Current Pain and Headache Reports

Fibromyalgia is a common idiopathic pain condition often resulting in increased morbidity and disability in patients. The lack of peripheral abnormalities in this disease has led clinicians and researchers alike to question if this syndrome represents a valid entity. Recent genetic findings suggest that specific gene mutations may predispose individuals to develop fibromyalgia. In addition, neurobiological studies indicate that fibromyalgia patients have abnormalities within central brain structures that normally encode pain sensations in healthy pain-free controls. Future studies that focus on central neurobiological and/or genetic influences in fibromyalgia may bring insight into mechanisms of this problematic disease and ultimately result in improved treatments.

Post-traumatic cluster headache (CH) is a very rare occurrence. Only one such case has been verified in the literature thus far. On the other hand, a non-casual association is almost certain to exist between previous head trauma and future CH onset. Considering the generally long interval of time separating the two events, it is not easy to accurately explain the nature of the head trauma/ CH relationship. Head trauma may damage extra- or intracranial peripheral or central nervous structures, hence predisposing to the future development of CH. However, there also is the possibility that previous head injuries may be more frequent among CH patients because of their lifestyle, which may leave them more exposed to the risk of traumatic events.

The effects of chronic pain, chronic illness, and physical disability in adolescence are diverse, often influencing every facet of an adolescent’s life. The biopsychosocialspiritual model provides a framework within which to conceptualize the experience of the adolescent with chronic pain and can be very helpful in guiding clinical care including creating comprehensive interdisciplinary treatment plans. Literature on chronic pain often focuses on pediatric or adult populations and does not lend information on how to provide evidence-based treatment for the adolescent in chronic pain. The study of chronic pain in adolescence has been largely limited by small samples, cross-sectional and observational designs, and studies that intertwine findings with pediatric and adult populations. Herein, we review the literature on the biopsychosocialspiritual experience of the adolescent with chronic pain.

Psychologic strategies for the treatment of cancer pain continue to be an important component of multiclimensional treatment programs. These techniques, including relaxation therapy. cognitive-behavioral therapy, biofeedback, and hypnosis have demonstrated efficacy and reduced medical costs. The impact of these techniques is on the sensory aspects of pain and the psychologic distress and maladaptive coping mechanisms people develop in response to pain. Although psychologic techniques have been used for many years, the recent literature is elucidating the pathophysiologic mechanisms of these techniques and better defining the best techniques to use in individual cases to maximize effectiveness.

The pathogenesis of fibromyalgia (FM) and related conditions is not entirely understood. Recent evidence suggests that these syndromes may share heritable pathophysiologic features. Familial studies suggest that genetic and familial factors may play a role in the etiopathogenesis of these conditions. There is evidence that polymorphisms of genes in the serotoninergic and catecholaminergic systems are linked to the pathophysiology of FM and related conditions and are associated with personality traits. The precise role of genetic factors in the etiopathology of FM remains unknown, but it is likely that several genes are operating together to initiate this syndrome. Larger longitudinal studies are needed to better clarify the role of genetics in the development of FM.

This review summarizes and discusses the history of continuous catheter blockade (CCB), its current applications, clinical considerations, economic benefits, potential complications, patient education, and best practice techniques. Regional catheters for outpatient surgery have greatly impacted acute post-operative pain management and recovery. Prior to development, options for acute pain management were limited to the use of opioid pain medications, NSAIDS, neuropathic agents, and the like as local anesthetic duration of action is limited to 4–8 h. Moreover, delivery of opioids post-operatively has been associated with respiratory and central nervous depression, development of opioid use disorder, and many other potential adverse effects. CCB allows for faster recovery time, decreased rates of opioid abuse, and better pain control in patients post-operatively. Outpatient surgical settings continue to focus on efficiency, quality, and safety, including strategies to prevent post-operative nausea, vomiting, and pain. Regional catheters are a valuable tool and help achieve all of the well-established endpoints of enhanced recovery after surgery (ERAS). CCB is growing in popularity with wide indications for a variety of surgeries, and has demonstrated improved patient satisfaction, outcomes, and reductions in many unwanted adverse effects in the outpatient setting.