Current Pain And Headache Reports[JOURNAL]
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200 papers
Mobile Health and Gamification of Chronic Pain Management: A Narrative Review.
Jung HS, Schatman ME, Liongson FAZ … +10 more , Kritzer MD, Yong RJ, Davis D, Kaye AD, Lee KWK, Issa M, Crowther JE, Bianco GL, Christo PJ, Robinson CL
Curr Pain Headache Rep · 2025 Jul · PMID 40742413 · Publisher ↗
PURPOSE OF REVIEW: The current literature on gamifying mobile health (mHealth) applications to address chronic pain management is evaluated in this narrative review. These approaches include utilizing wearable devices to...
PURPOSE OF REVIEW: The current literature on gamifying mobile health (mHealth) applications to address chronic pain management is evaluated in this narrative review. These approaches include utilizing wearable devices to track progress of various biomarkers, collecting digital rewards for utilizing in-app self-management educational tools, completing challenges to encourage the use of mental health resources, and leaderboards to promote shared learning and overcome social withdrawal. RECENT FINDINGS: There continues to be a growing emphasis on the collaboration between patients with chronic pain and physicians to form comprehensive management strategies to address patients' unique pharmacological, physical, and psychosocial needs. Despite the accessibility of mHealth apps, they usually fail to integrate easily into a patient's lifestyle. Moreover, there is promise for enhanced psychosocial support through mHealth apps. A small fraction of chronic pain mHealth apps have utilized principles of gamification to motivate patients to adhere to care plans. Evidence suggests that incorporating game-like elements in future mHealth app designs must be prioritized to improve user engagement and subsequently facilitate positive health behaviors and outcomes for more effective pain control.
The Administration of an Expectation Survey at a Pain Medicine Clinic to Improve Patient Satisfaction: A Prospective Study.
Borukh E, Nguyen P, Yeon Sim G … +9 more , Patel J, Bloomfield A, Koushik SS, Raghavan J, Viswanath O, Zacharoff K, Slinchenkova K, Gritsenko K, Shaparin N
Curr Pain Headache Rep · 2025 Jul · PMID 40736701 · Full text
PURPOSE OF REVIEW: Patients' expectations are important aspects to consider for improving patients' satisfaction and willingness to return for continued care. While expectation surveys are not novel in Pain Medicine, non...
PURPOSE OF REVIEW: Patients' expectations are important aspects to consider for improving patients' satisfaction and willingness to return for continued care. While expectation surveys are not novel in Pain Medicine, none specifically aim to improve satisfaction. This study evaluates whether administering an expectation survey during an initial pain clinic visit improves satisfaction with treatment plans and outcomes. We hypothesized that completing the survey could increase awareness and help align expectations and satisfaction. RECENT FINDINGS: This study was conducted at an outpatient multidisciplinary pain clinic at an urban academic hospital and 100 first-time, English speaking adult patients were recruited. Fifty patients completed a pre-visit questionnaire on pain and expectations (intervention group), while 50 did not (control group). A follow-up survey was completed six months later by 85% of participants to assess satisfaction level with pain treatment, meeting of goals and expectations, and overall clinic experience. No significant differences were found between intervention and control groups for pain treatment satisfaction (3.46 ± 1.31 vs. 3.50 ± 1.28, p = 0.48), goal achievement (3.76 ± 1.14 vs. 3.49 ± 1.20, p = 0.30), or overall experience (3.83 ± 1.20 vs. 3.72 ± 1.14, p = 0.67). Dissatisfaction stemmed from inadequate pain relief, lack of follow-up, and unmet expectations. The lack of statistical significance suggests that merely assessing expectations without patient education or provider engagement may be insufficient. Future studies could explore how patient education, communication, and treatment understanding can impact satisfaction to potentially improve pain management experiences.
Stellate Ganglion Block for Management of Nicolau's Syndrome Following Intravenous Ibuprofen Injection: a Case Report and Literature Review.
Shehata IM, Hassan SA, Rabie RAE … +2 more , Hasoon J, Abd-Elhak AA
Curr Pain Headache Rep · 2025 Jul · PMID 40715857 · Publisher ↗
PURPOSE OF THE REVIEW: Nicolau's syndrome (NS) is a rare but serious drug reaction that occurs after administration of many drugs through various routes, with a broad spectrum of manifestations ranging from severe pain u...
