Current Pain And Headache Reports[JOURNAL]
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200 papers
Applications of Celiac Plexus Block in Chronic Pancreatitis or Pancreatic Cancer.
Ke X, Robinson CL, Liu H … +3 more , Mei W, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2026 May · PMID 42096102 · Publisher ↗
PURPOSE OF REVIEW: Celiac plexus block (CPB) is an established interventional technique for the management of severe upper abdominal pain, particularly in patients with chronic pancreatitis (CP) and pancreatic cancer (PC...
PURPOSE OF REVIEW: Celiac plexus block (CPB) is an established interventional technique for the management of severe upper abdominal pain, particularly in patients with chronic pancreatitis (CP) and pancreatic cancer (PC). Pain in these conditions is complex, involving visceral and neuropathic mechanisms and, in CP, additional contributions from neuropathic remodeling, central sensitization, and altered descending modulation play a role. RECENT FINDINGS: CPB provides targeted neural blockade to disrupt nociceptive transmission from the upper abdominal viscera, thereby improving analgesia, reducing opioid requirements, and enhancing quality of life. This chapter emphasizes the role of CPB in treating pain resulting from CP and PC, with a specific focus on therapeutic timing, procedural approaches, technical considerations, efficacy, durability of pain relief, side effects, and recent advances. Current evidence suggests that CPB is highly effective in PC pain but provides only modest and short-lived benefit in CP, where it should be reserved for carefully selected refractory cases. Future directions include advanced imaging modalities, improved neurolytic agents, and integration of CPB into multimodal, mechanism-based strategies for comprehensive pain control.
Paravertebral Block for Postoperative Pain Management After Open Thoracotomy: A Review of Efficacy and Risks.
Duplechin DP, Wentling JG, Apgar TL … +6 more , Cazayoux EJ, Ahmadzadeh S, Allampalli V, Shekoohi S, Eng MR, Kaye AD
Curr Pain Headache Rep · 2026 May · PMID 42081157 · Publisher ↗
PURPOSE OF REVIEW: Paravertebral block (PVB) is an increasingly utilized regional anesthesia technique for managing postoperative pain in patients undergoing open thoracotomy. Effective pain control following thoracic su...
PURPOSE OF REVIEW: Paravertebral block (PVB) is an increasingly utilized regional anesthesia technique for managing postoperative pain in patients undergoing open thoracotomy. Effective pain control following thoracic surgery is crucial for optimizing patient recovery, reducing opioid consumption, and minimizing respiratory complications. RECENT FINDINGS: PVB provides unilateral analgesia by delivering local anesthetic to the paravertebral space, effectively blocking somatic and sympathetic nerve fibers. PVB has gained popularity as an alternative to epidural analgesia due to its efficacy and improved safety profile. While epidural analgesia remains the traditional gold standard for thoracic procedures, it is associated with complications such as hypotension, urinary retention, motor blockade, and the need for catheter placement. In contrast, PVB is easier to administer, produces less hemodynamic instability, and reduce systemic side effects. Recent literature suggests that PVB offers similar or improved pain control, reduced opiod requirements, and fewer postoperative complications. Risks such as vascular puncture, local anesthetic systemic toxicity, and incomplete spread persists; however, ultrasound guidance has iproved block reliability. Given its favorable safety profile and efficacy, PVB is emerging as a preferred option for postoperative pain control in open thoracotomy patients. Further research and randomized trials are needed to standardize technique, dosing, and peroperative protocols.
Metabolic Dysfunction and Metabolic Management in Episodic Migraine.
Denney DE, Marmura MJ
Curr Pain Headache Rep · 2026 May · PMID 42068433 · Full text
PURPOSE OF REVIEW: Evidence suggests a significant link between migraine and metabolic syndrome,, especially in those with chronic or refractory migraine. Weight loss and exercise may effectively prevent migraine. Here,...
PURPOSE OF REVIEW: Evidence suggests a significant link between migraine and metabolic syndrome,, especially in those with chronic or refractory migraine. Weight loss and exercise may effectively prevent migraine. Here, we review the evidence behind exercise and weight loss as migraine treatments. RECENT FINDINGS: While metabolic syndrome and pain have long had a known association, only recently have strong studies demonstrated a higher risk of developing metabolic syndrome in people with migraine. Additionally, other sequelae of metabolic syndrome, obesity, hypertension, hypercoagulability, and diabetes also interplay with migraine. New medications like GLP-1 agonists may be a potential treatment for migraine as well as obesity. For patients with migraine, metabolic syndrome, and obesity, care should be taken when selecting prophylactic medications, favoring those without a propensity to induce weight gain. Additionally, there is strong evidence for weight loss and exercise for improving migraine outcomes.
