Current Pain And Headache Reports[JOURNAL]
Sun
200 papers
Stellate Ganglion Block in the Treatment of Long COVID: A Systematic Review.
Peddireddy S, VanWingerden N, Patel P … +2 more , Howard G, Berger J
Curr Pain Headache Rep · 2026 Apr · PMID 41973314 · Full text
OBJECTIVES: This review evaluates stellate ganglion block as a treatment for long COVID, seeking to evaluate the treatment's efficacy by various symptoms and the limitations of the current literature. STUDY DESIGN: Syste...
OBJECTIVES: This review evaluates stellate ganglion block as a treatment for long COVID, seeking to evaluate the treatment's efficacy by various symptoms and the limitations of the current literature. STUDY DESIGN: Systematic Review. SETTING: Ambulatory or Outpatient Setting. METHODS, SUBJECTS: A systematic review of the current literature regarding use of stellate ganglion block in patients with long COVID was conducted. 2 databases were searched on August 28th, 2025. Search terms were "long COVID" and "stellate ganglion block", yielding 45 results. Studies examining patient outcomes after stellate ganglion block were included. Case reports, case series, basic science studies and previous reviews were excluded. Seven studies met inclusion criteria. RESULTS: Patients received a single stellate ganglion block in some studies and multiple stellate ganglion blocks in others. All studies reported symptomatic improvement without control groups. Response rates ranged from 55.8% to 100%. The most robust improvements (> 80% patients reporting relief) were seen in cough, dyspnea, headache, joint pain, pain interference/intensity, pins/needles, subjective relief. CONCLUSION: Stellate ganglion block is a promising treatment that appears to generate substantive benefit for many of the symptoms seen in long COVID. However, the current literature has small, uncontrolled studies with heterogenous study designs and follow-up periods. Standardized research with larger sample sizes, control groups, and longer-term follow up is necessary to elucidate the degree of benefit. IRB approval and clinical trial registration not required.
Exploring the Dynamic Relationship Between Migraine and Functional Neurological Disorders: A Narrative Review.
Eatz T, Margolesky J, Cocores A
Curr Pain Headache Rep · 2026 Apr · PMID 41973279 · Full text
PURPOSE OF REVIEW: Headache and functional neurologic disorders (FND) are the most diagnosed neurologic disorders, yet their relationship has not been comprehensively detailed. RECENT FINDINGS : Understandings of migrain...
PURPOSE OF REVIEW: Headache and functional neurologic disorders (FND) are the most diagnosed neurologic disorders, yet their relationship has not been comprehensively detailed. RECENT FINDINGS : Understandings of migraine and FND have each progressed tremendously. Headache may be the most common neurologic comorbidity in FND. Migraine may be identified as a predisposing factor and predate FND up to ten years. Schemas have been proposed to explain potential relationship and shared pathophysiologic mechanisms; the disorders share multiple comorbidities. Headache may contribute to disability in FND. Treatment of migraine may improve functional symptoms; both entities respond to multidisciplinary approaches. Migraine and FND commonly coexist, contributing to overall disability and decreased quality of life (QOL). Pathophysiologic interactions may impact management and outcomes. Headache history should be obtained in FND patients; headache when present should be treated appropriately. Future research should evaluate FND in cohorts of headache patients and if headache treatment could improve symptoms and QOL for specific FND phenotypes.
Disparities in Headache Care and Research in Children and Adolescents: A Narrative Review.
Ong B, Khan F, Cheng N … +2 more , Halker Singh RB, VanderPluym JH
Curr Pain Headache Rep · 2026 Apr · PMID 41973164 · Publisher ↗
PURPOSE OF REVIEW: Headache disorders are highly prevalent in children and adolescents and represent a significant source of disability during developmental years. Despite this, disparities in pediatric headache care and...
PURPOSE OF REVIEW: Headache disorders are highly prevalent in children and adolescents and represent a significant source of disability during developmental years. Despite this, disparities in pediatric headache care and research remain insufficiently characterized. This narrative review synthesizes current evidence on inequities across epidemiology, diagnosis, treatment access, and research participation. RECENT FINDINGS: Migraine and tension-type headache contribute substantially to years lived with disability in the pediatric population, with rising absolute burden over time. Important gaps persist between prevalence and formal diagnosis. Underdiagnosis is more common among younger children and among those from lower socioeconomic backgrounds, immigrant families, and marginalized racial and ethnic groups. Structural determinants, including insurance status, geographic maldistribution of specialists, language barriers, and limited caregiver health literacy, contribute to delayed diagnosis and fragmented care. Psychosocial stressors, adverse childhood experiences, discrimination, and pain-related stigma further influence headache frequency, disability, and healthcare engagement. Disparities also extend into pediatric headache research. Racial and ethnic minorities and non-English-speaking families remain underrepresented in clinical trials. Methodological challenges, including high placebo response rates and limited validation of patient-reported outcome measures in diverse populations, complicate evidence generation. Although telehealth and digital tools may expand access, unequal digital infrastructure may also reinforce existing inequities. Reducing differences in pediatric headache requires coordinated policy reform, strengthened primary care capacity, and developmentally informed transition planning. Centering equity in pediatric headache care is essential to improving long-term neurologic and psychosocial outcomes.