PURPOSE OF THE REVIEW: Nicolau's syndrome (NS) is a rare but serious drug reaction that occurs after administration of many drugs through various routes, with a broad spectrum of manifestations ranging from severe pain up to skin necrosis. In this review, we reported a case of advanced-grade NS following intravenous injection of ibuprofen. Moreover, we reviewed the existing knowledge and current practice to present in-depth any possible pathogeneses involved in this condition and highlight the specific pharmacological properties of the offending drugs that may play a role in the development of this syndrome. Eventually, we provided recommendations to prevent and treat the incidence of NS, with a focus on the therapeutic role of stellate ganglion block as a novel intervention in such cases. RECENT FINDINGS: We reported a case of Nicolau's syndrome after iatrogenic intravenous injection of ibuprofen, which caused severe upper limb ischemia. Notably, the condition was successfully managed with stellate ganglion block, representing a promising effective approach in the management of this serious complication. Early Stellate ganglion block may help in treating this condition effectively with its vasodilatory effect. To our knowledge, it is the first time stellate ganglion block has been implemented in managing this syndrome, fostering new hope in curing these cases.
Risk Factors and Consequences of Cutaneous Allodynia among Individuals with Migraine: A Scoping Review.
Sruthi KS, Rajkumar E, Gopi A … +2 more , Julia GJ, Romate J
Curr Pain Headache Rep · 2025 Jul · PMID 40694183 · Publisher ↗
PURPOSE OF REVIEW: Cutaneous allodynia is a frequent complaint among individuals with migraine and serves as a critical marker of central sensitization, which plays a pivotal role in migraine pathophysiology. This can ex...
PURPOSE OF REVIEW: Cutaneous allodynia is a frequent complaint among individuals with migraine and serves as a critical marker of central sensitization, which plays a pivotal role in migraine pathophysiology. This can exacerbate migraine severity and diminish quality of life. Understanding the risk factors associated with cutaneous allodynia is essential, as it can help identify individuals at higher risk of developing this condition and guide early intervention strategies. Identifying its consequences provides critical insights into disease progression, treatment response, and disability. Hence, this scoping review aimed to determine the risk factors and consequences of cutaneous allodynia in individuals with migraine. RECENT FINDINGS: A total of 47 studies were included from the 2116 retrieved studies. Most of the studies adopted a cross-sectional design (n = 29). Other designs included cohort (n = 8), longitudinal (n = 4), experimental (n = 2), qualitative (exploratory) (n = 2), and observational (n = 1) research designs. Most participants were individuals diagnosed with migraine aged 18–65 (n = 40), and some studies included the pediatric population (n = 5). The study highlighted various risk factors such as psychological, migraine-associated, neurophysiological, biological, socio-demographic, and lifestyle-related factors. The identified consequences were classified as mental health, physical health, neurophysiological, migraine-associated, and treatment-related consequences. The evaluation of risk factors and consequences of cutaneous allodynia among individuals with migraine significantly highlighted the multidimensional risk factors of cutaneous allodynia and its debilitating effects on the lives of the affected individuals. These factors are significant for designing targeted, multifaceted interventions for managing cutaneous allodynia and thus provide an essential step in effective migraine management.
A Pain in the Neck: Occipital Neuralgia vs. Cervicogenic Headache vs. Migrainous Cervicalgia.
Mathew PG, Sailesh S
Curr Pain Headache Rep · 2025 Jul · PMID 40691746 · Publisher ↗
PURPOSE OF REVIEW: Occipital neuralgia, cervicogenic headache, and migraine are disorders that are commonly accompanied by neck pain. Although these disorders may present with similar features, coexist in the same patien...
PURPOSE OF REVIEW: Occipital neuralgia, cervicogenic headache, and migraine are disorders that are commonly accompanied by neck pain. Although these disorders may present with similar features, coexist in the same patient, and have variable degrees of involvement of the C2 and C3 nerve roots, it is important to distinguish between these three entities, as the presumed diagnosis can lead to different diagnostic and therapeutic modalities. RECENT FINDINGS: Occipital neuralgia in particular is underdiagnosed, occipital nerve blocks are underutilized, and technical aspects that can influence the efficacy of occipital nerve blocks are not taught in most clinical training programs. There are often significant delays in referring refractory cases for interventional and surgical management. In patients presenting with headache and neck pain, making an accurate diagnosis is critical in order to optimize management. Without addressing comorbid diagnoses, patients tend to have suboptimal responses to both acute and preventative headache pharmacological therapies.
Efficacy and Clinical Role of Rhomboid Intercostal Nerve Block for Postoperative Pain Management: a Narrative Review.
