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Migraine is the most common disabling primary headache globally. Attacks typically present with unilateral throbbing headache and associated symptoms including, nausea, multisensory hypersensitivity, and marked fatigue. In this article, the authors address the underlying neuroanatomical basis for migraine-related headache, associated symptomatology, and discuss key clinical and preclinical findings that indicate that migraine likely results from dysfunctional homeostatic mechanisms. Whereby, abnormal central nervous system responses to extrinsic and intrinsic cues may lead to increased attack susceptibility.
This study sought to examine the association between early life stressors and adolescent headache in the Canadian population, and the potential mediating influence of symptoms of depression and anxiety.
Chronic pain is a public health problem associated with opioid misuse. Yet, it is important to understand factors underlying opioid misuse in the context of pain. Alcohol use is one factor to consider given past work documenting use of alcohol to manage pain. However, it is unknown whether alcohol use severity exacerbates the relation between pain and opioid misuse. This study sought to examine relations between pain and prescription opioid misuse and the moderating role of alcohol use severity in two online survey studies of individuals with chronic pain.
: Information on prescriptions of oral analgesics for the treatment of pain is beneficial. However, there have been few reports on the prescription status of oral analgesics from a nation-wide, large-scale prescription database in Japan. : The authors analyzed the prescription data of 2,042,302 patients prescribed oral analgesics in 2017. The numbers/proportions of patients prescribed oral analgesics, adherence with approved doses, co-prescription patterns, dose changes, drug adherence, and treatment-discontinuation rates were evaluated. : Loxoprofen was prescribed to 32.5% of the patients, followed by celecoxib, prescribed to 16.0% of patients. Acetaminophen and pregabalin were prescribed to 10.5% and 9.4% of patients, respectively. Many analgesics were prescribed at lower doses than the approved doses. The most frequently used concomitant medication was pregabalin. For duloxetine and pregabalin, high proportions of patients were prescribed these drugs for > 90 days. : Loxoprofen was the most prescribed of the non-steroidal anti-inflammatory drugs in Japan. The information obtained provides an overview of prescribed oral analgesics in Japan and could be useful for potential research into prescribed oral analgesics in the future.
In the United States, chronic low-back pain affects up to 37% of adults and is a multi-billion dollar healthcare market. Spinal Cord Simulation (SCS) has been established as an effective treatment alternative for chronic neuropathic low-back and leg pain especially for patients suffering from Failed Back Surgery Syndrome (FBSS) or Chronic Regional Pain Syndrome (CRPS). The field of SCS has rapidly advanced such that analgesia can now be achieved through numerous different waveforms, each claiming to offer improved outcomes. These waveforms include traditional paresthesia-based stimulation (PB-SCS; <100 Hz), paresthesia-free high-frequency stimulation (HF-SCS; 5-10 kHz), burst stimulation, and sub-perception stimulation (SP-SCS; 1-5 kHz). Level 1 evidence critically evaluating the efficacy of these different waveforms is lacking. We conducted a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines to identify all randomized controlled trials (RCTs) of SCS in the treatment of chronic neuropathic low-back and leg pain, FBSS, or CRPS. A total of 38 eligible studies were reviewed to yield a final 13 RCTs that were included in our systematic review. We review the evidence from RCTs in the field of SCS that have established PB-SCS, HF-SCS, Burst, and SP-SCS as viable treatment options for chronic neuropathic low-back and leg pain. We critically evaluate the evidence that claims to support the use of one waveform over the other and review the literature on patient preference for different waveforms.
The primary objective was to investigate the prevalence of neuropathic-like pain in patients with psoriatic arthritis (PsA). Secondary outcomes were to investigate whether mood, fatigue, pain, disease severity and fibromyalgia are associated with neuropathic-like pain in PsA patients.
Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain.
In this randomized clinical trial, we examined whether the effect of true acupuncture can be differentiated from sham acupuncture (pain and functionality) by analyzing quantitative sensory testing (QST) profiles in chronic pain participants. We recruited 254 healthy or chronic back and neck pain participants. Healthy subjects were included to control for a possible effect of acupuncture on baseline QST changes. Study participants received six sessions (twice weekly) of true acupuncture, sham acupuncture, or no acupuncture treatment (routine care). QST profiles, pain scores and functionality profile were obtained at baseline (visit 1) and after 3 (visit 4) or 6 sessions (visit 7). A total of 204 participants were analyzed. We found no QST profile changes among three groups (P = 0.533 and P = 0.549, Likelihood-ratio tests) in either healthy or chronic pain participants. In chronic back and neck pain participants, true acupuncture reduced pain [visit 4: DIM (difference in mean) = -0.8, 95% CI: -1.4 to -0.1, adjusted P = 0.168; visit 7: DIM = -1.0, 95% CI: -1.7 to -0.3, adjusted P = 0.021) and improved functional status including physical functioning (DIM = 14.21, 95% CI: 5.84 to 22.58, adjusted P = 0.003) and energy/fatigue (DIM = 12.28, 95% CI: 3.46 to 21.11, adjusted P = 0.021) as compared to routine care. Our results indicate that QST was not helpful to differentiate between true acupuncture and sham acupuncture (primary outcome) in this study, although true acupuncture reduced pain and improved functionality (secondary outcomes) when compared with routine care.
The field of biased agonism has grown substantially in recent years and the μ opioid receptor has been one of the most intensively studied receptor targets for developing biased agonists. Yet, despite extensive research efforts the development of analgesics with reduced adverse effects remains a significant challenge. In this review we discuss the evidence to support the prevailing hypothesis that a G protein biased agonist at the μ opioid receptor would be an effective analgesic without the accompanying adverse effects associated with conventional μ opioid agonists. We also assess the current status of established and novel μ opioid receptor ligands that are proposed to be biased ligands. SIGNIFICANCE STATEMENT: The idea that biased agonists at the &[mu] opioid receptor might provide a therapeutic advantage in terms of producing effective analgesia but with fewer adverse effects has driven the design of novel G protein-biased agonists. However is the desirability of G protein-biased agonists at &[mu] opioid receptor substantiated by what we know of the physiology and pharmacology of the receptor? Also do any of the novel biased agonists live up to their initial promise? Here we address these issues by critically examining the evidence that G protein bias really is desirable and also by discussing whether the ligands so far developed are clearly biased in vitro and whether this produces responses in vivo that might be commensurate with such bias.