Cognitive Dysfunction in Migraine: Underlying Mechanisms and Clinical Implications.
Cuneo A, Robertson CE, Stern JI … +3 more , Krashin D, Siddika A, Murinova N
Curr Pain Headache Rep · 2026 Apr · PMID 41961434 · Publisher ↗
PURPOSE OF REVIEW: Cognitive dysfunction (CD) is a common and disabling, yet under-recognized, symptom of migraine. Difficulty with receptive and expressive language, attention, and memory are reported ictally, while mem...
PURPOSE OF REVIEW: Cognitive dysfunction (CD) is a common and disabling, yet under-recognized, symptom of migraine. Difficulty with receptive and expressive language, attention, and memory are reported ictally, while memory-related deficits are common interictally. Furthermore, migraine-related comorbidities can contribute independently to CD. RECENT FINDINGS: Both subjective patient-reported and objective neuropsychological testing cognitive changes occur in migraine. The pathophysiology of CD in migraine involves altered subcortical activity affecting the hypothalamus, hippocampus, and thalamus, as well as changes in brain network connectivity and energy imbalances. Though some studies suggest benefit for acute and preventive migraine treatments in migraine-related CD, limited data exists. CD is an important aspect of migraine-related disability. Development of validated assessment tools and biomarkers for CD in migraine remains a priority to optimize patient-centered care. Management of migraine-related CD requires a multi-dimensional approach addressing both migraine and comorbidities that can contribute to cognitive symptoms.
Buprenorphine Microinduction Treatment in Tri-Diagnosis Patients with Opioid Use Disorder and Chronic Non-Cancerous Pain.
Lynch P, Murphy A, Syed A … +2 more , Reilly M, Abd-Elsayed A
Curr Pain Headache Rep · 2026 Apr · PMID 41961202 · Publisher ↗
Tri-diagnosis patients cause prevalent economic and healthcare burdens. A tri-diagnosis patient presents with three concurrent conditions: a mental illness, a substance use disorder, and an additional chronic medical con...
Tri-diagnosis patients cause prevalent economic and healthcare burdens. A tri-diagnosis patient presents with three concurrent conditions: a mental illness, a substance use disorder, and an additional chronic medical condition. The medical conditions of interest include chronic non-cancerous pain (CNCP) and co-occurring with opioid use disorder (OUD). These patients are complex to treat, and an intensive outpatient program (IOP) would be appropriate to address the severity of their symptoms. OUD is prevalent among this population, especially for those in poverty, and in the United States generally. However, it is not fully addressed in the United States, and for those who receive treatment, only 25% will receive medication-assisted treatment. Buprenorphine Microdosing Induction (BPMI), often referred to as the Bernese method, is a novel approach traditionally used in opioid use disorder (OUD) treatment. It can serve as medication-assisted treatment for OUD treatment and pain management simultaneously in an IOP. Because buprenorphine is a partial-opioid agonist, it mitigates withdrawal symptoms and side effects of opioid withdrawal while still providing analgesic effects. Furthermore, this article describes the protocol of BPMI for tri-diagnosis patients who are struggling with OUD and chronic pain and explores the substantial positive outcomes and higher efficacy in contrast to opioids.
Efficacy and Risks of Intradiscal Electrothermal Therapy (IDET) for Treatment of Low Back Pain: A Narrative Review.
Litch A, Thomassen A, Sudini S … +8 more , Anwar AI, Broocks KM, Palowsky ZR, Ahmadzadeh S, Chami AA, Shekoohi S, Abd-Elsayed A, Kaye AD
Curr Pain Headache Rep · 2026 Apr · PMID 41954807 · Publisher ↗
PURPOSE OF REVIEW: Chronic low back pain, particularly discogenic pain, remains challenging to treat effectively due to complex underlying mechanisms and variability in patient response. Intradiscal Electrothermal Therap...
PURPOSE OF REVIEW: Chronic low back pain, particularly discogenic pain, remains challenging to treat effectively due to complex underlying mechanisms and variability in patient response. Intradiscal Electrothermal Therapy (IDET) has emerged as a minimally invasive intervention to alleviate discogenic back pain through targeted thermal denaturation of nociceptive nerve fibers and collagen remodeling within the intervertebral disc. The present investigation critically examines existing literature to assess efficacy, safety profile, optimal patient selection criteria, and relative effectiveness compared to alternative minimally invasive treatments such as nucleoplasty and radiofrequency annuloplasty. RECENT FINDINGS: While several randomized controlled trials and meta-analyses suggest IDET provides moderate short-term relief, some studies highlight significant placebo effects and question its long-term efficacy. Notably, careful patient selection, guided by clinical presentation and diagnostic imaging, emerges as a critical factor influencing outcomes. This review addresses potential complications, including rare but serious conditions like cauda equina syndrome and discitis. Emerging techniques such as biacuplasty and radiofrequency annuloplasty are also discussed, contextualizing IDET among other minimally invasive thermal procedures. Further research with rigorous methodological standards and consistent patient criteria is necessary to clarify the clinical utility of IDET and identify the patient populations most likely to benefit from this intervention.