Kaye AD, Ilochi J, Thomassen A … +5 more , Thomas NL, DeOliveira SI, Robichaux C, Ahmadzadeh S, Shekoohi S
Curr Pain Headache Rep · 2025 Jul · PMID 40691403 · Publisher ↗
PURPOSE OF REVIEW: This narrative review evaluates the efficacy and clinical applications of the rhomboid intercostal nerve block (RINB) for postoperative pain management. With growing interest in ultrasound-guided regio...
PURPOSE OF REVIEW: This narrative review evaluates the efficacy and clinical applications of the rhomboid intercostal nerve block (RINB) for postoperative pain management. With growing interest in ultrasound-guided regional anesthetic techniques, RINB has emerged as a promising approach for thoracic, abdominal, and breast surgeries. We aim to synthesize current evidence on its analgesic effectiveness, opioid-sparing potential, and comparative advantages. RECENT FINDINGS: An ultrasound guided rhomboid intercostal nerve block (RINB), delivers anesthetic into the intercostal muscles to relieve chest wall pain, including thoracoscopic, abdominal, and mastectomy surgeries. Anesthetic delivered between the rhomboid major and intercostal muscle demonstrated clinical efficacy resulting in improved patient recovery, post-operative analgesia, and reduced opioid consumption. Clinical studies have demonstrated that RINB has comparable and even more effective analgesic efficacy of previously utilized ultrasound guided nerve blocks with an excellent safety profile in patients receiving thoracoscopic, abdominal, and mastectomy surgeries.
Clinical Efficacy and Risks of Intradiscal Orthobiological Injections: A Narrative Review.
Serio MA, Bartolina R, Sudini S … +5 more , MacDonald EM, Thomassen AS, Shekoohi S, Chami AA, Kaye AD
Curr Pain Headache Rep · 2025 Jul · PMID 40646365 · Publisher ↗
PURPOSE OF REVIEW: Chronic discogenic low back pain (LBP) is a common cause of disability worldwide. Current management options include conservative, surgical, and minimally invasive interventional injections. Intradisca...
PURPOSE OF REVIEW: Chronic discogenic low back pain (LBP) is a common cause of disability worldwide. Current management options include conservative, surgical, and minimally invasive interventional injections. Intradiscal orthobiological injections of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cells (MSCs) have been introduced as regenerative treatment options. RECENT FINDINGS: Many studies have demonstrated improvements in patients' reported outcomes (PROMs) measuring the areas of pain, disability, function, and satisfaction. The results are promising with statistical improvements shown throughout various studies. Adverse events such as increased pain and infection have been reported with these injections; however, the complication rate has yet to be delineated. Numerous studies report no adverse events in their sample size. The present investigation summarizes recent evidence for the efficacy and risks of PRP, BMAC, and MSC injections.
Clinical Implications of Antidepressants and Associated Risk of Bleeding: A Narrative Review.
Kaye AD, Cooper HD, Mashaw SA … +5 more , Anwar AI, Hollander AV, Thomassen AS, Singh A, Shekoohi S
Curr Pain Headache Rep · 2025 Jun · PMID 40560485 · Publisher ↗
PURPOSE OF REVIEW: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are widely prescribed for mental health disorders. These medicati...
PURPOSE OF REVIEW: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are widely prescribed for mental health disorders. These medications, however, are linked to increased bleeding risks related to inhibition of serotonin reuptake, which impairs platelet aggregation. The present investigation explores the pharmacodynamics of antidepressants, clinical evidence of bleeding complications, and strategies to manage these risks. RECENT FINDINGS: While SSRIs and SNRIs pose the highest risk, tricyclic and atypical antidepressants show comparatively lower bleeding incidences. The concomitant use of anticoagulants, NSAIDs, or antiplatelet agents significantly amplifies bleeding risk. Current guidelines stress individualized risk assessment, alternative drug selection, and preventive measures, such as gastroprotective agents. Future research may offer novel approaches to mitigate bleeding while maintaining therapeutic efficacy, ensuring the safety of antidepressants in clinical practices.
Lumbar Radiofrequency Ablation (LRFA)- Myths and Facts: A Narrative Review of the Literature.
Tieppo Francio V, Leavitt L, Radlicz C … +2 more , Gill B, Sayed D
Curr Pain Headache Rep · 2025 Jun · PMID 40560301 · Publisher ↗
PURPOSE OF REVIEW: Lumbar radiofrequency ablation (LRFA) is an interventional procedure that utilizes thermal energy to selectively ablate the lumbar medial branch nerves (LMBN) to provide relief from facet-mediated chro...
