intracellular cascades, both of which are involved in migraine. Intravenous infusion of KATP channel opener, levcromakalim, provoked migraine attack associated with dilation of...
Source: Current Pain and Headache Reports - December 3, 2020 Category: Neurology Source Type: research

Patient Satisfaction in Academic Pain Management Centers: How Do We Compare?
AbstractPurpose of ReviewThe aim of the study was to investigate patient satisfaction amongst academic pain management centers and associated factors.Recent FindingsApproximately 25% of pain management centers perform better than other practices on Press Ganey surveys. The majority of respondents (96%) indicated that pain management practices were uniquely positioned to receive poorer scores on patient satisfaction surveys. The majority of respondents (20/26), who reported a reason, indicated that limiting opioid prescribing led to poor patient satisfaction scores. Eighty-three percent of respondents indicated that they re...
Source: Current Pain and Headache Reports - November 18, 2020 Category: Neurology Source Type: research

Interventional Procedures in Episodic Migraine
AbstractPurpose of ReviewMigraine is a common disorder which in many cases can be adequately treated with medications. However, there are some patients who may either not respond to medications or have contraindications to their use. In this review, we will evaluate the available literature on the interventional procedures available to treat patients with episodic migraine. We will review the technical details of performing the procedures, the potential mechanisms of action, and available data on their effectiveness.Recent FindingsRecent studies conducted on the subject of interventional procedures including peripheral ner...
Source: Current Pain and Headache Reports - November 12, 2020 Category: Neurology Source Type: research

Narrative Review: Headaches After Reversible Cerebral Vasoconstriction Syndrome
AbstractPurpose of ReviewReversible cerebral vasoconstriction syndrome (RCVS) is a disorder with distinct features: recurrent thunderclap headaches with reversible vasoconstriction of intracranial arteries. Substantial studies regarding outcomes after RCVS were conducted, showing favorable functional outcomes in most patients despite the potentially life-threatening complications of RCVS, including ischemic stroke, intracranial hemorrhage, or convexity subarachnoid hemorrhage. However, patients may report headaches after the resolution of RCVS while relative studies were scarce.Recent FindingsTwo prospective studies from d...
Source: Current Pain and Headache Reports - November 8, 2020 Category: Neurology Source Type: research

Exparel for Postoperative Pain Management: a Comprehensive Review
AbstractPurpose of ReviewMultimodal pain management is the most effective way to treat postsurgical pain. However,  the use of opioids for acute pain management has unfortunately been a significant contributor to the current opioid epidemic. The use of opioids should be limited and only considered a “rescue” pain medication after other modalities of pain management have been utilized.Recent FindingsIt may be difficult to curtail the use of opioids in the treatment of chronic pain; however, in the postsurgical setting, there is compelling evidence that an  opioid-centric analgesic approach is...
Source: Current Pain and Headache Reports - October 23, 2020 Category: Neurology Source Type: research

The Impact of the Quantity and Quality of Social Support on Patients with Chronic Pain
AbstractPurpose of ReviewSocial support is an important yet often overlooked aspect of chronic pain management. Understanding the impact of social support on patients with chronic pain and determining if a relationship exists between a patient ’s perceived social support and their perceived quality of life is a crucial component to completely treating a pain patient. We sought to develop an intervention for patients with chronic pain that addresses the different types of social support, barriers to using social support, and ways to impr ove the quality of their social support.Recent FindingsA retrospective review of ...
Source: Current Pain and Headache Reports - October 15, 2020 Category: Neurology Source Type: research

Nummular Headache - a Case Report of a Rare Entity
AbstractPurpose of ReviewThe purpose of this manuscript is to shed light on systematic work-up of a diagnostic challenge such as nummular headache (NH), and to summarize the relevant literature on NH.Recent FindingsThe specific nature of the shape of the pain site is usually characteristic of NH. Multiple modalities of investigation including succinct imaging are necessary to successfully rule out other similar conditions.SummaryA 26-year-old female patient of Asian-Indian origin presented to the clinic with the chief complaint of chronic persistent left parietal headache for more than 10 years, which has been worsening ov...
Source: Current Pain and Headache Reports - October 12, 2020 Category: Neurology Source Type: research