Headache Attributed to Infection: A Clinical and Pathophysiological Overview.
Kozák M, Mechtler L, Ralyea C … +3 more , Bencs V, Hodossy-Takács R, Várkonyi I
Curr Pain Headache Rep · 2026 Apr · PMID 41949738 · Full text
PURPOSE OF REVIEW: This narrative review summarizes current knowledge on infection-related headaches, with focus on classification, clinical presentation, and underlying pathophysiology. As infections increasingly presen...
PURPOSE OF REVIEW: This narrative review summarizes current knowledge on infection-related headaches, with focus on classification, clinical presentation, and underlying pathophysiology. As infections increasingly present with neurological symptoms, recognizing headache as a potential red flag remains essential. RECENT FINDINGS: Headaches attributed to infection range from typical forms such as bacterial meningitis to more subtle parasitic, fungal, or postinfectious entities. The ICHD-3 provides structured diagnostic subtypes, including acute, chronic, and persistent forms. Emerging data on CSF biomarkers and neuroimaging aid in distinguishing secondary headaches from primary mimics. Postinfectious headache, particularly after viral illness or in immunocompromised states, is gaining attention as a long-term sequela. Infectious headaches are clinically diverse and require a structured, classification-based diagnostic approach. Integrating clinical phenotype, imaging, and CSF analysis can support early diagnosis. Further research is warranted to clarify pathogen-specific mechanisms and optimize management.
Epidemiology, Risk Factors, and Management of Pregnancy-Related Chronic Back Pain.
Jung HS, Liongson FAZ, Fonseca A … +7 more , Yuan C, Therond A, Christo PJ, Nguyen A, Kulich RJ, Hasoon JJ, Robinson CL
Curr Pain Headache Rep · 2026 Mar · PMID 41874872 · Publisher ↗
PURPOSE OF REVIEW: Pregnancy-related back pain, defined as musculoskeletal pain arising during pregnancy and primarily attributable to gestational adaptations, is highly prevalent and often perceived as an inevitable, se...
PURPOSE OF REVIEW: Pregnancy-related back pain, defined as musculoskeletal pain arising during pregnancy and primarily attributable to gestational adaptations, is highly prevalent and often perceived as an inevitable, self-limited condition. However, a substantial proportion of individuals develop symptoms that persist beyond 3 months postpartum (herein referred to as pregnancy-related chronic back pain) with significant consequences for physical function, mental health, and quality of life. This narrative review summarizes current evidence regarding the epidemiology, mechanisms, risk factors, and management of pregnancy-related chronic back pain. RECENT FINDINGS: Pregnancy induces biomechanical and hormonal changes that increase susceptibility to such pain conditions. Risk factors for persistent postpartum pain include high pre-pregnancy BMI, multiparity, prior pain history, early onset of gestational symptoms, and psychosocial comorbidities. Management should emphasize multimodal strategies, with first-line interventions including patient education, exercise therapy, lumbopelvic stabilization, and psycho-behavioral approaches. Pharmacologic therapies require careful maternal-fetal risk assessment, and adjunctive or procedural interventions may be considered in refractory cases. Recognizing pregnancy-related chronic back pain as a potentially debilitating condition may improve early identification, targeted prevention, and continued advancement of evidence-based care.
Selective NaV1.8 Inhibition for Pain Management: Current Evidence and Future Potential of Suzetrigine.
Abd-Elsayed A, Hashimoto N, Reilly M … +2 more , Kohr D, Sahin MZ
Curr Pain Headache Rep · 2026 Mar · PMID 41842993 · Publisher ↗
PURPOSE OF REVIEW: Pain is a complex sensory and emotional experience influenced by biological, psychological, and social factors. While NSAIDs, opioids, anticonvulsants, and antidepressants are frequently used for analg...