PURPOSE OF REVIEW: Lumbar radiofrequency ablation (LRFA) is an interventional procedure that utilizes thermal energy to selectively ablate the lumbar medial branch nerves (LMBN) to provide relief from facet-mediated chronic axial low back pain. While LRFA is widely performed, considerable variability exists in its technical execution. This review aims to synthesize the current literature on key device- and procedure-related factors that influence radiofrequency lesioning and to clarify common misconceptions regarding LRFA. RECENT FINDINGS: Emerging evidence suggests that several device-related parameters-including cannula and needle size, active tip length, temperature settings, lesioning duration, and needle angulation-affect lesion size and clinical outcomes. However, the impact of adjunctive steroid administration on lesion characteristics and therapeutic efficacy remains inconclusive. Furthermore, while some concerns have been raised regarding the potential for LRFA to accelerate spinal degeneration, definitive evidence is lacking. There is, however, a plausible association between LRFA and multifidus atrophy. The use of motor testing prior to ablation is warranted. Current data support the safety of LRFA in patients with posterior spinal instrumentation and implantable devices. Device- and procedure-specific variables may significantly influence LRFA lesion characteristics and clinical outcomes. While the safety profile of LRFA is generally favorable, potential complications exist, underscoring the need for a nuanced understanding of optimal procedural techniques. Despite its widespread adoption, misconceptions persist regarding optimal approaches, safety considerations, and determinants of efficacy. This review critically evaluates the existing literature to address these controversies and provide an evidence-based perspective on LRFA.
Low Dose Naltrexone In The Management Of Chronic Pain Syndrome: A Meta-Analysis Of Randomized Controlled Clinical Trials.
Hegde NC, Mishra A, V D … +3 more , Maiti R, Hota D, Srinivasan A
Curr Pain Headache Rep · 2025 Jun · PMID 40540205 · Publisher ↗
OBJECTIVE: Chronic pain conditions are among the leading causes of years lost to disability. Low Dose Naltrexone (LDN) has anti-inflammatory and immunomodulatory properties. LDN, by blocking Toll-Like Receptors (TLR), pr...
OBJECTIVE: Chronic pain conditions are among the leading causes of years lost to disability. Low Dose Naltrexone (LDN) has anti-inflammatory and immunomodulatory properties. LDN, by blocking Toll-Like Receptors (TLR), prevents central sensitization and conversion of acute pain state to a state of chronic pain. This meta-analysis compared LDN's effectiveness in chronic pain syndromes based on published randomized trials. METHOD: Seven studies were included after a systematic search and screening from PubMed, Embase, Scopus, Cochrane, and clinical trial registries. The efficacy outcome analyzed was the standardized mean difference (SMD), the Cohen's d, of change in pain scores between LDN and the comparator drugs using the random-effect model. Subgroup analyses by condition type and comparator were performed to analyze the effect of LDN. Adverse events were evaluated using incidence rate ratio(IRR), publication bias by funnel plot, risk of bias by Cochrane Risk of Bias tool version 2.0, and certainty of evidence by GRADE evaluation. RESULTS: LDN did not show a significant difference in pain response compared to control groups [d = -0.11 (95%CI -0.96 to 0.74); P = 0.31]. In fibromyalgia, LDN had improvement compared to placebo [d = -0.34 (95%CI -0.62 to -0.06); P = 0.0186]. Against active comparators, LDN had no difference [d = 0.67 (95% CI -4.69 to 6.02); P = 0.35]. Adverse events were increased with LDN compared to placebo [IRR = 1.4 (95% CI 1.12 to 1.75); P = 0.0026] but comparable to active comparators [IRR = 0.55 (95% CI 0.04 to 7.31); P = 0.65]. CONCLUSION: LDN is better than placebo in fibromyalgia pain management, and LDN is similar to active controls in chronic pain management. PROSPERO REGISTRATION NUMBER: CRD42024511451.
Emerging Clinical Roles of Gabapentin and Adverse Effects, Including Weight Gain, Obesity, Depression, Suicidal Thoughts and Increased Risk of Opioid-Related Overdose and Respiratory Depression: A Narrative Review.
Kaye AD, Cassagne G, Abbott BM … +7 more , Dubuisson AM, Fagan JJ, Indovina I, Gungor D, Kallurkar A, Kaye AM, Shekoohi S
Curr Pain Headache Rep · 2025 Jun · PMID 40540060 · Publisher ↗
PURPOSE OF REVIEW: Gabapentin, introduced in the 1990s as an anticonvulsant and anti-epileptic drug, has become a cornerstone treatment for various neurological and pain-related conditions. Its approved uses include seiz...
