Current pain and headache reports
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Deep brain stimulation (DBS) for chronic pain has been controversial. Despite the discouraging outcomes from multicenter clinical trial in the twentieth century, there is sustained interest in optimizing its use to improve patient outcomes. Here we provide a concise overview of DBS for chronic pain as a reference for clinicians. ⋯ Recently published data lends tentative support for DBS as a means of treating chronic pain. Still, high level-of-evidence data remain elusive. There are a handful of ongoing and prospective clinical trials exploring DBS for pain in the context of closed-loop neuromodulation, invasive electroencephalography monitoring, stimulation parameters, and novel intracranial targets. DBS is a potentially viable method of treating chronic pain. Procedure success is dependent on a number of factors including proper patient and intracranial target selection. Outcomes for ongoing and future clinical trials will help clinicians refine DBS use for this clinical indication.
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Curr Pain Headache Rep · Jan 2023
ReviewThe Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment.
This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. ⋯ Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.