Current pain and headache reports
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Curr Pain Headache Rep · Dec 2022
ReviewPill Counting as an Intervention to Enhance Compliance and Reduce Adverse Outcomes with Analgesics Prescribed for Chronic Pain Conditions: A Systematic Review.
Appropriate use of opioid analgesics is a key concern within the field of pain medicine. Several methods exist to discourage abuse and facilitate effective treatment regimens. Pill counting is often cited as one such method and frequently employed in varying fashions within clinical practice. However, to date, there is no published review of the evidence to support this practice. This was a comprehensive review of the available literature that was conducted with analysis of the efficacy and practical application of pill counting during treatment of chronic pain conditions. ⋯ There is paucity in data regarding pill count importance in pain management. Pill count is a very important tool to monitor compliance of opioids use which in turn can prevent several complications associated with opioid misuse. Pill counting may be used in conjunction with other abuse deterrents, although increased support for this practice requires standardized methods of pill counting and further analysis of its effectiveness.
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Curr Pain Headache Rep · Dec 2022
ReviewA Comprehensive Review: Chronic Pain Sequelae in the Presence of Ehlers-Danlos Syndrome.
Patients diagnosed with Ehlers-Danlos syndromes (EDS), and especially those with the hypermobility subtype, often experience a diverse range of acute and chronic pain conditions throughout their lifetime. These can present in a variety of different phenotypes and comorbidities, making it difficult to develop structured treatment protocols. This review seeks to summarize the current literature to address old and novel treatments for EDS. ⋯ Historically, medications and surgery have been used to treat patients with EDS but with low efficacy. Newer therapies that have shown promising effects for both decreasing pain and increasing quality of life include physical/occupational therapy, transcutaneous electrical nerve stimulation units, trigger point injections, low-dose naltrexone, and laser therapy. In addition, addressing the psychosocial aspects of pain with EDS through methods like cognitive behavioral therapy and patient education has shown to be vital in minimizing pain. Most research also emphasizes that pain management should not only focus on pain reduction, but on helping reduce symptoms of hypermobility, central sensitization, and fatigue to make an impactful difference. Research on pain in EDS is still limited with good clinical practice guidelines often limited by poor sample size and lack of clinical studies. Treatment options should be structured based on the specific type of pain pathology and presenting symptoms of each patient and their comorbidities. Future research should attempt to prioritize larger sample sizes, clear definitions of EDS subtypes, randomized trials for treatment efficacy, and more studies dedicated to non-musculoskeletal forms of pain.
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Curr Pain Headache Rep · Dec 2022
ReviewA Comprehensive Review of Spinal Cord Stimulator Infections.
Spinal cord stimulator (SCS) is approved to treat various pain conditions and is commonly seen in the chronic pain patient population. Due to the nature of the device and its location, infections associated with SCS have a particularly high morbidity. According to post-market data and medical device reports, 87% of patients receiving SCS implants were given perioperative antibiotics as the implantable neurostimulator or receiver pocket serve as the most common sites of infection. The most common antibiotics for surgical prophylaxis given are first-generation cephalosporins (cefalexin, cefazolin) at the time of implantation. If deep infection is suspected, imaging in the form of CT scan should be obtained as physical exam is not always sufficient. ⋯ If meningitis is suspected, a lumbar puncture is recommended. Positive cultures can help guide antibiotic therapy.
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Curr Pain Headache Rep · Dec 2022
ReviewHeadache After Vaccination: An Update on Recent Clinical Trials and Real-World Reporting.
The aim of this review is to characterize headache as a vaccine adverse event (VAE) in clinical trials. ⋯ Of the recent phase III vaccine RCTs (non-COVID-19), 53 studies reported on headache (13 infectious agents). The median rate (interquartile range) of headache was 15.6% (IQR: 9.6-37.6%). Of these, 24.5% of the RCTs reported headache greater in the vaccine group compared to the placebo/control group. In the herpes zoster vaccination trials, headache was more common in all active groups: median rate 33.9% (IQR: 29.7-40.5%) as compared to placebo: median rate 17.7% (IQR: 15.4-23.8%). Influenza and HPV vaccination trials were the 2nd and 3rd most common to have headache as a VAE. Of the 6 widely distributed COVID-19 vaccinations, median rate of post-vaccination headache was 39% (IQR: 28-50%). Headache is a common VAE in vaccine trials. Standardized grading methods, predictors of persistence, and treatment regimens are warranted.
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Curr Pain Headache Rep · Dec 2022
ReviewPulsed Radiofrequency for the Treatment of Trigeminal Neuralgia.
Trigeminal neuralgia is a sudden, unilateral, stabbing pain in the distribution of one or more branches of the fifth cranial nerve, with an overall prevalence ranging between 0.03 and 0.3%. While conservative treatments may offer temporary relief, many patients experience chronic headaches associated with their neuralgia. Invasive treatments are available for patients with intractable neuralgia; however, they may cause permanent tissue damage and often do not provide relief. This article examines pulsed radiofrequency (PRF) ablation (RFA) of the trigeminal nerve as a minimally invasive procedure that offers a promising alternative to invasive procedures for relief of trigeminal neuralgia while minimizing tissue damage. ⋯ Efficacy of PRF and RFA in treating trigeminal neuralgia has been studied before, but literature lacks large size studies. The results of this retrospective study indicate that PRF can be used as a safe and effective treatment for patients suffering from trigeminal neuralgia that is refractory to conservative measures.