Current pain and headache reports
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Curr Pain Headache Rep · Nov 2022
ReviewHeadache Education Adaptation During the COVID-19 Pandemic: Impact on Undergraduate and Graduate Medical Education.
Our goal was to describe the changes to headache and neurological education that occurred as a result of the COVID-19 pandemic, and the impact this had on medical learners. We also discuss subsequent implications for the future of education in the field of headache medicine. ⋯ Both educators and learners faced many challenges during the pandemic. These include the following: cancellation of in-person educational meetings, limited in-person networking and wellness events, disengagement from virtual didactic curricula, limitations in procedure-based learning, redeployment to inpatient settings with a decrease in outpatient exposures, and blurred boundaries between home and work life due to more virtual collaboration and home computer use. The development of telehealth programs and trainee wellness initiatives, improved collaboration opportunities among geographically distant institutions, and greater access to conferences for learners are among the many improvements forged by these challenging times in medical education. Given the high prevalence of headache disorders and the paucity of headache specialists, training new clinicians with competency in headache medicine is essential. There were many educational challenges and opportunities identified in the literature that resulted from the pressures of the pandemic. Educators need to develop assessments that capture any gaps in learning that may have occurred during this tumultuous time and be vigilant of remediation needs in our learners over the coming years. It is imperative to intentionally design curricula for the future by harnessing new pedagogical tools, innovations, and perspectives gleaned from our experience with the COVID-19 pandemic.
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Curr Pain Headache Rep · Nov 2022
ReviewReview of Opioid Sparing Interventional Pain Management Options and Techniques for Radiofrequency Ablations for Sacroiliac Joint Pain.
The goal of this clinical review was to provide an update about the existing treatment options and associated evidence for various radiofrequency ablation techniques for sacroiliac joint pain. An electronic literature search on radiofrequency for the treatment of sacroiliac joint pain was conducted using PubMed, NCBI and Google Scholar. The following search keywords were used: radiofrequency ablation (cooled, pulsed, conventional, bipolar, intra-articular), sacroiliac joint and sacroiliac pain. The search was limited to human subjects, English language and articles with available full text. The bibliographic sections of all manuscripts were further searched for additional relevant citations. The full text of the relevant articles was reviewed by all the authors. ⋯ Our study showed that radiofrequency ablation is a safe and effective treatment option that can be utilized to manage sacroiliac joint pain. It offers accessibility to the primary care physician, reduces office visits with "pain" as the primary complaint and provides the added benefit of acting as a non-opioid sparing means of analgesia.
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Curr Pain Headache Rep · Nov 2022
ReviewPathophysiology of Chronic Migraine: Insights from Recent Neuroimaging Research.
Chronic migraine (CM) is a highly disabling primary headache disorder with a substantial impact on patients' quality of life. Episodic migraine (EM) and CM are dynamic states; CM usually evolves from EM alongside increased headache frequency, comorbidities, and medication overuse, supporting the notion that migraine is a spectrum disorder. This narrative review aims to summarize neuroimaging studies to better understand the pathophysiology of CM. ⋯ Positron emission tomography studies have revealed abnormal energy metabolism and metabolic changes in the dorsal rostral pons in individuals with CM, suggesting that this structure has a key role in the pathophysiology of migraine generation and chronification. Magnetic resonance spectroscopy studies have suggested that thalamocortical pathway dysfunction may contribute to migraine chronification, while functional magnetic resonance imaging studies have highlighted that hypothalamic activity may be involved. Recent evidence highlights functional and structural alterations in cortical and subcortical pain-related brain regions in patients with CM. Whether these functional and structural abnormalities of the brain cause migraine chronification or are a consequence of repeated attacks is still debated. In the future, imaging patterns that predict the transformation from EM to CM should be identified.
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Curr Pain Headache Rep · Nov 2022
ReviewUltrasound-Guided Peripheral Nerve Blocks: A Practical Review for Acute Cancer-Related Pain.
Ultrasound-guided regional techniques, including catheter-based approaches, are a subset of interventional therapies that have gained interest as an option for managing acute cancer-related pain. The authors sought to review the available published evidence and to discuss practical recommendations for expanding access to such therapies. ⋯ In a MEDLINE/Pubmed search of ultrasound-guided peripheral nerve blocks and peripheral nerve catheters for specific anatomic targets, a total of 28 case reports and case series were identified. Included studies described improved analgesia and reduced opioid requirements with highly variable duration of effect. Current level of evidence remains limited. Pain is a symptom that markedly impacts the quality of life of cancer patients and ultrasound-guided regional techniques are a promising therapeutic option albeit with a limited evidence base. Practical recommendations offered for coordinating access to such therapies in the inpatient, emergency department, and outpatient settings may expand interest and facilitate higher quality research.
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Post-COVID headache may be unique in presentation and mechanism, often presenting as a new phenotype in patients with a history of a primary headache disorder or resulting in a new headache syndrome in those without history of headache. This review presents a description of the literature published focused on post-COVID headache. Additionally, we discuss potential mechanisms and considerations for treatment of post-COVID headache. ⋯ A 42-year-old woman with a history of episodic migraine without aura presents over video visit with a new headache type. Her typical headaches are predominantly left sided, throbbing in nature, and associated with photophobia and phonophobia. They are fully relieved by oral sumatriptan 2 h after treatment. She describes this new headache as a constant, pulsating, holocephalic pain with no other migrainous features that have been ongoing for 6 weeks. She notes that the headache has been persistent since that time. She has tried over-the-counter acetaminophen and ibuprofen and her typical migraine abortive therapy without relief. She is debilitated and wonders if there is anything that will take the pain away. She shares that she tested positive for COVID-19 about 2 days prior to headache onset and has associated rhinorrhea, anosmia, and ageusia.