Pain Unraveled: Kinesio Taping as a Novel Approach to Myofascial Pain Management.
Mittal P, Mittal S
Curr Pain Headache Rep · 2026 May · PMID 42068432 · Publisher ↗
PURPOSE OF REVIEW: Myofascial pain syndrome (MPS) is a musculoskeletal system disorder that is exceedingly painful and distinct from other chronic pain syndromes. MPS can occur on its own or in conjunction with other mus...
PURPOSE OF REVIEW: Myofascial pain syndrome (MPS) is a musculoskeletal system disorder that is exceedingly painful and distinct from other chronic pain syndromes. MPS can occur on its own or in conjunction with other muscle disorders. Symptoms of MPS include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and hot and red skin. In addition, symptoms of MTrPs include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and/or hot and red skin. Kenzo Kase, a Japanese chiropractor, invented Kinesiology Tape (KT) in the 1970s, with a potential role in modulating pain, enhancing muscle function and improving ROM. This review aims to examine the underlying mechanisms of MPS and evaluate current therapeutic strategies, with particular emphasis on the mechanism and clinical application of KT in managing MPS. RECENT FINDINGS: Recent literature highlights the advances in understanding the pathophysiology of MTrP, conventional therapies and their limitations. KT is a dynamic, stretchable tape that resembles human skin which may be utilised to treat pain and muscle activity as well as increase range of motion (ROM). The majority of the time, KT is used in the treatment and prevention of sports injuries. Clinical studies report improvements in pain intensity, muscle flexibility, and ROM following KT application in individuals with MPS, particularly in sports and rehabilitation settings. MPS is a complex pain disorder requiring multimodal management. KT represents a promising non-invasive intervention that may address both pain and functional restoration through neurophysiological and biomechanical mechanisms. While clinical findings are promising, regulatory protocols are yet to be standardised to ensure long term safety and efficacy of KT in the treatment of MPS.
Discrepancies in Urine Drug Screening Among Patients Receiving Chronic Opioid Therapy for Non-Cancer Pain: A Retrospective Review.
Hasoon J, Viswanath O, Urits I … +2 more , Varrassi G, Kaye AD
Curr Pain Headache Rep · 2026 Apr · PMID 42060008 · Publisher ↗
PURPOSE OF REVIEW: This study reviews urine drug screening (UDS) outcomes in patients undergoing chronic opioid therapy for non-cancer related pain. The objective was to assess the prevalence of aberrant results, includi...
PURPOSE OF REVIEW: This study reviews urine drug screening (UDS) outcomes in patients undergoing chronic opioid therapy for non-cancer related pain. The objective was to assess the prevalence of aberrant results, including the presence of non-prescribed substances, absence of prescribed opioids, and other discrepancies, using random electronic medical record (EMR) review over a one-year period. RECENT FINDINGS: Fifty-six patient records from January 1, 2024, to December 31, 2024, were randomly selected and reviewed. Urine drug screens were compared against prescribed opioid regimens. Eight patients (14.3%) tested positive for tetrahydrocannabinol (THC) compounds, while one patient (1.8%) tested positive for cocaine. Notably, nine patients (16.1%) had negative screens for opioids that were currently prescribed, raising concerns about diversion or nonadherence. Additionally, three patients (5.4%) tested positive for an opioid different from the one prescribed. Overall, discrepancies between prescribed medications and urine drug screen findings were common, suggesting challenges in adherence monitoring and the need for structured screening protocols. CONCLUSION: Unexpected urine drug screening results are prevalent among patients on chronic opioid therapy for non-cancer pain. The high rates of absent prescribed opioids, presence of non-prescribed substances, and detection of illicit drugs highlight the importance of routine screening, careful documentation, and patient-provider communication to optimize safe opioid prescribing practices.
The OPRM1 A118G Polymorphism Revisited: Recent Developments and Implications for Personalized Treatment.
Daybell I, Wie C, Johnson B … +4 more , Covington S, Freeman J, Pew S, Maloney J
Curr Pain Headache Rep · 2026 Apr · PMID 42047908 · Publisher ↗
PURPOSE OF REVIEW: The OPRM1 A118G polymorphism, a single nucleotide variation in the mu-opioid receptor (MOR) gene, has been investigated for its role in opioid efficacy, addiction vulnerability, opioid-related adverse...