PURPOSE OF REVIEW: Pain is a complex sensory and emotional experience influenced by biological, psychological, and social factors. While NSAIDs, opioids, anticonvulsants, and antidepressants are frequently used for analgesia, these conventional therapies often fail to provide adequate pain relief for many patients. Moreover, their use is limited by safety concerns and adverse effects, thus emphasizing the need for more targeted non-opioid alternatives. Voltage-gated sodium channel NaV1.8 has emerged as a compelling therapeutic target due to its expression in peripheral nociceptors and its critical role in action potential propagation during inflammatory and neuropathic pain conditions. RECENT FINDINGS: While early drug development efforts were limited by challenges with selectivity and toxicity, technological advancements within the field of pharmacology have enabled the creation of highly selective small-molecule inhibitors. Suzetrigine, approved by the FDA in 2025, is the first highly selective, orally administered NaV1.8 inhibitor, demonstrating potent inhibition of nociceptive signaling without central nervous system (CNS) or cardiac effects. Recent phase 3 trials indicate that suzetrigine provides clinically significant analgesia for moderate to severe acute postoperative pain, with efficacy comparable to opioid therapy but without the risks of respiratory depression, sedation, or dependence. Suzetrigine represents a novel, non-opioid approach to pain management by selectively targeting peripheral nociceptive signaling. This review summarizes the physiological basis of pain, limitations of current analgesics, the rationale for targeting NaV1.8, and the pharmacology, clinical evidence, and emerging therapeutic potential of suzetrigine. Further studies on the use of suzetrigine in chronic neuropathic pain conditions are warranted.
An Updated Review of Utilization Patterns of Sacroiliac Joint Interventions in the Fee-for-service (ffs) Medicare Population from 2000 to 2022.
Manchikanti L, Pampati V, Kaye AD … +5 more , Abd-Elsayed A, Shekoohi S, Sanapati MR, Soin A, Hirsch JA
Curr Pain Headache Rep · 2026 Mar · PMID 41838245 · Publisher ↗
PURPOSE OF THE REVIEW: This updated review evaluates utilization patterns of sacroiliac joint (SIJ) interventions, including SIJ injections, radiofrequency neurolysis, and SIJ fusion, using data from the Centers for Medi...
PURPOSE OF THE REVIEW: This updated review evaluates utilization patterns of sacroiliac joint (SIJ) interventions, including SIJ injections, radiofrequency neurolysis, and SIJ fusion, using data from the Centers for Medicare and Medicaid Services (CMS) and Physician Supplier Procedure Summary (PSPS) database. RECENT FINDINGS: Between 2019 and 2022, Medicare data revealed a notable significant decline in SIJ intervention utilization, with a cumulative drop of 28.9% and an annual decrease of 10.7% per 100,000 beneficiaries. This represents a stark contrast to the minimal 0.4% annual decline observed from 2010 to 2019. The most significant reduction occurred from 2019 to 2020 (− 18.7%), coinciding with the onset of the COVID-19 pandemic. Utilization declined slightly from 2020 to 2021 (− 1.1%), then more sharply again from 2021 to 2022 (− 11.5%). These patterns mirror trends seen in similar studies on epidural and facet joint interventions, which often evaluate SIJ procedures in tandem. While the Medicare population increased by 63.3% from 2000 to 2022, SIJ injections rose by 281% overall during the same period, with an annual increase of 6.3%. However, post-COVID-19 (2019–2022), there was a 13.5% overall decrease in SIJ procedures, averaging a 4.7% annual decline. The largest drop occurred in 2020 (− 19.2%), followed by an 8.3% rebound in 2021, and a subsequent 1.2% decline in 2022. These findings highlight shifting trends in interventional pain management, particularly in response to public health and economic disruptions.
Ultrasound Guided Radiofrequency Ablation of Suprascapular Nerve for Shoulder Pain: A Novel Technique Description.
Abd-Elsayed A, Şahin MZ, Hashimoto N
Curr Pain Headache Rep · 2026 Mar · PMID 41824169 · Publisher ↗
PURPOSE OF REVIEW: Chronic shoulder pain is a widespread and disabling condition that often persists despite conservative treatments. For patients who remain unresponsive, minimally invasive techniques like radiofrequenc...
PURPOSE OF REVIEW: Chronic shoulder pain is a widespread and disabling condition that often persists despite conservative treatments. For patients who remain unresponsive, minimally invasive techniques like radiofrequency ablation (RFA) offer effective and lasting pain relief while avoiding the risks of surgery. Although RFA of the suprascapular nerve has shown promising outcomes, most existing studies have focused primarily on pulsed radiofrequency (RF) compared with nerve blocks or steroid injections. Comprehensive evaluations that include pulsed RF, continuous, and cooled RFA techniques remain limited, particularly given the anatomical variability of the suprascapular nerve. This technical report outlines the procedural techniques and parameters of three RFA modalities (pulsed RF, continuous, and cooled RFA) used to target the suprascapular nerve at either the suprascapular or spinoglenoid notch under ultrasound or fluoroscopic guidance for the treatment of chronic shoulder pain. RECENT FINDINGS: Continuous RFA provides long-lasting pain relief, pulsed RF is preferred for its lower risk of adverse effects, and cooled RFA, which produces broader and more uniform lesions, is especially beneficial in cases of variable nerve anatomy.
Beyond the Procedure: Non-Clinical Complaints and Gender Disparity Dominate One-Star Yelp Reviews of Pain Physicians.
