Current pain and headache reports
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Curr Pain Headache Rep · Jan 2025
ReviewFunctional Magnetic Resonance Imaging of Post-Traumatic Headache: A Systematic Review.
To evaluate existing functional magnetic resonance imaging (fMRI) studies on post-traumatic headache (PTH) following traumatic brain injury (TBI). ⋯ We conducted a systematic search of PubMed and Embase databases from inception to February 1, 2024. Eligible fMRI studies were required to include adult participants diagnosed with acute or persistent PTH post-TBI in accordance with any edition of the International Classification of Headache Disorders. We identified five eligible fMRI studies: two on acute PTH and three on persistent PTH. These studies assessed resting-state functional connectivity involving comparisons with one or more of the following groups: people with migraine, those with mild TBI but no PTH, and healthy controls. In acute PTH, studies focused exclusively on functional connectivity between the periaqueductal gray or hypothalamus and other brain regions. In persistent PTH, evidence of altered functional connectivity was identified primarily within cingulate, sensorimotor, and visual regions, indicating a hypersensitivity to sensory stimuli in PTH. Despite these insights, the fMRI data remains sparse and is limited by inconsistent results and small samples. The paucity of fMRI studies on PTH limits our understanding of its neurobiological basis. The available evidence suggests that alterations in functional connectivity occur within brain areas involved in emotional and sensory discriminative aspects of pain processing. However, inconsistent results and small sample sizes underscore a critical need for larger, more rigorous fMRI studies. Future studies should also consider using task-based fMRI to investigate possible hypersensitivity to different sensory stimuli in PTH after TBI.
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Curr Pain Headache Rep · Jan 2025
ReviewKetamine Infusion for Complex Regional Pain Syndrome Treatment: A Narrative Review.
Complex Regional Pain Syndrome (CRPS) is a neuropathic pain disorder characterized by pain disproportionate to the inciting event that is constant for an extended duration. Numerous treatment options for this condition have been explored with unsatisfactory results in many cases. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist typically used as an anesthetic and analgesic, presents a promising potential treatment for CRPS in patients who fail to respond to traditional therapies. ⋯ The present investigation summarizes existing knowledge and research surrounding ketamine infusions for CRPS to provide a well-rounded depiction of advantages and disadvantages for physicians who may be considering it for patients with this challenging and complex condition.
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Curr Pain Headache Rep · Jan 2025
ReviewA Review of the Prospera Spinal Cord Stimulation System with Multiphase Stimulation and Proactive Care.
The purpose of this review is to describe the development and key features of the Prospera™ Spinal Cord Stimulation (SCS) System, as well as the clinical evidence supporting its use. Prospera delivers therapy using a proprietary multiphase stimulation paradigm and is the first SCS system to offer proactive care through automatic, objective, daily, remote device monitoring and remote programming capabilities. ⋯ Results from the recently published BENEFIT-02 trial support the short-term safety and efficacy of multiphase stimulation in patients with chronic pain. BENEFIT-03 is an ongoing, multicenter, single-arm study with 24-month follow-up; interim analyses suggest that multiphase therapy is safe and effective and that patients and clinicians have positive experiences with remote device management. Preliminary evidence suggests that the Prospera SCS System represents an opportunity to improve patient care by combining an effective multiphase stimulation paradigm with an efficient proactive care model.
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Curr Pain Headache Rep · Jan 2025
ReviewPain Management Services Can Be a Cost-Effective Option over Surgery for the Treatment of Chronic Pain.
The number of facilities and physicians that offer pain management services has grown significantly since the 1970s. Despite the rise in prevalence of individuals with chronic pain during that time, interventional pain physicians remain underutilized. One reason why this may be the case is a large number of patients are referred directly to surgical specialists prior to being seen by an interventional pain physician. With the rising cost of healthcare, a shift away from surgical specialists and towards pain specialists as part of a multidisciplinary care team may help reduce the cost of care for chronic pain patients. ⋯ Through comparing the costs for patients with various types of chronic back pain, it was found that those who were treated by a pain physician rather than a surgeon saved up to over $8000 USD. Despite the cost benefits, it is important to recognize that healthcare disparities still exist which prevent patients from accessing interventional pain physicians. These disparities include patient location and insurance coverage. Overall, the treatment paradigm should start with non-invasive treatments, followed by minimally invasive procedures, with surgical interventions reserved as a last resort for when less invasive measures fail. Early incorporation of a multidisciplinary care team that includes chronic pain management services is critical for providing appropriate and cost-effective patient care.
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This review aims to understand the foundations of cognitive behavioral therapy (CBT) and biofeedback, their indications for therapy, and evidence-based support. ⋯ Both CBT and biofeedback are noninvasive therapy options for patients who are suffering from a variety of chronic pain conditions, including chronic low back pain, headache, fibromyalgia, and temporomandibular disorder (TMD). CBT has been shown to be effective in treating multiple chronic pain conditions.