PURPOSE OF REVIEW: The OPRM1 A118G polymorphism, a single nucleotide variation in the mu-opioid receptor (MOR) gene, has been investigated for its role in opioid efficacy, addiction vulnerability, opioid-related adverse effects, and patient behavior. This review synthesizes recent findings, with a focus on clinical implications for patients with this polymorphism. RECENT FINDINGS: Recent research into the OPRM1 A118G polymorphism continues to explore the variant G allele’s impact on opioid response in pain management. Though guidelines do not yet recommend clinical adoption of testing for this polymorphism, recent studies have begun to show the potential value of incorporating genotype-guided therapy for G allele carriers. The OPRM1 A118G polymorphism presents a complex clinical picture with implications for therapeutic outcomes. Its diverse effects underscore the potential for personalized treatment, particularly for individuals with the AG/GG genotype. Future research into optimized medical, procedural, and behavioral therapies for G allele carriers will be crucial in advancing genotype-guided treatment.
Clinical Efficacy and Risks of Intra-Operative Intravenous Methadone in Spine Surgeries: A Narrative Review.
Kaye AD, Duplechin MO, Bolton AT … +5 more , Ford BM, Hollander AV, Torres YL, Shekoohi S, Ahmadzadeh S
Curr Pain Headache Rep · 2026 Apr · PMID 42043719 · Publisher ↗
PURPOSE OF REVIEW: Effective postoperative pain management is paramount in spine surgery, where patients often experience severe and prolonged pain related to extensive tissue disruption and long operative times. RECENT...
PURPOSE OF REVIEW: Effective postoperative pain management is paramount in spine surgery, where patients often experience severe and prolonged pain related to extensive tissue disruption and long operative times. RECENT FINDINGS: Traditional approaches rely heavily on short-acting opioids, which require frequent dosing and are associated with numerous adverse effects. Intra-operative intravenous methadone has emerged as a favorable alternative related to long duration of action and multimodal mechanism of action. As both a potent µ-opioid receptor agonist and NMDA receptor antagonist, methadone targets multiple pain pathways, offering prolonged pain relief and potential benefits in minimizing central sensitization. The present investigation evaluates current evidence surrounding intra-operative IV methadone in spine surgery. Studies show that methadone reduces postoperative opioid consumption, improves pain scores, and enhances patient satisfaction without significantly increasing adverse events. Despite these advantages, methadone presents important risks, including delayed respiratory depression and QTc interval prolongation, particularly in opioid-naive or medically complex patients. Variability in dosing effects and exclusion of high-risk populations in clinical trials limit our current understanding. In this regard, careful patient selection, preoperative screening, and postoperative monitoring are essential for safe use. Future research should aim to refine dosing protocols and evaluate methadone mediated roles within standardized Enhanced Recovery After Surgery (ERAS) pathways. In summary, intra-operative IV methadone represents a valuable tool in spine surgery analgesia, offering durable pain relief and opioid-sparing effects. With appropriate clinical considerations, it may be an effective component of perioperative spine surgery pain management strategies.
Efficacy of Rectus Sheath Block in the Management of Laparoscopic Cholecystectomy Mediated Pain: A Narrative Review.
Ahmadzadeh S, Duplechin MO, Hollander AV … +4 more , Thompson FC, Bembenick KN, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2026 Apr · PMID 42043685 · Publisher ↗
PURPOSE OF REVIEW: Effective postoperative pain management is essential for optimizing recovery after laparoscopic cholecystectomy, one of the most commonly performed abdominal surgeries. Despite being minimally invasive...
PURPOSE OF REVIEW: Effective postoperative pain management is essential for optimizing recovery after laparoscopic cholecystectomy, one of the most commonly performed abdominal surgeries. Despite being minimally invasive, the procedure is associated with significant somatic pain, which is frequently managed with systemic opioids and non-opioid analgesics. However, the reliance on opioids raises concerns related to associated side effects such as nausea, sedation, respiratory depression, and risk of dependence. RECENT FINDINGS: Regional anesthesia techniques, including the rectus sheath block, have gained attention as promising adjuncts or alternatives for pain control. The rectus sheath block specifically targets the anterior abdominal wall by anesthetizing the terminal branches of the intercostal nerves, potentially reducing incisional pain. This narrative review explores the anatomical rationale, technique, and current evidence on the efficacy of rectus sheath block for pain management following a laparoscopic cholecystectomy. We summarize findings from randomized controlled trials and observational studies comparing the rectus sheath block with placebo, systemic analgesia, and other regional techniques such as the transversus abdominis plane block. Outcomes of interest include postoperative pain scores, opioid consumption, time to ambulation, and incidence of adverse effects. While results vary across studies, the current literature suggests that the rectus sheath block may contribute to improved postoperative analgesia and reduced opioid requirements, particularly when combined with multimodal analgesic regimens. However, variations in study quality and differences in how the block is performed make it hard to draw firm conclusions. Well-designed, consistent research is needed to better understand the role of the rectus sheath block in recovery following a laparoscopic cholecystectomy.
