Current pain and headache reports
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The purpose of this review is to provide the most recent update and summary on the consideration, benefits and application of regional anesthesia in the ICU setting, as it pertains to the management of perioperative pain. ⋯ Regional anesthesia and analgesia have become ubiquitous in the perioperative setting, with numerous indications and benefits. As integral part of the multimodal analgesia approach, various regional blocks have been increasingly utilized in critically ill patients. We focus this review on various regional techniques employed for critically ill patients after cardiac, thoracic, and major abdominal surgery, including neuraxial and novel truncal blocks. Effective pain management in critically ill patients poses many challenges and is extremely important. Regional anesthesia, in combination with other analgesia modalities, while still under-utilized, can help reduce acute perioperative pain, stress response, opioid use and related side effects and expedite recovery and improve clinical outcomes.
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Curr Pain Headache Rep · Jan 2025
ReviewPost-laparoscopic Shoulder Pain Management: A Narrative Review.
Post-laparoscopic shoulder pain (PLSP) can slow patient recovery and extend hospital stays, making its management crucial for patients undergoing laparoscopic surgery. Current consensus guidelines say little about how to prevent or manage PLSP. In this context, a multimodal approach to PLSP management that maybe extend beyond the pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to analgesics. In this review, we explore the potential causes of PLSP. Additionally, by searching relevant databases and reviewing existing literature, we provide a comprehensive summary of current PLSP management strategies excluding analgesics. ⋯ A total of 30 articles were reviewed. The review identified a number of different treatments for PLSP, including trendelenburg position, discharge of residual gas, pulmonary recruitment manoeuvre, low-pressure pneumoperitoneum and phrenic nerve block, among others. However, the inconsistencies in the study designs resulted in disparate conclusions. While the current studies provide valuable insights, there is a clear need for further research in this area.
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Curr Pain Headache Rep · Jan 2025
ReviewDiagnosis and Management of Mild Traumatic Brain Injury (mTBI): A Comprehensive, Patient-centered Approach.
The purpose of this review is to provide an update regarding recent research and recommendations in the care of mild traumatic brain injury (mTBI). ⋯ New diagnostic criteria for mTBI have recently been developed by the American Congress of Rehabilitation Medicine through the Delphi method and this will help to standardize assessment, diagnosis, and treatment. Symptoms of mTBI are diverse and can sometimes become persistent. Treatment of mTBI should be patient-centered and may require subspeciality referral and coordinated, inter-disciplinary, or multi-disciplinary treatment.
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Curr Pain Headache Rep · Jan 2025
ReviewPain and Perception: Exploring Psychedelics as Novel Therapeutic Agents in Chronic Pain Management.
Chronic pain affects approximately 1.5 billion people worldwide, representing the leading cause of disability and a significant financial burden on healthcare systems. Conventional treatments, such as opioids and non-steroidal anti-inflammatory drugs, are frequently linked to adverse effects, including dependency and gastrointestinal issues, and often offer limited long-term relief. This review explores the potential of psychedelics, including psilocybin, LSD, and ketamine, as alternative therapeutic agents in chronic pain management. ⋯ These substances modulate pain perception through actions on serotonergic and glutamatergic systems and may promote neuroplasticity, offering novel pathways for pain relief. Specifically, the review details the pharmacologic actions of psychedelics, their effects on chronic pain syndromes such as cancer pain, migraines, and neuropathic pain, and their clinical implications. The safety profiles, patient responses, and analgesic properties of these compounds are examined, highlighting the need for further research to validate their efficacy and optimize their therapeutic use in pain management.
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Management of primary headache disorders during pregnancy is limited due to known teratogenicity or unknown safety of many currently available pharmaceutical therapies. Here, we explore the safety and efficacy of non-invasive neuromodulatory devices as another treatment modality for pregnant patients. ⋯ There are six FDA-cleared, non-invasive neuromodulatory devices currently available for the management of headache that include remote electrical neuromodulation (REN), noninvasive vagal nerve stimulation (nVNS), external trigeminal nerve stimulation (eTNS), single-pulse transcranial magnetic stimulation (sTMS), and external concurrent occipital and trigeminal neurostimulation (eCOT-NS). Neuromodulatory devices are a safe, effective, and well tolerated non-pharmacological option for migraine and other primary headache disorders. Although evidence of safety and tolerability use in pregnancy is limited, they may serve as a therapeutic alternative or adjunct to improve the care of our pregnant patients.