Owens A, Poulter J, Borowski B … +5 more , Koushik S, Viswanath O, Smith M, Kang P, Wilhelmi B
Curr Pain Headache Rep · 2026 Mar · PMID 41811635 · Full text
BACKGROUND: Yelp.com allows patients to review their experiences. Few studies have focused on dissatisfaction in pain medicine. This study aims to characterize one-star Yelp reviews of anesthesiology-trained pain physici...
BACKGROUND: Yelp.com allows patients to review their experiences. Few studies have focused on dissatisfaction in pain medicine. This study aims to characterize one-star Yelp reviews of anesthesiology-trained pain physicians to better understand the scope and nature of extreme patient dissatisfaction. RESULTS: Non-clinical issues comprised the most complaints (n = 927; 70%), while clinical concerns comprised 391 (30%). Office staff communication topped non-clinical complaints (n = 200). Unsatisfactory results (n = 90) topped clinical concerns. Eastern cities like Philadelphia, PA (53%) had the most one-star reviews, whereas Western cities such as Los Angeles, CA (21%) had the lowest. Solo practices were associated with a higher rate of one-star reviews (33%) than group practices (28%). Gender-based analysis showed that female-only practices received significantly more one-star reviews (mean = 12.17) compared to male-only (mean = 2.90) and mixed-gender (mean = 7.00) practices. Poisson regression analysis indicated a higher relative risk of one-star reviews for female providers (RR = 1.00 [ref]), with reduced risk for male providers (RR = 0.58) and increased risk for mixed-gender practices (RR = 1.40; all p < 0.001). CONCLUSION: Patient dissatisfaction is most frequently due to non-clinical experiences. Regional factors, practice type, and physician gender demonstrated significant associations with patterns of patient dissatisfaction. Eastern cities exhibited higher rates of negative reviews. Solo practitioners appeared more susceptible to critical feedback. Female providers seemed to have a disproportionate number of one-star ratings. These trends may reflect underlying systemic and implicit biases and demonstrate vulnerabilities within specific practice models.
Efficacy of Erector Spinae Plane Block for Postoperative Pain Management in Breast Surgeries: A Systematic Review and Meta-analysis.
Ahmadzadeh S, Cooper HD, Asif T … +5 more , Patel NR, Dorius B, Colontonio MM, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2026 Feb · PMID 41739367 · Publisher ↗
BACKGROUND: Postoperative pain after breast surgery is common and can progress to chronic pain. Regional blocks like the erector spinae plane block (ESPB) could attenuate pain while limiting opioid consumption. METHODS:...
BACKGROUND: Postoperative pain after breast surgery is common and can progress to chronic pain. Regional blocks like the erector spinae plane block (ESPB) could attenuate pain while limiting opioid consumption. METHODS: We searched PubMed, OneSearch, and Cochrane Library on May 2, 2025, for randomized controlled trials (2010–2025) evaluating the efficacy of an ESPB for postoperative pain in breast surgery. Thirteen trials (n = 856) met eligibility criteria. Pain (visual analogue or numeric rating scales) at 2, 4, 6, 12, and 24 h, cumulative 24-hour opioid consumption (converted to IV morphine equivalents), and time to first rescue analgesic were extracted. Medians and interquartile ranges (IQRs) were converted to means and standard deviations (SD) with the Wan method; pooled mean differences (MD) were calculated with inverse-variance random-effects models. Certainty was assessed using the GRADE approach; evidence profiles and a Summary of Findings table are provided. RESULTS: Eleven trials were used for the pain analysis. ESPB lowered pain scores from 2 hours (MD -0.83 units, 95% confidence intervals (CI), -1.64 to -0.02) through 24 h (MD -0.45, -0.86 to -0.05). Heterogeneity was high (I2 > 95%). Five trials (n = 332) reported usable opioid data; ESPB reduced 24-hour opioid consumption by approximately − 2.1 mg IV morphine equivalents (-4.3 to 0.2, p = 0.07). Six trials (n = 402) showed ESPB delayed rescue analgesia by 3.64 h (0.71 to 6.56). Sensitivity analyses excluding high-risk studies yielded comparable results. Evidence certainty was moderate for pain, but low for opioid and rescue analgesia outcomes. CONCLUSION: ESPB provides modest yet clinically relevant reductions in pain for the first 24 h after breast surgery and prolongs the interval before additional analgesia is required, with a trend toward opioid sparing. Given its technical simplicity and favorable safety profile, the ESPB represents a practical addition to multimodal enhanced recovery pathways. Larger, head-to-head trials are needed to refine effect sizes and explore long-term outcomes.
Integrating Pain Prehabilitation into Surgical Pathways: Current Modalities, Outcomes, and Research Gaps.
Sosa EA, Henick A, Binda DD … +12 more , Joseph C, Kim S, Mathew D, Nair S, Kim J, Adams DC, Gritsenko K, Kaye AD, Yener U, Ciftci HB, Wahezi SE, Shaparin N
Curr Pain Headache Rep · 2026 Feb · PMID 41656443 · Full text
PURPOSE OF REVIEW: Prehabilitation constitutes a multidisciplinary strategy aimed at improving physiological and psychological readiness prior to surgery. Within pain medicine, prehabilitation provides an opportunity to...