Medication Overuse Headache in Children and Adolescents: A Narrative Review.
Ransick J, VanderPluym J
Curr Pain Headache Rep · 2026 Apr · PMID 42043623 · Publisher ↗
PURPOSE OF REVIEW: Medication overuse headache (MOH) is a secondary headache disorder that occurs in patients with pre-existing primary headache disorders who frequently use acute headache medications. While management s...
PURPOSE OF REVIEW: Medication overuse headache (MOH) is a secondary headache disorder that occurs in patients with pre-existing primary headache disorders who frequently use acute headache medications. While management strategies for MOH have been increasingly studied in adults, there remains limited data guiding diagnosis and treatment in children and adolescents. This review summarizes recent evidence on the epidemiology, medication patterns, and management strategies for pediatric MOH and compares these findings with the adult literature. RECENT FINDINGS: Through our literature search over the past 5 years, we revealed only 2 studies evaluating treatment strategies in MOH in pediatrics. Recent epidemiologic studies of pediatric MOH revealed an increased impact to quality of life, time spent in ictal state, and absenteeism compared to peers with other primary headache disorders. Despite its impact on quality of life and school attendance, pediatric MOH remains understudied. Larger prospective studies are needed to determine optimal treatment strategies and improve evidence-based management in this population.
Use of CGRP Monoclonal Antibodies in Japan, South Korea, and Taiwan: A Narrative Review.
Ihara K, Ling YH, Kano Y … +11 more , Takizawa T, Ha WS, Inagaki M, Lee MJ, Kim BK, Wang YF, Chiang CC, Chen SP, Wang SJ, Chu MK, Takeshima T
Curr Pain Headache Rep · 2026 Apr · PMID 42032384 · Publisher ↗
PURPOSE OF REVIEW: Despite the established efficacy and safety of calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) worldwide, evidence from East Asian countries remains limited and may differ from that...
PURPOSE OF REVIEW: Despite the established efficacy and safety of calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) worldwide, evidence from East Asian countries remains limited and may differ from that in Western countries. RECENT FINDINGS: This narrative review comprehensively summarises clinical trials and real-world studies on CGRP mAbs in East Asian populations. A total of 12 clinical trials and 23 real-world studies on galcanezumab, fremanezumab, and erenumab in East Asia were identified through MEDLINE and manual searches. After reviewing each country’s regulations on CGRP mAb usage, we summarised the findings across several categories and compared them with reports from Western countries: effectiveness, adverse events, patient-reported outcome measures, associated symptoms, patient satisfaction, switching, responder characteristics, and discontinuation. Although effectiveness and safety were comparable, notable differences regarding evidence on switching and responder characteristics were observed, likely attributable to variations in inclusion criteria and study design. Overall, the effectiveness and safety profiles of CGRP mAbs in Japan, South Korea, and Taiwan are comparable to those reported in Western countries. However, differences in regulatory policies significantly influenced the findings of real-world reports, highlighting the importance of region- and country-specific evidence.
Erector Spinae Plane Block for Pain Management in Pediatric Urologic Surgeries: A Narrative Review.
Ahmadzadeh S, Mohammed WK, Azhar SZ … +5 more , Thompson FC, Bartolina R, Parker-Actlis TQ, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2026 Apr · PMID 42032213 · Publisher ↗
PURPOSE OF REVIEW: The erector spinae plane (ESP) block is a relatively novel regional anesthesia technique that has shown promising results in providing postoperative analgesia for pediatric urologic surgeries. Original...
PURPOSE OF REVIEW: The erector spinae plane (ESP) block is a relatively novel regional anesthesia technique that has shown promising results in providing postoperative analgesia for pediatric urologic surgeries. Originally described for thoracic neuropathic pain, the ESP block has since expanded in use related to simplicity, safety, and efficacy across various surgical procedures. RECENT FINDINGS: This review explores the application of the ESP block in pediatric urology, including technique, dosing, indications, comparative advantages, and current evidence from case reports. Particular attention is given to its role in surgeries such as pyeloplasty, nephrectomy, and ureteral reimplantation, where both somatic and visceral pain must be effectively managed. Ultrasound guidance, the use of long-acting local anesthetics, and consideration of patient-specific factors make this technique especially suited for pediatric patients. While case-based evidence supports the block’s analgesic efficacy and opioid-sparing benefits, especially in comparison to traditional neuraxial techniques, limitations remain due to the lack of randomized trials and unclear patterns of anesthetic spread. Further research is needed to standardize practice and confirm the long-term utility of the ESP block in pediatric urologic surgery.