PURPOSE OF REVIEW: Gabapentin, introduced in the 1990s as an anticonvulsant and anti-epileptic drug, has become a cornerstone treatment for various neurological and pain-related conditions. Its approved uses include seizure disorders, postherpetic neuralgia, and restless leg syndrome, while off-label applications commonly include diabetic neuropathy, fibromyalgia, post-traumatic stress disorder, and insomnia. The efficacy of gabapentin stems from its ability to modulate voltage-gated calcium channels, reducing excitatory neurotransmitter release in the central nervous system. However, its pharmacological versatility is accompanied by significant risks, including weight gain and combination additive and/or synergistic opioid-related respiratory depression. RECENT FINDINGS: Weight gain, affecting up to 25% of patients, is primarily attributed to secondary effects such as altered gastrointestinal function and peripheral edema. This adverse effect can negatively impact treatment adherence, especially in patients with chronic conditions requiring long-term therapy. Patients with preexisting metabolic disorders face heightened risks, necessitating strategies like dietary counseling and tailored treatment adjustments to mitigate weight gain. In multimodal pain management, gabapentin mediated additive and/or synergistic effects with opioids enable reduced opioid doses but increase the risk of respiratory depression and overdose. These dose-dependent interactions amplify sedative effects, particularly in vulnerable populations such as the elderly. To optimize therapeutic benefits while minimizing risks, healthcare providers must adopt individualized treatment plans, carefully adjust dosages, and educate patients. Further research is essential to better understand mechanisms of action, improve safety profiles, and develop prescribing practices that balance efficacy with reduced adverse outcomes.
Trialing Strategies Prior to Intrathecal Drug Delivery in Cancer-Related Pain: A Narrative Review.
Roux E, Kaye AD, Shah SS … +2 more , Shekoohi S, Hao D
Curr Pain Headache Rep · 2025 Jun · PMID 40537714 · Publisher ↗
PURPOSE OF REVIEW: Cancer-related pain poses a significant clinical challenge, especially in advanced stages where systemic analgesic therapies become insufficient or intolerable. Intrathecal drug delivery systems (IDDS)...
PURPOSE OF REVIEW: Cancer-related pain poses a significant clinical challenge, especially in advanced stages where systemic analgesic therapies become insufficient or intolerable. Intrathecal drug delivery systems (IDDS) offer targeted pain control while minimizing systemic exposure. However, the optimal trialing approach before permanent IDDS implantation remains contentious. This narrative review examines literature on IDDS trialing strategies in cancer pain management. A comprehensive search was conducted of PubMed, MEDLINE, and Embase databases and identified studies published up to January 2025. The review included prospective and retrospective studies, randomized controlled trials, cohort studies, and case series on trialing techniques, clinical outcomes, safety, tolerability, and efficacy. Key strateghies assessed include single-shot intrathecal bolus, multiple intrathecal boluses, continuous epidural infusion, and continuous intrathecal infusion. The review found significant variability in trialing practices, with limited high-quality comparative data to support standardized protocols. Trial success criteria varied widely, encompassing pain reduction, side effects, and patient-reported outcomes. RECENT FINDINGS: The studies described a range of trialing strategies with varying durations, opioid dosages, and criteria for success. However, due to the lack of direct comparisons between these approaches, it is difficult to draw clear conclusions about the relative effectiveness of continuous intrathecal, continuous epidural, and bolus-based trials. Some institutions bypassed trialing, prioritizing symptom relief over procedural risks. CONCLUSION: This review highlights the need for individualized trialing strategies based on patient status, institutional preferences, and clinician expertise. Given the variability in current practices, further research is needed to establish evidence-based guidelines and optimize clinical decision-making.
Adverse Effects Associated With High-Dose Ketamine Infusions For Refractory Pain And Psychiatric Conditions.
Javaheri ED, Wie C, Covington S … +5 more , Misra L, Pew S, Viswanath O, Freeman J, Maloney J
Curr Pain Headache Rep · 2025 Jun · PMID 40536569 · Publisher ↗
PURPOSE OF REVIEW: As higher doses of ketamine are being used in numerous medical conditions such as Complex Regional Pain Syndrome (CRPS), it is critical to examine common adverse effects (AEs) explicitly associated wit...