Clinical Effectiveness and Mechanism of Action of Spinal Cord Stimulation for Treating Chronic Low Back and Lower Extremity Pain: a Systematic Review
AbstractPurpose of ReviewThe purpose of the present systematic review is to provide a current understanding of the mechanism of action and the evidence available to support clinical decision-making. The focus is to summarize randomized controlled trials (RCTs) and nonrandomized or observational studies of spinal cord stimulation in chronic pain to understand clinical effectiveness and the mechanism of action.Recent FindingsSeveral recent studies have demonstrated the benefit of spinal cord stimulation in managing chronic pain. Until recently, the mechanism of action was founded on a central paradigm derived from gate contr...
Source: Current Pain and Headache Reports - September 29, 2020 Category: Neurology Source Type: research

Brain Metabolism and Structure in Chronic Migraine
AbstractPurpose of ReviewThe purpose of this paper is to review and synthesize current literature in which neurochemical and structural brain imaging were used to investigate chronic migraine (CM) pathophysiology and to further discuss the clinical implications.Recent FindingsSpectroscopic and structural MRI studies have shown the presence of both impaired metabolism and structural alterations in the brain of CM patients. Metabolic changes in key brain regions support the notion of altered energetics and homeostasis as part of CM pathophysiology. Furthermore, CM, like other chronic pain disorders, may undergo structural re...
Source: Current Pain and Headache Reports - September 28, 2020 Category: Neurology Source Type: research

Complications Associated with Lumbar Transforaminal Epidural Steroid Injections
AbstractPurpose of ReviewLow back pain with radicular symptoms is a common cause of disability in the adult population in the USA. Lumbar transforaminal epidural steroid injection (TFESI) is one of the most frequently used intervention for lumbar radiculitis. The purpose of this review is to evaluate complications associated with lumbar TFESI.Recent FindingsBased on the literature review, the reported rate of minor complications was between 2.4 and 9.6%. The major complications including spinal abscess, spinal cord infarct, and epidural hematoma were documented as case reports. Some patients with spinal cord infarct had pe...
Source: Current Pain and Headache Reports - September 28, 2020 Category: Neurology Source Type: research

Chronic Cluster Headache Update and East –West Comparisons: Focusing on Clinical Features, Pathophysiology, and Management
AbstractPurpose of ReviewThis review provides an update on chronic cluster headache (CH) focusing on clinical features, pathophysiology, and management as well as comparisons between Eastern and Western populations.Recent FindingsChronic CH in Eastern populations was relatively rare, compared to that in Western populations. Lacrimation and/or conjunctival injection is the most frequently reported cranial autonomic symptom, and visual aura is predominant in chronic CH patients. Neuroimaging evidence in both ethnic groups suggests that CH pathophysiology involves the hypothalamus and pain-modulatory areas, with dynamic alter...
Source: Current Pain and Headache Reports - September 28, 2020 Category: Neurology Source Type: research

Efficacy and Feasibility of Behavioral Treatments for Migraine, Headache, and Pain in the Acute Care Setting
AbstractPurpose of ReviewThis narrative review examines the use of behavioral interventions for acute treatment of headache and pain in the emergency department (ED)/urgent care (UC) and inpatient settings.Recent FindingsBehavioral interventions demonstrate reductions of pain and associated disability in headache, migraine, and other conditions in the outpatient setting. Behavioral treatments may be a useful addition for patients presenting with acute pain to hospitals and emergency departments.SummaryWe review challenges and limitations and offer suggestions for implementation of behavioral interventions in the acute sett...
Source: Current Pain and Headache Reports - September 25, 2020 Category: Neurology Source Type: research

Post Traumatic Headache: Clinical care of athletes vs non athletes with Persistent Post Traumatic Headache after Concussion: Sports Neurologist and Headache Specialist Perspective
AbstractPurposeThe purpose of this paper is to review and outline the similarities and differences in the treatment of athletes compared with that of other populations with a persistent post-traumatic headache after a concussion.Recent FindingsAfter an extensive review of the literature and despite well over 2 million Americans experiencing post-traumatic headache (PTH) each year, a number of which will continue to experience persistent post-traumatic headache (PPTH). There is little evidence on the management of the disorder and essentially no evidence-based research when it comes to the management of athletes.SummaryWith...
Source: Current Pain and Headache Reports - September 2, 2020 Category: Neurology Source Type: research

