Medication-Overuse Headache: Results from a Pain Medicine Clinic Cohort

Background and Objective: Medication-overuse headache (MOH) is a common, disabling, and treatable cause of chronic daily headache. This study evaluates the characteristics of a cohort of patients with MOH seen in a pain medicine clinic. Methods: We conducted a retrospective study of consecutive patients seen by a neurologist in the pain medicine clinic at the University of California, San Diego. Demographics, headache diagnoses, and overused medications were extracted from clinical records from 83 patients ≥ 18 years of age where a diagnosis of MOH was entered into the electronic medical record September 12, 2017-March 30, 2020. Results: Opioids were the most overused medications (42/83, 50.6%) followed by caffeine-containing compounds (20/83, 24.1%), triptans (12/83, 14.5%) and non-steroidal anti-inflammatory drugs (10/83, 12.9%). Chronic migraine was the most common underlying headache syndrome (54/83, 65.1%), followed by secondary headache disorder (13/83, 15.7%) and tension-type headache (8/83, 9.6%). Men were more likely to be overusing opioids (OR 3.3, p = 0.026) while women were more likely to be overusing caffeine-containing compounds (OR 5.4, p = 0.041). Discussion and Conclusions: It is crucial for pain specialists to recognize MOH in the pain clinic setting. Opioid overuse headache is more common among men, likely in part due to migraine being underrecognized in men and therefore men not receiving migraine-specific medications. Caffeine-containing compound overuse is more common among women; these are over-the-counter (OTC) and often do not appear on patients’ medications lists. Pain specialists should specifically ask patients with headache whether they are using OTC caffeine-containing compounds.

Updates on Palliative Medicine in the COVID-19 Era

The advances in knowledge in the field of pain medicine in the last half century have recently been reported from both the scientific and the social points of view [...]

Peripheral Nerve Stimulation: The Evolution in Pain Medicine

Peripheral nerve stimulation (PNS) involves the application of electrical stimulation near the proximity of peripheral nerves. Although the mechanism of action remains unknown, PNS likely modulates both the central and peripheral nervous systems to provide analgesia for a wide variety of pain disorders involving the head, extremities, and trunk. Historically, PNS was not utilized widely due to underwhelming results from earlier studies. However, significant innovations in device technologies, including improved implantation techniques, hardware miniaturization, and externalized pulse generators, have led to the resurgence of PNS in the field of pain medicine. This editorial briefly reviews the evolution of PNS in the field of pain medicine and highlights areas for future investigation.

Global Scientific Output on Medical Education during the COVID-19 Pandemic

The objective of the present study is to characterize the global scientific production on medical education during the COVID-19 pandemic in seven scientific databases from January 2020 to April 2021. We worked with a universe of 248 articles of which bibliometric indicators were analyzed using Publish or Perish software v. 7.19 and the same analytical software for the chosen databases. The results indicate an average of 39.5 citations. 27.95, 0.87 and 17.90 citations per year, citations per article and citations per author respectively. Among the most cited articles in the Scopus and Microsoft academic databases, Maintaining High-Quality Multidisciplinary Scholarship Programs in Pain Medicine stands out: Part I: Innovations in Education, Research, Candidate Selection Process, Wellness, and Implementation from ACGME during the COVID-19 pandemic. This article is also the second most cited article in the Web of Science database. These results show that the production of scientific articles on educational medicine in the context of the COVID-19 pandemic has not had a significant development.

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.MethodsIn August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.ResultsTwenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.ConclusionsCervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.