PURPOSE OF REVIEW: As higher doses of ketamine are being used in numerous medical conditions such as Complex Regional Pain Syndrome (CRPS), it is critical to examine common adverse effects (AEs) explicitly associated with high doses of ketamine (HDK). RECENT FINDINGS: HDK is often associated with psychiatric symptoms such as agitation, anxiety, and sleep disturbances. Psychiatric effects have been documented in various methods of administration of HDK, including oral, intravenous, and intranasal formulations. Emesis is a common AE of HDK and is more prevalent at higher ketamine doses. Hepatotoxicity is common after HDK, is dose-dependent, and is usually transient. HDK-induced uropathy is another potential AE. When monitored appropriately, HDK administered in a hospital setting appears safe; practitioners should be mindful that certain AEs of HDK are likely dose-dependent.
Persistent Opioid Use Following Major Orthopedic Surgery.
Islam RK, Tynes BE, Tong VT … +10 more , Pelto A, Bratton M, Islam KN, Urman RD, Ahmadzadeh S, Siddaiah H, Rieger R, Sterritt J, Shekoohi S, Kaye AD
Curr Pain Headache Rep · 2025 May · PMID 40439820 · Publisher ↗
PURPOSE OF REVIEW: This narrative review addresses the growing public health concern of persistent opioid use following major orthopedic surgery. It aims to identify and analyze the critical factors that contribute to th...
PURPOSE OF REVIEW: This narrative review addresses the growing public health concern of persistent opioid use following major orthopedic surgery. It aims to identify and analyze the critical factors that contribute to the transition from acute to persistent opioid consumption in this context. RECENT FINDINGS: Patient-related characteristics, including pre-existing conditions and prior substance use, are critical predictors of prolonged opioid use. Additionally, surgery-related factors such as the type and duration of procedures complicate postoperative pain management. The prevalence of persistent opioid use after surgery remains high despite the emergence of effective Enhanced Recovery After Surgery protocols and patient education initiatives. Multimodal analgesia is highlighted as a vital strategy for reducing the risk of long-term opioid dependency. Persistent opioid use after orthopedic surgery poses significant challenges, including increased risks of physical and mental health complications, the development of opioid use disorder, and a substantial economic burden on healthcare systems. Targeted interventions and continuous research are essential to mitigate these risks, reduce long-term opioid dependency, and improve overall patient outcomes.
Cluster Headache in Children: Current Status, Diagnostic and Treatment Challenges and Future.
Yang H, Liu W, Zou Q … +1 more , Li D
Curr Pain Headache Rep · 2025 May · PMID 40423737 · Publisher ↗
PURPOSE OF REVIEW: This review aims to summarize the current understanding of cluster headaches (CH) in children, focusing on epidemiology, pathophysiology, clinical characteristics, diagnostic challenges, treatment stra...
PURPOSE OF REVIEW: This review aims to summarize the current understanding of cluster headaches (CH) in children, focusing on epidemiology, pathophysiology, clinical characteristics, diagnostic challenges, treatment strategies, and future research directions. RECENT FINDINGS: Cluster headaches in children are infrequent, with an incidence that appears to be significantly lower than that observed in adults, highlighting the need for more comprehensive studies. Pediatric patients often present with atypical symptoms, such as shorter pain duration and less pronounced autonomic features, leading to frequent misdiagnosis or delayed diagnosis. The hypothalamus plays a central role in the pathophysiology of CH, involving circadian rhythm disturbances, trigeminal nerve-vascular activation, and autonomic dysfunction. High-flow oxygen and triptan medications are effective for acute treatment in adults, but their safety and efficacy in children require further validation. Preventive treatments, such as verapamil, are used cautiously in pediatric patients, with close monitoring for side effects. Non-pharmacological interventions, including lifestyle adjustments and psychological support, are critical for long-term management. Cluster headaches in children are a rare but debilitating condition that poses significant diagnostic and therapeutic challenges. Current diagnostic criteria, primarily based on adult data, may not fully capture the unique clinical features of pediatric patients, leading to misdiagnosis or missed diagnosis. Treatment strategies are largely extrapolated from adult studies, with limited evidence-based data for children. Future research should focus on improving diagnostic criteria, exploring pediatric-specific pathophysiological mechanisms, and validating safe and effective treatment options. Early identification and intervention are essential to improving the quality of life and long-term outcomes for pediatric patients.
Prognostic Value of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Profiles in Predicting Outcomes of Occipital Nerve Stimulation for Refractory Chronic Migraine: A Retrospective Bias-Corrected Multivariable Analysis.