Comparative Analysis of Quadratus Lumborum Versus Epidural Blocks for Postoperative Pain Management in Urologic Surgeries.
Ahmadzadeh S, Folds GT, Mosleh YN … +5 more , Cooper HD, MacDonald EM, Armstrong CJ, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2026 Apr · PMID 42029950 · Publisher ↗
PURPOSE OF REVIEW: To compare quadratus lumborum block (QLB) and epidural block for postoperative analgesia in urologic surgeries, focusing on clinical efficacy, safety, and practical technique selection within contempor...
PURPOSE OF REVIEW: To compare quadratus lumborum block (QLB) and epidural block for postoperative analgesia in urologic surgeries, focusing on clinical efficacy, safety, and practical technique selection within contemporary perioperative care. RECENT FINDINGS: This narrative, literature-based comparative analysis synthesized five single-center randomized controlled trials and related secondary analyses published between 2019 and 2025 that directly compared QLB with epidural block for common urologic procedures, together with recent systematic reviews and meta-analyses. Across radical cystectomy and laparoscopic nephrectomy, posterior and anterior QLB generally provided postoperative pain scores and opioid consumption comparable to epidural block, with several trials reporting more stable hemodynamics, fewer vasopressor interventions, and lower rates of postoperative nausea in QLB groups. In open partial nephrectomy, continuous subcostal anterior QLB did not meet prespecified non-inferiority margins for opioid consumption or pain scores relative to continuous epidural block. The available evidence is limited by small sample sizes, heterogeneity in block techniques and epidural protocols, and a predominant focus on short-term outcomes. CONCLUSION: Current randomized data suggest that QLB is a useful alternative to epidural block for postoperative pain management in selected urologic procedures, particularly when neuraxial techniques are less desirable or contraindicated, whereas epidural block remains the benchmark for more extensive open flank surgery. Technique selection should be individualized according to procedure type, patient comorbidities, and institutional expertise. Larger, standardized multicenter trials are needed to clarify the relative roles of QLB and epidural block within enhanced recovery pathways for urologic surgery.
The Efficacy and Safety of Rimegepant Every Other Day as Preventive Treatment for Migraine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Attar A, Alqsair A, Halabi M … +8 more , Barwais K, Alzaid A, Alshaikhi R, Alamri L, Aljadani H, Alsharif J, Zagzoog N, Aladdin Y
Curr Pain Headache Rep · 2026 Apr · PMID 42024209 · Publisher ↗
BACKGROUND: Rimegepant is an oral CGRP receptor antagonist initially approved for the acute treatment of migraine, demonstrating rapid onset of action and a favorable tolerability profile. Recently, a limited number of r...
BACKGROUND: Rimegepant is an oral CGRP receptor antagonist initially approved for the acute treatment of migraine, demonstrating rapid onset of action and a favorable tolerability profile. Recently, a limited number of randomized controlled trials have evaluated its prophylactic use. The aim of this systematic review and meta-analysis is to assess the effectiveness and safety of rimegepant as a preventive therapy for migraine. METHODOLOGY: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (ID: CRD420251142208). We systematically searched Embase, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Science Direct, and Clinical trials.gov from inception to March 2026. Keywords and MeSH terms were applied to identify randomized controlled trials assessing rimegepant for migraine prevention compared with placebo. Primary efficacy endpoints were the change from the observation period in the mean number of monthly migraine days over the entire study period ( Weeks 1–12 ), in the last month (Weeks 9–12 ), and in the first month (Weeks 1–4 ) Additional primary outcomes include the change from baseline in MSQ scores, the proportion of participants achieving ≥ 50% reduction in moderate to severe migraine attacks from the observation phase, and the reported safety outcomes. RESULTS: Screening of 792 articles yielded four randomized controlled trials comprising 2,365 participants. Rimegepant significantly reduced monthly migraine days compared with placebo : in the first four weeks (MD − 1.49; 95% CI: −1.84 to − 1.15, p < 0.00001; I²=31%), over the entire study period (MD − 0.98; 95% CI: − 1.33 to − 0.64, p < 0.00001; I²=43%), and in the last four weeks (MD − 0.91; 95% CI: −1.39 to − 0.44, p < 0.00001; I²=47%). Migraine Specific Quality-of-life score was improved (MD 4.36; 95% CI: 2.80 to 5.92, p < 0.00001; I²=9%). Responders rate of ≥ 50% reduction in the number of moderate-to-severe migraine attacks : in the last four weeks was higher in rimegepant group (RR 1.19; 95% CI: 1.04 to 1.36, p = 0.010;I²=0) and over the entire study period (RR 1.72; 95% CI: 0.86 to 3.34, p = 0.12;I²=92). Adverse events leading to discontinuation were higher in rimegepant (RR 1.76; 95% CI: 0.90 to 3.46, p = 0.10; I²=0). Rimegepant was associated with higher rates of nausea (RR 2.02; 95% CI: 1.02 to 4.00, p = 0.05; I²=0). CONCLUSION: To our knowledge, this is the first systematic review and meta-analysis evaluating rimegepant for migraine prophylaxis. Rimegepant showed statistically significant pooled effect in reducing monthly migraine days and was associated with improved quality of life. However, further studies are warranted to prove the clinical effectiveness of rimegepant as preventive treatment for migraine.