PURPOSE OF REVIEW: Prehabilitation constitutes a multidisciplinary strategy aimed at improving physiological and psychological readiness prior to surgery. Within pain medicine, prehabilitation provides an opportunity to address modifiable pain-related and functional risk factors prior to major procedures. This narrative review synthesizes contemporary evidence on prehabilitation modalities, their impact on surgical and pain-relevant outcomes, and persistent knowledge gaps limiting integration into perioperative pain pathways. RECENT FINDINGS: A targeted PubMed search was performed on June 25, 2025. Supplementary exploratory searches in Web of Science and Scopus did not identify unique eligible studies beyond those already captured in PubMed. After excluding non-original reports and studies lacking outcome data, 153 clinical studies were included. The most frequently represented surgical specialties were general surgery (43%), orthopedic surgery (21%), and cardiothoracic surgery (18%). Single-modality prehabilitation was reported in 43% of studies, whereas multimodal approaches varied by specialty, occurring in 36% of general surgery studies and 13% of cardiothoracic surgery studies. Five principal prehabilitation modalities were identified: exercise, nutrition, psychological intervention, substance cessation, and medical optimization. Exercise-based interventions were the most common, incorporated in 84.7% of studies, followed by nutritional interventions in 29.5%. Overall, 82% reported improvements in at least one postoperative or functional outcome, although pain-specific endpoints were inconsistently reported. Prehabilitation appears beneficial across surgical specialties; however, pain outcomes remain underreported, and multimodal programs remain limited. Future work should standardize pain endpoints and evaluate multimodal interventions to guide integration of prehabilitation into perioperative pain management pathways.
Pivotal Factors for Minimizing the Risks of Therapeutic Failure in Trigeminal Neuralgia and Hemifacial Spasm.
Pătrășcan AM, Brehar FM, Gorgan RM
Curr Pain Headache Rep · 2026 Feb · PMID 41642504 · Publisher ↗
PURPOSE OF REVIEW: Despite the scarce literature regarding the matter, this current article identifies the most important factors that lead to the best outcomes in the therapeutic approach of trigeminal neuralgia and hem...
PURPOSE OF REVIEW: Despite the scarce literature regarding the matter, this current article identifies the most important factors that lead to the best outcomes in the therapeutic approach of trigeminal neuralgia and hemifacial spasm. However, notwithstanding the central focus lies on the neurosurgical perspective, the authors also integrate insights from adjacent medical specialties. Thus, the main objective of this comprehensive narrative review is to enhance understanding of the factors that can dramatically influence the course of these conditions. RECENT FINDINGS: This article provides a state-of-the-art perspective regarding the therapeutic management of trigeminal neuralgia and hemifacial spasm. Preoperative diagnosis has the first pivotal role in managing this condition, and 3D multimodal image fusion based on Time-Of-Flight Magnetic Resonance Angiography (TOF MRA) with high-resolution T2-weighted imaging has been proven to be the most effective and accurate method. Focusing on the correct therapeutic approach is the second pivotal factor, given that the therapeutic options comprise various approaches ranging from oral medication to neurosurgical microvascular decompression. It has been concluded that microvascular decompression remains the most effective treatment for drug-resistant trigeminal neuralgia and hemifacial spasm. Pain freedom is achieved in around 76-84% of patients, and long-term durability remains substantial, with 64-73% still pain-free at ten years, particularly when the compression is arterial rather than venous. The endoscopic approaches demonstrated efficacy in selected cases, while combined procedures such as MVD with partial sensory rhizotomy may increase numbness without improving long-term results. Systematic reviews concluded that radiosurgery and percutaneous procedures can provide pain relief in many patients, but with less durable outcomes. Altogether, these findings support MVD as the cornerstone surgical therapy while underlining the importance of careful patient selection and modern adjuncts to maximize success. When the neurosurgical intervention represents the treatment option for trigeminal neuralgia or hemifacial spasm, several pivotal factors must be taken into account in order to provide the best clinical results with minimal to no complications.
Perioperative Management of Patients on Buprenorphine.
Vadivelu N, Mydlo N, Dextras C … +7 more , Ng J, Silverman M, Kodumudi G, Chowdhari S, Hines R, Thomas DA, Hickey T
Curr Pain Headache Rep · 2026 Feb · PMID 41642407 · Publisher ↗
PURPOSE OF THE REVIEW: Our review discusses the pharmacologic profile of buprenorphine, then dives into the current literature regarding buprenorphine's use to treat chronic pain, opioid use disorder, and acute postopera...