Mercieri M, Leoni MLG, Naccarato A … +5 more , Viswanath O, Sarmi SSA, Varrassi G, Cascella M, Arcioni R
Curr Pain Headache Rep · 2025 May · PMID 40418385 · Full text
BACKGROUND: Refractory chronic migraine (rCM) is characterized by debilitating headaches that do not respond adequately to conventional medical treatments, leaving patients severely disabled. In these rare cases, central...
BACKGROUND: Refractory chronic migraine (rCM) is characterized by debilitating headaches that do not respond adequately to conventional medical treatments, leaving patients severely disabled. In these rare cases, central cervical spinal cord stimulation or occipital nerve stimulation (ONS) may offer a potential therapeutic option. However, these techniques are not without risks, lack clear scientific evidence, and impose a significant economic burden. Therefore, it is crucial to identify parameters that can assist physicians in selecting appropriate candidates for implantation. This study aimed to investigate the role of psychological profiles in predicting outcomes for ONS in rCM patients. METHODS: We conducted a retrospective analysis on rCM patients treated with ONS at a second-level neuromodulation university facility. These patients were refractory to conventional medical treatments, including onabotulinumtoxin-A injections (monoclonal antibodies targeting CGRP were not yet available). The NRS for migraine intensity, the number of monthly migraine attacks, and drug consumption were assessed at 6-month and 12-month follow-ups post-implant. Psychological profiles were evaluated prior to OCN using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A multivariable logistic regression model was developed to predict ONS outcomes, incorporating MMPI-2 as a covariate. The model's accuracy and performance were assessed through non-parametric bootstrap, calibration, and discrimination analyses. RESULTS: Twenty-three rCM patients were analysed. ONS was able to significantly reduce the pain intensity, the number of headache attacks per month, and drug consumption compared to pre-treatment levels at both 6- and 12-month follow-ups. The final multivariable logistic model at 12 months showed that the MMPI-2 Depression score was independently and negatively associated with favourable outcomes following ONS (optimism-adjusted OR 0.52, 95% CI 0.21-0.77, p = 0.03). The ROC curve indicated high model sensitivity (AUC: 0.96, 95% CI: 0.88-0.98), and the calibration plot revealed a good fit, with some improvement needed in mid-range predicted probabilities. CONCLUSION: ONS significantly reduced pain intensity, headache frequency, and drug use at the 12-month follow-up compared to pre-treatment levels. The MMPI-2 Depression score was an independent predictor of ONS failure, highlighting the importance of comprehensive psychological assessments in patient selection for ONS.
Review of Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain.
Manchikanti L, Abd-Elsayed A, Kaye AD … +4 more , Sanapati MR, Knezevic NN, Manocha V, Hirsch JA
Curr Pain Headache Rep · 2025 May · PMID 40410617 · Publisher ↗
PURPOSE OF REVIEW: This article assesses the current evidence and guidelines on peripheral nerve stimulation (PNS) and provides recommendations for its use in managing moderate to severe chronic pain. RECENT FINDINGS: PN...
PURPOSE OF REVIEW: This article assesses the current evidence and guidelines on peripheral nerve stimulation (PNS) and provides recommendations for its use in managing moderate to severe chronic pain. RECENT FINDINGS: PNS has been utilized for over 50 years in the treatment of chronic pain. However, since 2015, the Food and Drug Administration (FDA) has approved percutaneously implanted PNS leads and neurostimulators, providing a minimally invasive, non-opioid alternative for managing persistent and refractory chronic pain. The American Society of Interventional Pain Physicians (ASIPP) has established evidence-based consensus guidelines for the clinical use of PNS systems in addressing chronic pain. ASIPP guidelines performed extensive evidence synthesis, including systematic reviews, randomized controlled trials (RCTs), and observational studies using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria or certainty of evidence, and qualitative synthesis based on the best available evidence. The evidence level and recommendations showed fair evidence with moderate strength of recommendation for implantable PNS systems following a trial or selective lumbar medial branch stimulation without a trial and for temporary PNS for 60 days. This review offers a comprehensive analysis of peripheral neuropathic pain as a cause of chronic, intractable, function-limiting, and high-impact pain. It discusses the diagnosis of peripheral nerve and neuropathic pain, evidence evaluation and synthesis, medical necessity criteria, patient education, and clinical recommendations. The goal is to enhance patient outcomes by integrating PNS technology into clinical practice.
Notalgia Paresthetica: An Updated Review of Pathophysiology, Diagnosis, and Treatment Approaches.