Efficacy and Safety of Phrenic-Nerve Sparing Blocks vs. Interscalene Brachial Plexus Block for Shoulder Surgery.
Davis JS, Robart J, Ashiru BR … +3 more , Patel PK, Archibald M, Heinz E
Curr Pain Headache Rep · 2026 Apr · PMID 42018194 · Publisher ↗
PURPOSE OF REVIEW: Shoulder arthroplasty is often associated with significant postoperative pain, making effective analgesia a crucial part of surgery day. The interscalene brachial plexus nerve block (ISB) is the gold s...
PURPOSE OF REVIEW: Shoulder arthroplasty is often associated with significant postoperative pain, making effective analgesia a crucial part of surgery day. The interscalene brachial plexus nerve block (ISB) is the gold standard for regional anesthesia in otherwise healthy patients. However, its use is limited by a high incidence of ipsilateral phrenic nerve paralysis, which may result in respiratory compromise, particularly in patients with chronic obstructive pulmonary disease (COPD), reduced pulmonary reserve, or preexisting diaphragmatic dysfunction. The incidence of hemidiaphragmatic paralysis (HDP) is often cited as high as 100% given the location of the phrenic nerve in relation to the brachial plexus roots, which are blocked with an ISB. This review aims to consolidate current evidence on phrenic-sparing nerve block techniques for postoperative analgesia following shoulder arthroplasty. RECENT FINDINGS: Growing interest has emerged in alternative regional anesthesia techniques that minimize phrenic nerve involvement while maintaining adequate analgesia. Several phrenic-sparing approaches have been described in recent literature, with varying degrees of efficacy and safety. These techniques aim to reduce the incidence of hemidiaphragmatic paralysis while still providing clinically meaningful pain control in the postoperative period. These phrenic sparing nerve blocks include the superior trunk block, the suprascapular block, the infraclavicular block, the axillary block, and the erector spinae block when performed either solo or in combination. Phrenic-sparing nerve blocks represent a promising alternative to ISB, particularly for patients at increased risk of respiratory complications. While current evidence supports their potential to provide effective analgesia with reduced diaphragmatic impairment, further high-quality studies are needed to establish optimal techniques and standardize their use in clinical practice.
The Connections Between Pain and Itch: Shared Neuroimmune Mechanisms and Therapeutic Implications.
Abd-Elsayed A, Troka M, Kim J … +3 more , Moghim R, Kaye AD, Reilly M
Curr Pain Headache Rep · 2026 Apr · PMID 42014517 · Publisher ↗
PURPOSE OF REVIEW: Pain and itch are distinct somatosensory modalities with essential protective functions, yet they exhibit substantial neurobiological and clinical overlap. Although traditionally considered separate se...
PURPOSE OF REVIEW: Pain and itch are distinct somatosensory modalities with essential protective functions, yet they exhibit substantial neurobiological and clinical overlap. Although traditionally considered separate sensory systems, accumulating evidence indicates that nociception and pruritus are mediated and modulated by interacting neuronal populations, shared signaling pathways, and common inflammatory mechanisms. This review aims to synthesize current understanding of the convergent peripheral and central processes underlying pain and itch and to highlight their implications for diagnosis and treatment. RECENT FINDINGS: Recent advances have identified overlapping molecular and cellular substrates involved in pain and itch processing, including transient receptor potential (TRP) channels, G-protein–coupled receptors (GPCRs), and neuroimmune signaling mediated by cytokines, mast cells, and glial activation. At the spinal level, inhibitory gating mechanisms that suppress itch in response to noxious stimuli have been elucidated, as well as maladaptive plasticity contributing to central sensitization in chronic pain and chronic pruritus states. Clinically, these shared mechanisms manifest across diverse conditions, including neuropathic disorders, dermatologic diseases, and systemic illnesses, complicating phenotypic differentiation between pain-dominant and itch-dominant presentations. Therapeutic strategies increasingly target overlapping pathways, encompassing gabapentinoids, opioid-modulating agents, biologic therapies, and emerging gene-silencing approaches. Pain and itch represent interconnected sensory experiences supported by shared neurobiological substrates rather than fully independent systems. Integrating mechanistic insights with clinical phenotyping provides a unified framework for understanding these modalities and highlights opportunities for mechanism-based, cross-modal therapeutic strategies. Such an approach may improve diagnostic accuracy and optimize treatment outcomes for complex sensory disorders characterized by overlapping pain and itch phenotypes.