PURPOSE OF THE REVIEW: Our review discusses the pharmacologic profile of buprenorphine, then dives into the current literature regarding buprenorphine's use to treat chronic pain, opioid use disorder, and acute postoperative pain. We aim to focus on how that literature may influence the perioperative management of patients on buprenorphine and prompt reconsideration of buprenorphine as a frontline opioid analgesic. RECENT FINDINGS: Buprenorphine has been used effectively for both acute and chronic pain management, for the treatment of opioid withdrawal, and for the treatment of opioid use disorder due to its unique pharmacological profile. Historically, there has been controversy over the best practice recommendations for buprenorphine use in the perioperative setting, though the data now overwhelmingly refutes the full discontinuation of buprenorphine preoperatively. It has also been seen in recent times that buprenorphine is at least as effective as usual care opioids for acute pain management, with important safety advantages. Expanding our analgesic toolkit to more thoroughly understand the unique mechanism of action and properties of buprenorphine is paramount in our treatment of perioperative pain in both opioid-naïve and opioid-tolerant patients.
Perioperative Pain Management in Non-Operating Room Anesthesia (NORA) Settings.
Vadivelu N, Mydlo N, Rosales I … +5 more , Kodumudi G, Rao S, Lockwood N, Hung KW, Muniraj T
Curr Pain Headache Rep · 2026 Feb · PMID 41642390 · Publisher ↗
PURPOSE: The purpose of this review is to present an updated overview of the literature concerning the safe and effective management of perioperative pain in NORA settings. The increasing demand for minimally invasive pr...
PURPOSE: The purpose of this review is to present an updated overview of the literature concerning the safe and effective management of perioperative pain in NORA settings. The increasing demand for minimally invasive procedures, driven by advancements in technology, has led to the growing utilization of non-operating room anesthesia (NORA) across multiple medical disciplines. RECENT FINDINGS: Despite the growing utilization, there is a notable dearth of literature regarding the outcomes of NORA cases, particularly regarding pain management. NORA environments, such as bronchoscopy suites, magnetic resonance imaging (MRI) facilities, interventional cardiology suites, and gastrointestinal (GI) endoscopic units managing conditions like masses, cancers, and bleeding, present distinct challenges for effective pain control. Anesthesiology providers must exhibit adept familiarity and attentiveness, and be vigilant and prepared for diverse NORA settings, some of which may suffer from understaffing, inadequate infrastructure, or remote accessibility, potentially compromising patient outcomes. Further investigation into pain management strategies for NORA patients is imperative. The adaptation and progression of pain services within the dynamic healthcare landscape of NORA, characterized by continual evolution and shifting paradigms, are essential to meet the evolving demands of patient care effectively.
The Management of Myogenous Temporomandibular Disorders with Botulinum Toxin: A Narrative Review and Management Recommendations.
Mathew PG, Romero-Reyes M, Virk AS … +7 more , Manrriquez SL, Duarte RA, Teruel A, Merrill RL, Robertson CE, Tanenbaum D, Cohen R
Curr Pain Headache Rep · 2026 Feb · PMID 41636950 · Publisher ↗
PURPOSE OF REVIEW: To describe the use of botulinum toxin (BTX) injections for the management of myogenous temporomandibular disorders (TMD) based on current evidence and clinical practice. RECENT FINDINGS: Onabotulinum...
PURPOSE OF REVIEW: To describe the use of botulinum toxin (BTX) injections for the management of myogenous temporomandibular disorders (TMD) based on current evidence and clinical practice. RECENT FINDINGS: Onabotulinum Toxin Type A (OBTX) is approved by the Food and Drug Administration (FDA) for the treatment of chronic migraine using an evidence-based standardized injection paradigm. OBTX is widely used by dental and medical clinicians for the management of Temporomandibular Disorders (TMD) despite not being FDA approved for this indication. There are currently no clear guidelines for indications of use and no standardized injection protocols. A literature review using Pubmed was conducted regarding the use of BTX for the management of TMD. The review included retrospective studies, systematic reviews, meta-analysis, clinical trials, and basic science studies that were published after 1990. Based on the available literature, BTX can be effective for TMD management in cases of myogenous TMD and significant bruxism that have been refractory to conventional therapy as well as in cases of TMD in the setting of comorbid headache disorders when conventional treatment has not been effective in managing the TMD component. Special procedural considerations, including the use of EMG guidance, may be necessary for certain masticatory muscle injections, such as the medial and lateral pterygoid muscles. There are currently no standardized injection protocols. BTX injections can involve potential long-term risks including loss of bone density and changes in muscle structure, but there are no prospective studies that evaluate its long-term consequences. CONCLUSIONS: BTX is not a first-line treatment nor standard of care for the management of TMD. Further research, including prospective studies and randomized clinical trials are needed to delineate clear indications, injection paradigms, as well as the potential risks with the long-term use of BTX in TMD management. In refractory cases, evaluation by an orofacial pain specialist or clinician familiar with TMD to establish a proper diagnosis is critical for appropriate patient selection and optimization of the use of BTX.