Nguyen P, Parikh S, Ko C … +4 more , Nguyen G, Kaye AD, Urits I, Hasoon J
Curr Pain Headache Rep · 2025 May · PMID 40397314 · Publisher ↗
PURPOSE OF REVIEW: Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia, most commonly affecting the upper back. Despite being a relatively common condition, it r...
PURPOSE OF REVIEW: Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia, most commonly affecting the upper back. Despite being a relatively common condition, it remains underdiagnosed and frequently mismanaged. This review covers the pathophysiology, clinical presentation, diagnostic evaluation, and treatment approaches for NP. RECENT FINDINGS: Recent studies support a multifactorial pathogenesis for NP, with compression or irritation of the dorsal rami of thoracic spinal nerves playing a central role. Imaging and electromyography have shown variable utility in diagnosis, while histological findings often lack specificity. Although there is no universally effective treatment, advances in topical medications, systemic oral medications, and interventional therapies may be considered. Physical therapy and postural correction remain important non-pharmacologic strategies. NP is a neuropathic condition with evolving diagnostic and therapeutic approaches. Early recognition, multidisciplinary evaluation, and individualized treatment plans are essential for improving patient outcomes. Further research is needed to establish standardized diagnostic criteria and long-term treatment efficacy.
The Efficacy of Magnesium Sulfate in Perioperative Multimodal Analgesia.
Lopez-Ruiz AA, Trinchet LP, Morozowich S … +1 more , Misra L
Curr Pain Headache Rep · 2025 May · PMID 40397239 · Publisher ↗
PURPOSE OF REVIEW: Patients frequently report inadequate pain management following surgical procedures. Physicians must often prescribe analgesics, notably opioids, as a means of providing pain relief. Due to the addicti...
PURPOSE OF REVIEW: Patients frequently report inadequate pain management following surgical procedures. Physicians must often prescribe analgesics, notably opioids, as a means of providing pain relief. Due to the addictive nature of this class of medications, improper post-surgical pain management propagates the United States opioid crisis. The administration of multimodal analgesia is a strategy implemented to decrease long-term outpatient prescription opioid use. Magnesium sulfate has recently attracted interest for its potential use as an adjunct in multimodal analgesia in addition to its other diverse uses in medicine. This review aims to highlight the most recent data validating the use of magnesium sulfate in perioperative multimodal analgesia. RECENT FINDINGS: A narrative review was conducted using PubMed and Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations. Articles that examined the effects of intravenous magnesium sulfate on perioperative pain and/or recovery from 1946 to present were considered. 15 articles met the inclusion criteria and discussed the use of magnesium sulfate as an adjunct in multimodal analgesia across the following surgical specialties: cardiac surgery, general surgery, gynecologic surgery, orthopedic surgery, urologic surgery, neurosurgery, and otolaryngology surgery. The results of the cited studies indicate that magnesium sulfate is a well-tolerated multimodal analgesic agent that reduces postoperative pain, reduces opioid consumption, and increases patient satisfaction.
Burden of Emotional Stress in Chronic Pain Care: A Wake-up Call for the Care Team.
Kao G, Parmar J, Javed S
Curr Pain Headache Rep · 2025 May · PMID 40394430 · Publisher ↗
PURPOSE OF REVIEW: Chronic pain management presents significant emotional challenges for clinicians due to the complex and prolonged nature of the conditions they treat. This editorial aims to explore how emotional stres...
PURPOSE OF REVIEW: Chronic pain management presents significant emotional challenges for clinicians due to the complex and prolonged nature of the conditions they treat. This editorial aims to explore how emotional stressors, such as compassion fatigue, emotional labor, and ethical dilemmas, impact both clinician well-being and patient outcomes. It also emphasizes the need for effective strategies to address clinician stress and enhance overall care quality. RECENT FINDINGS: Healthcare professionals working in chronic pain management are particularly susceptible to emotional stress, which can lead to burnout, job dissatisfaction, and poor mental health. Research highlights the prevalence of stressors such as compassion fatigue, emotional labor, heavy workloads, and time pressures. These stressors contribute to a decline in clinician well-being, which in turn negatively impacts patient care quality. Many studies also point to the interconnection between clinician burnout and compromised patient outcomes, emphasizing the importance of addressing these issues. Addressing the emotional stress faced by clinicians in chronic pain care is crucial for improving both clinician satisfaction and patient outcomes. Effective strategies, including mindfulness practices, self-compassion, wellness programs, and flexible work schedules, have been identified as potential solutions to mitigate burnout and enhance clinician resilience. By implementing these strategies, healthcare systems can improve clinician well-being and ultimately provide higher-quality care to patients.
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