Neuroscientific Basis of Ketamine as an Analgesic and Emerging Role in the Management of Depression.
Coggins NC, Chokr HA, Meyer TA … +3 more , Patel M, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2026 Apr · PMID 42012726 · Publisher ↗
PURPOSE OF REVIEW: Ketamine was originally developed as a dissociative anesthetic and has remained a valuable agent in anesthesia related to its ability to preserve airway reflexes and relative hemodynamic stability. Ove...
PURPOSE OF REVIEW: Ketamine was originally developed as a dissociative anesthetic and has remained a valuable agent in anesthesia related to its ability to preserve airway reflexes and relative hemodynamic stability. Over time, its clinical applications have expanded beyond procedural sedation to include roles in pain management and psychiatry. In pain medicine, the therapeutic rationale is primarily grounded in its noncompetitive antagonism of the N-methyl-D-aspartate (NMDA) receptor and modulation of central sensitization, a key mechanism underlying refractory neuropathic and centralized pain states. RECENT FINDINGS: Evidence from preclinical studies and randomized clinical trials suggests that intravenous ketamine may provide short-term analgesic benefit in the treatment of resistant neuropathic pain, phantom limb pain, and complex regional pain syndrome. Low-dose perioperative administration has demonstrated opioid-sparing effects as part of multimodal analgesia strategies. However, heterogeneity in dosing protocols, variability in duration of response, and limited long-term data restrict definitive recommendations. In psychiatry, ketamine and its S-enantiomer, esketamine, have demonstrated rapid antidepressant effects in patients with major depressive disorder and treatment-resistant depression, further highlighting its evolving therapeutic scope. Despite these promising applications, the use of ketamine requires careful patient selection and monitoring related to dissociative effects, cardiovascular changes, and potential for misuse. This narrative review synthesizes current evidence regarding ketamine’s mechanistic basis and clinical utility across anesthesia, pain management, and psychiatry, with particular emphasis on its role in chronic and perioperative pain. Continued research is needed to clarify optimal dosing strategies, durability of response, and long-term safety across diverse patient populations.
Troubles in the Pocket: Evidence- and Experience-Based Multidisciplinary Expert Consensus Recommendations for Implantable Pulse Generator Placement and Management of Associated Inconveniences.
Kollenburg L, Arnts I, Edelbroek C … +5 more , Milliner C, Matis G, Abd-Elsayed A, Kallewaard JW, Kurt E
Curr Pain Headache Rep · 2026 Apr · PMID 42008196 · Full text
PURPOSE: More than half of patients treated with neuromodulation experience inconveniences related to the implantable pulse generator (IPG). Despite their significance, there is an absence of standardized guidelines and...
PURPOSE: More than half of patients treated with neuromodulation experience inconveniences related to the implantable pulse generator (IPG). Despite their significance, there is an absence of standardized guidelines and recommendations minimizing and/or preventing these issues, reinforcing the continuous burden posed by IPG-related inconveniences. This study aims to provide evidence- and experience-based recommendations for preoperative counselling, implantation site, surgical technique, and management strategies, improving IPG-related inconveniences, by combining a comprehensive literature review with insights gathered from global expert meetings on the topic. METHODS: In this evidence-and experience-based consensus study, a literature analysis was performed using the PubMed, MEDLINE, and EMBASE databases. Experts’ insights on the topic were systematically collected during various expert-based meetings. Recommendations were developed through an integration of literature evidence and clinical expertise, with the aim of preventing and reducing IPG-related inconveniences. The level of evidence for each recommendation has been assessed using the GRADE system and the degree of consensus was evaluated using an independent expert-analysis. RESULTS: A total of 26 articles, published between 2001 and 2024, were included in the literature search. Twenty-six recommendations were formulated. Outcomes emphasized the importance of thorough preoperative counseling, strategic implant site selection, well-considered surgical technique, and tailored postoperative management in reducing the incidence and severity of IPG-related issues. The level of evidence was low to moderate, while the degree of consensus was high for most of the recommendations proposed in this study. CONCLUSIONS: Given the impact of IPG-related inconveniences, clear and practical recommendations are essential for consistent and effective neuromodulation practice.