Efficacy and Safety of Melatonin in Migraine Prophylaxis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Abouelmagd ME, Aldemerdash MA, Khatatbeh AA … +6 more , Osman ASA, Abbas A, Allam S, AlEdani EM, Aldemerdash A, Monteith TS
Curr Pain Headache Rep · 2026 Feb · PMID 41627537 · Full text
BACKGROUND: Migraine is a chronic, disabling brain disorder. Melatonin, a circadian regulator with anti-inflammatory and antinociceptive actions, has been proposed for migraine prevention. We evaluated the efficacy and s...
BACKGROUND: Migraine is a chronic, disabling brain disorder. Melatonin, a circadian regulator with anti-inflammatory and antinociceptive actions, has been proposed for migraine prevention. We evaluated the efficacy and safety of melatonin for prophylaxis. METHODS: We systematically searched PubMed, Cochrane, Scopus, Embase, and Web of Science (September 29, 2024) for randomised controlled trials (RCTs) comparing melatonin with placebo or other active drugs. Outcomes were analysed as change from baseline to last follow-up using mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). RESULTS: Nine RCTs (n = 788) were included. Versus placebo, melatonin reduced attack duration (MD -4.98 h; 95% CI -9.30 to -0.67; p = 0.02), headache days (MD -1.54 days; 95% CI -2.50 to -0.58; p < 0.01), headache severity (MD -2.08; 95% CI -2.91 to -1.26; p < 0.01), and analgesic use (MD -1.38; 95% CI -2.41 to -0.36; p < 0.01). Melatonin also increased the response rate (≥ 50% reduction in monthly headache frequency) (RR 1.38; 95% CI 1.11-1.70; p < 0.01) and improved sleep quality (PSQI: MD -1.64; 95% CI -2.85 to -0.42; p = 0.008) and disability (MIDAS: SMD - 4.07; 95% CI -5.45 to -2.69; p < 0.001). Compared with amitriptyline, melatonin was generally less effective for attack duration and severity, with no consistent advantage on analgesic use or response; however, melatonin showed a more favourable tolerability profile, including lower risk of sleepiness (RR 0.49; 95% CI 0.28-0.87; p = 0.01). CONCLUSIONS: Melatonin demonstrates benefits over placebo for reducing migraine burden and improving patient-reported outcomes, with a favourable safety profile. While amitriptyline remains more potent for several efficacy endpoints, melatonin represents a reasonable preventive option, particularly as an adjunct during titration of first-line agents. Further head-to-head trials with standardised dosing and longer follow-up are warranted.
Pain-Related Social and Behavioral Changes: a Complex Interplay.
Abd-Elsayed A, Pawar N, Hasoon J … +3 more , Pritzlaff S, Saasouh W, Bianco GL
Curr Pain Headache Rep · 2026 Jan · PMID 41591584 · Publisher ↗
PURPOSE OF REVIEW: Behavioral lifestyle factors such as physical activity, stress, sleep, and nutrition are increasingly recognized as essential contributors to chronic pain. Their influence on chronic pain highlights it...
PURPOSE OF REVIEW: Behavioral lifestyle factors such as physical activity, stress, sleep, and nutrition are increasingly recognized as essential contributors to chronic pain. Their influence on chronic pain highlights its widespread, modifiable nature, affecting large population segments. This reinforces chronic pain as a significant public health issue and its socioeconomic impact and need for population-level prevention strategies. Pain is inherently subjective, and pain research traditionally relies on the self-reported pain score as a common primary outcome. This provides an incomplete measure of the impact of pain interventions on these challenges. RECENT FINDINGS: Neuroimaging studies reveal structural brain changes in chronic pain generally via maladaptive synaptic plasticity. Targeting brain regions such as the anterior cingulate cortex, amygdala, and the rostral ventromedial medulla and their associated receptors offers promising new avenues for treating chronic pain, especially when emotional and stress-related components are involved. Understanding the interplay between neurological and biopsychosocial mechanisms can help us create and evaluate targeted interventions that address both neural and emotional contributors to pain. The biopsychosocial model, which considers biological, psychological, and social factors, is fundamental to chronic pain research. It emphasizes recognition of all three of these factors and the significant influence they each have on pain severity, disability, emotional distress, work status, and healthcare utilization. As a result, behavioral and cognitive-behavioral treatments have become essential components of many interdisciplinary treatment centers and behavioral medicine clinics, though access remains limited in some areas. Biopsychosocial approaches recognize pain-related behaviors are shaped by past experiences and current circumstances, with cognitive, affective, and sensory factors playing key roles-consistent with the principles of the neuromatrix theory Melzack (J Dent Educ. 2001;65:1378-82, 2001). Effective chronic pain treatment goes beyond simply reducing pain-it helps patients manage their condition in ways that support meaningful daily activities, reduce emotional distress, and promote responsible healthcare use. A comprehensive, interdisciplinary approach may be beneficial for delivering treatment that effectively helps people manage chronic pain. Herein, we highlight the multifaceted nature of chronic pain-its neurobiological foundations, behavioral influences, and social implications-underscoring the importance of integrating cognitive, affective, and sensory dimensions in understanding and treating chronic pain.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe