Current pain and headache reports
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Curr Pain Headache Rep · Jan 2025
Review Meta AnalysisEfficacy of Intra-Articular Platelet-Rich Plasma Injections in Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis.
Knee osteoarthritis (OA) is a gradual deterioration of articular cartilage characterized by pain and physical dysfunction. Although analgesic pharmacological agents are the first-line treatment for knee OA, they are not effective for all patients. In this study, we evaluate the efficacy of an intra-articular injection treatment using platelet-rich plasma (PRP) in reducing pain and improving functional ability. ⋯ Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review and meta-analysis (SR/MA) provides an updated overview for the role of PRP in knee OA treatment. Ten articles, published between 2016 and 2023, met the inclusion criteria and compared PRP treatment to a placebo control at six-month follow-up. A total of 9,409 potential studies were identified from a review of four different databases: PubMed (n = 4595), Cochrane (n = 4252), VHL (n = 112), and OpenSigle (n = 450). After the titles and abstracts and inclusion and exclusion criteria were considered, a total of 10 studies were analyzed. Although a significant improvement among PRP-treated groups in some studies was found, there was variability such as where the aforementioned scores appeared to worsen and some only demonstrated trends. Overall, PRP may be a promising treatment for symptomatic knee OA. However, further research is necessary to determine the efficacy of PRP in treating knee OA, with specific considerations for times at follow-up, frequency and dosage of injections, and comorbidities, which were unaccounted for in this SR/MA.
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Curr Pain Headache Rep · Jan 2025
ReviewInfluence of Obesity, Race and Gender on Radiation Exposure for Epidural Procedures.
This retrospective, case controlled, comparative evaluation review of radiation exposure during epidural procedures in interventional pain management assessed variations in radiation exposure based on obesity, race, and gender. ⋯ Numerous publications have shown increasing radiation exposure based on body mass index (BMI). However, the influence of race and gender have not been studied. A recent study assessing radiation exposure for epidural procedures with mandated 2 views, compared to a single view or optional 2 views, showed an increase in exposure time of 21%, with radiation dose increases of 133%. The influence of obesity, has been studied, but potential influence of race, and gender on radiation exposure for epidural procedures has not been studied. The present review shows a prevalence of total obesity with BMI of 30 or above of 50.9%, with a higher prevalence in patients below the age of 45, female gender, and African Americans. Mean fluoroscopy time and dose increased significantly from 6.9 s to 0.925 milligray (mGy) for all epidural procedures for those who are underweight to 10.0 s and 6.7 mGy for those with Class 3 obesity above BMI of 40. However, after adjusting for body mass index, no significant differences were noted in race for both fluoroscopy time and radiation dose across multiple epidural procedures. Fluoroscopy time and radiation dose increased in males in cervical interlaminar and lumbar transforaminal procedures.
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Curr Pain Headache Rep · Jan 2025
ReviewEthical Considerations in the Use of Artificial Intelligence in Pain Medicine.
Although the integration of artificial intelligence (AI) into medicine and healthcare holds transformative potential, significant challenges must be necessarily addressed. This technological innovation requires a commitment to ethical principles. Key issues concern autonomy, reliability, and bias. ⋯ S. executive orders, provide essential guidelines for the responsible use of AI. This step is crucial for balancing innovation with rigorous ethical standards, ultimately leveraging the incredible AI's benefits. As the field evolves rapidly and concepts like algorethics and data ethics become more widespread, the scientific community is increasingly recognizing the need for specialists in this area, such as AI Ethics Specialists.
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Migraine prevalence in females is up to 3 times higher than in males and females show higher frequency, longer duration, and increased severity of headache attacks, but the reason for that difference is not known. This narrative review presents the main aspects of sex dimorphism in migraine prevalence and discusses the role of sex-related differences in mitochondrial homeostasis in that dimorphism. The gender dimension is also shortly addressed. ⋯ The imbalance between energy production and demand in the brain susceptible to migraine is an important element of migraine pathogenesis. Mitochondria are the main energy source in the brain and mitochondrial impairment is reported in both migraine patients and animal models of human migraine. However, it is not known whether the observed changes are consequences of primary disturbance of mitochondrial homeostasis or are secondary to the migraine-affected hyperexcitable brain. Sex hormones regulate mitochondrial homeostasis, and several reports suggest that the female hormones may act protectively against mitochondrial impairment, contributing to more effective energy production in females, which may be utilized in the mechanisms responsible for migraine progression. Migraine is characterized by several comorbidities that are characterized by sex dimorphism in their prevalence and impairments in mitochondrial functions. Mitochondria may play a major role in sexual dimorphism in migraine through the involvement in energy production, the dependence on sex hormones, and the involvement in sex-dependent comorbidities. Studies on the role of mitochondria in sex dimorphism in migraine may contribute to precise personal therapeutic strategies.
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Curr Pain Headache Rep · Jan 2025
Review Meta AnalysisEfficacy of Transcutaneous Electrical Nerve Stimulation in Management of Cancer Pain: a Meta Analysis.
The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile. ⋯ Related to various limitations of this meta-analysis, no definitive conclusions could be concluded regarding efficacy of TENS in the treatment of cancer or chemotherapy-related pain. Additional randomized primary studies with standardized treatment protocols and pain measurements are needed for future meta-analysis and recommendations for clinical practice.