Brain-Centered Interventions for Nociplastic Pain: From Symptom Management to Pain Resolution.
Thérond A, Yuan C, Aiyer R … +6 more , Hasoon JJ, Yong RJ, Stark-Inbar A, Starnino L, Kulich RJ, Robinson CL
Curr Pain Headache Rep · 2026 Apr · PMID 41996032 · Publisher ↗
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Local Anesthetic Resistance: Pathophysiology, Clinical Recognition, and Management Strategies.
Kanchetty N, DeAngelo A, Davis J
Curr Pain Headache Rep · 2026 Apr · PMID 41995765 · Publisher ↗
PURPOSE OF REVIEW: Local anesthetics (LAs) are a foundational component of surgical pain management and play a critical role in multimodal analgesia, particularly in opioid-sparing perioperative strategies. While general...
PURPOSE OF REVIEW: Local anesthetics (LAs) are a foundational component of surgical pain management and play a critical role in multimodal analgesia, particularly in opioid-sparing perioperative strategies. While generally effective, rare instances of LA resistance have been reported, in which standard doses fail to provide adequate analgesia. This review aims to consolidate current evidence on local anesthetic resistance, including its proposed pathophysiology, diagnostic considerations, and management strategies. RECENT FINDINGS: Most cases of apparent LA failure are attributable to technical factors, such as poor procedural technique, suboptimal dosing, medication errors, or inadequate spread to target nerves. True pharmacologic resistance is exceedingly rare, with potential mechanisms involving alterations in voltage-gated sodium channels. Genetic contributions remain incompletely understood. Local anesthetic resistance has also been observed in patients with certain connective tissue or neuromuscular disorders, including Ehlers–Danlos syndrome, specific muscular dystrophies, and hypermobility disorders. Clinical consequences of resistance include inadequate postoperative pain control, increased opioid consumption, prolonged post-anesthesia care unit stays, unplanned hospital admissions, and reduced patient satisfaction. Although rare, local anesthetic resistance presents a significant challenge to effective perioperative pain management. Awareness of this phenomenon is critical for clinicians to optimize analgesia in affected patients. Current evidence underscores the need for further research to clarify underlying mechanisms, establish reliable diagnostic approaches, and develop tailored management strategies to mitigate its impact on surgical outcomes.
A Review of Chronic Post-Sternotomy Pain Syndrome.
Bui R, Macnojia A, Li T … +3 more , Hasoon J, Khalifa A, Nguyen A
Curr Pain Headache Rep · 2026 Apr · PMID 41973330 · Publisher ↗
PURPOSE OF REVIEW: Chronic post-sternotomy pain syndrome (CPSPS) is a common yet frequently underrecognized complication following cardiac and other intrathoracic procedures requiring median sternotomy. This review cover...
PURPOSE OF REVIEW: Chronic post-sternotomy pain syndrome (CPSPS) is a common yet frequently underrecognized complication following cardiac and other intrathoracic procedures requiring median sternotomy. This review covers current evidence regarding the definition, epidemiology, pathophysiology, risk factors, morbidity, and contemporary management strategies for CPSPS. RECENT FINDINGS: Recent prospective cohort studies and meta-analyses demonstrate that persistent pain after sternotomy remains prevalent despite advances in surgical and perioperative care, with some patients experiencing symptoms for several years. Data demonstrates distinct pain trajectories following cardiac surgery and emphasize the contribution of neuropathic mechanisms and central sensitization. Identified risk factors include younger age, female sex, pre-existing chronic pain, psychological distress, internal mammary artery harvesting, re-sternotomy, prolonged operative duration, and inadequate acute pain control. Regional anesthesia techniques such as thoracic epidural analgesia and thoracic paravertebral blocks can reduce acute pain and opioid consumption, with mixed evidence regarding chronic pain prevention. Other newer modalities such as erector spinae plane blocks, parasternal blocks, peripheral nerve stimulation, and cryoneurolysis show promise but require further study. CPSPS represents a multifactorial pain condition with significant long-term implications for functional recovery, quality of life, and healthcare utilization. Early identification of high-risk patients, optimization of perioperative analgesia, and adoption of multimodal, multidisciplinary management strategies are central to mitigating chronic pain development. Continued investigation into targeted preventive interventions and long-term outcomes is essential to reduce the enduring burden of post-sternotomy pain.
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