Low-Dose Naltrexone for Chronic Pain: Update and Systemic Review
AbstractPurpose of ReviewThe purpose of this review is to evaluate and explain our current understanding of the clinical use of low-dose naltrexone in the treatment of chronic pain.Recent FindingsRecent pre-clinical uses and clinical studies further elucidate the use of low-dose naltrexone in the treatment of chronic pain.SummaryLow-dose naltrexone (LDN) has shown promise to reduce symptoms related to chronic pain conditions such as fibromyalgia, inflammatory bowel conditions, and multiple sclerosis. The mechanism of LDN appears to be modulation of neuro-inflammation, specifically, the modulation of the glial cells and rel...
Source: Current Pain and Headache Reports - August 25, 2020 Category: Neurology Source Type: research

Complications of Fluoroscopically Guided Cervical Interlaminar Epidural Steroid Injections
AbstractPurpose of ReviewCervical interlaminar epidural steroid injection is a common intervention in the management of cervical radiculitis. Given the large number of injections done annually, it is important to assess the potential complications associated with this procedure.Recent FindingsBased on current published studies, the overall complication rate varies. The vast majority are minor complications. However, this review also identified potentially catastrophic complications following cervical interlaminar epidural steroid injections.SummaryBased upon our review, cervical epidural steroid injection is considered a s...
Source: Current Pain and Headache Reports - August 25, 2020 Category: Neurology Source Type: research

Epidemiology of Headache in Children and Adolescents —Another Type of Pandemia
AbstractPurpose of ReviewHeadaches are not only responsible for restrictions in everyday life in adults. In children and adolescents, regular headaches lead also to reduced life quality and limitations in the social sphere, in school education, and in professional careers. Here, we provide an overview on the frequency of headache in children and adolescents with the aim of increasing awareness about this particular health issue.Recent FindingsOverall, headache prevalence in children and adolescents has been increasing in recent years. From various regions worldwide, data describing headache, its forms, and consequences are...
Source: Current Pain and Headache Reports - August 24, 2020 Category: Neurology Source Type: research

Pain Syndromes Secondary to Cluneal Nerve Entrapment
AbstractPurpose of ReviewThe purpose of this review is to provide an overview of the cluneal nerves, present a summary of pain syndromes secondary to clunealgia, and evaluate current literature for diagnostic and treatment modalities.Recent FindingsMultiple trials and studies have reported success with numerous modalities ranging from nerve blocks, neuroablation, and even peripheral neuromodulation with varying degrees of clinical benefit.SummaryCluneal nerve entrapment or chronic impingement can cause buttock pain or referred pain to nearby areas including the lower back, pelvic area, or even the lower extremities. Clunea...
Source: Current Pain and Headache Reports - August 20, 2020 Category: Neurology Source Type: research

Surgical Flow Disruptions, a Pilot Survey with Significant Clinical Outcome Implications
This study, therefore, attempted to better understand SFDs and their impact from the perspective of operating room team members.Recent FindingsAfter Institutional Review Board approval, a survey was sent to operating room team members including surgeons, anesthesia providers, nurses, and surgical technologists. The survey was developed to assess the perceived frequency and consequences of SFDs, and the ability to report and perceive the efficacy of reporting to management. Among 111 survey participants, 65% reported that surgical flow disruptions happen either “several times a day” or “every procedure.&rd...
Source: Current Pain and Headache Reports - August 17, 2020 Category: Neurology Source Type: research

Ultrasound-Guided Neuraxial Anesthesia
AbstractPurpose of ReviewThere has been a recent surge of interest in clinical applications of ultrasound, which has revolutionized acute pain management. This review is to summarize the current status of ultrasound utilization in neuraxial anesthesia, the most common type of regional anesthesia.Recent FindingsUltrasound-assisted and ultrasound-guided neuraxial anesthesia has improved clinical accuracy and patient safety through landmark identification including proper vertebral level and midline, as well as via measurements on neuraxial space. Direct needle or catheter visualization during the entire procedure has not yet...
Source: Current Pain and Headache Reports - August 17, 2020 Category: Neurology Source Type: research

