Current pain and headache reports
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Curr Pain Headache Rep · Sep 2023
ReviewAcute Pain and Development of Opioid Use Disorder: Patient Risk Factors.
Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. ⋯ This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.
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Curr Pain Headache Rep · Sep 2023
ReviewCognitive Behavioral Therapy for the Management of Episodic Migraine.
This article provides an overview of the application of CBT in the management of episodic migraine while also providing context and insight into the underlying neurophysiological mechanisms of therapeutic change. It discusses the theoretical foundations of CBT and highlights key components including education, cognitive restructuring, behavioral interventions, relaxation techniques, and lifestyle changes. ⋯ Cognitive behavioral therapy (CBT) is an empirically based treatment that is well suited for the management of episodic migraine. Although first-line treatments of migraine are typically pharmacological, a review of empirical literature suggests growing evidence for the use of CBT as a standard non-pharmacological treatment of headache conditions. In summary, this article explores evidence supporting the efficacy of CBT in reducing the frequency, intensity, and duration of migraine attacks as well as improving the quality of life and psychological well-being of those with episodic migraine.
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Curr Pain Headache Rep · Sep 2023
ReviewA Brief Review on the Novel Therapies for Painful Diabetic Neuropathy.
Almost half of people diagnosed with diabetes mellitus will develop painful diabetic neuropathy (PDN), a condition greatly impacting quality of life with complicated pathology. While there are different FDA approved forms of treatment, many of the existing options are difficult to manage with comorbities and are associated with unwanted side effects. Here, we summarize the current and novel treatments for PDN. ⋯ Current research is exploring alternative pain management treatments from the first line options of pregabalin, gabapentin, duloxetine, and amitriptyline which often have side effects. The use of FDA approved capsaicin and spinal cord stimulators (SCS) has been incredibly beneficial in addressing this. In addition, new treatments looking at different targets, such as NMDA receptor and the endocannabinoid system, show promising results. There are several treatment options that have been shown to be successful in helping treat PDN, but often require adjunct treatment or alterations due to side effects. While there is ample research for standard medications, treatments such as palmitoylethanolamide and endocannabinoid targets have extremely limited clinical trials. We also found that many studies did not evaluate additional variables other than pain relief, such as functional changes nor were there consistent measurement methods. Future research should continue trials comparing treatment efficacies along with more quality of life measures.
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The purpose of the study is to review and discuss the use of telemedicine in headache medicine. ⋯ Before the COVID-19 pandemic, the use of telemedicine for headache was most common in Europe. In recent years, however, telemedicine has been used broadly within headache medicine, including for pediatric patients and behavioral interventions. Several randomized clinical trials have shown that telemedicine is non-inferior to face-to-face visits. Multiple studies have reported substantial benefits associated with telemedicine, including high satisfaction rates, improved access to headache specialists, reduced travel, quicker visits, greater cost-effectiveness, reduced wait times, reduced no-show rates, and the increased comfort of remaining in one's home environment. The main limitation reported is the lack of a physical examination, including fundus assessment. Telemedicine has become a vital tool in headache patient care, with the data supporting its use for patient follow-up in particular.
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Postoperative pain continues to be one of the most common challenges following surgeries. Multimodal analgesia has been of particular focus as non-opioid alternatives have been encouraged due to concerns of the opioid epidemic. Ketamine has been an especially useful adjunct in multimodal pain regimens within the past few decades. This article highlights the current use and advances surrounding the perioperative use of ketamine. ⋯ Ketamine has antidepressive effects at subanesthetic doses. Intraoperative ketamine may be beneficial in reducing postoperative depression. Additionally, newer studies are exploring whether ketamine can be useful in reducing postoperative sleep disturbances. Ketamine continues to be a great tool in perioperative pain control, especially during an opioid epidemic. As its use continues to expand and gain more popularity in the perioperative period, more research could shed light on the additional nonanalgesic benefits of ketamine use.