An Update on Idiopathic Hypertrophic Cranial Pachymeningitis for the Headache Practitioner
AbstractPurpose of ReviewWe aim to review idiopathic hypertrophic cranial pachymeninigitis (IHCP), describe common head pain patterns and features associated with the disorder, suggest potential classification of head pain syndromes based on the recently published International Classification of Headache Disorders-3, explore pathophysiology found to be associated with cases of IHCP, and indicate common treatment for the disorder.Recent FindingsIt is suggested that a subset of IHCP is an IgG4-related autoimmune disorder. Patients with IHCP were found to have elevated cerebrospinal fluid (CSF) protein and lymphocytic pleocyt...
Source: Current Pain and Headache Reports - August 16, 2020 Category: Neurology Source Type: research

Neurophysiological Mechanisms Supporting Mindfulness Meditation –Based Pain Relief: an Updated Review
AbstractPurpose of ReviewThis review examines recent (2016 onwards) neuroscientific findings on the mechanisms supporting mindfulness-associated pain relief. To date, its clear that mindfulness lowers pain by engaging brain processes that are distinct from placebo and vary across meditative training level. Due to rapid developments in the field of contemplative neuroscience, an update review on the neuroimaging studies focused on mindfulness, and pain is merited.Recent FindingsMindfulness-based therapies produce reliably reductions in a spectrum of chronic pain conditions through psychological, physiological, and neural me...
Source: Current Pain and Headache Reports - August 16, 2020 Category: Neurology Source Type: research

Neurosurgical Evaluation for Patients with Chronic Lower Back Pain
AbstractPurpose of ReviewChronic low back pain (CLBP) is a major cause of disability in the USA, and it affects approximately 1 in 4 Americans. CLBP patients are commonly referred to or seek out neurosurgical evaluations and opinions for treatment and management.Recent FindingsLiterature shows that only a minority of patients with CLBP may benefit from a surgical procedure. These patients that present to clinic often have been ailing for a considerable amount of time and are eager for effective treatment to alleviate pain. However, determining if a patient with CLBP is a surgical candidate is predicated upon having no succ...
Source: Current Pain and Headache Reports - August 16, 2020 Category: Neurology Source Type: research

Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review
ConclusionWhile conservative management continues to be the mainstay of treatment for plantar fasciitis, multiple minimally invasive treatment options are emerging with potential effectiveness in reducing pain and improving the function. (Source: Current Pain and Headache Reports)
Source: Current Pain and Headache Reports - August 11, 2020 Category: Neurology Source Type: research

Correction to: Intravenous Migraine Treatment in Children and Adolescents
The original publication of this article unfortunately contained the incorrect version of the manuscript. The original article has been corrected. (Source: Current Pain and Headache Reports)
Source: Current Pain and Headache Reports - August 10, 2020 Category: Neurology Source Type: research

Novel Agents in Neuropathic Pain, the Role of Capsaicin: Pharmacology, Efficacy, Side Effects, Different Preparations
AbstractPurpose of ReviewCapsaicin is a natural substance used to treat neuropathic pain because of its ability to be used in a more direct form on patients and efficiently treat their pain without the amount of side effects seen in the use of oral medications.Recent FindingsCurrently, the treatments for neuropathic pain are, control of the underlying disease process, then focused on symptomatic relief with pharmacotherapy, topical analgesics, or other interventions. When all pharmacological agents fail to relieve the pain, interventional strategies can be considered, such as neural blocks, spinal cord stimulation, and int...
Source: Current Pain and Headache Reports - August 5, 2020 Category: Neurology Source Type: research

Neuropathic Pain and Sickle Cell Disease: a Review of Pharmacologic Management
AbstractPurpose of ReviewSickle cell disease (SCD) remains among the most common and severe monogenic disorders present in the world today. Although sickle cell pain has been traditionally characterized as nociceptive, a significant portion of sickle cell patients has reported neuropathic pain symptoms. Our review article will discuss clinical aspects of SCD-related neuropathic pain, epidemiology of neuropathic pain among individuals with SCD, pain mechanisms, and current and future potential pharmacological interventions.Recent FindingsNeuropathic pain in SCD is a complicated condition that often has a lifelong and signif...
Source: Current Pain and Headache Reports - July 23, 2020 Category: Neurology Source Type: research