ABSTRACTBackgroundIn 2021, the term persistent spinal pain syndrome (PSPS) was introduced. PSPS type 2 (PSPS‐T2) replaced the unsatisfactory term failed back surgery syndrome (FBSS). PSPS type 1 (PSPS‐T1) is a clinical picture of signs and symptoms of FBSS but without prior surgery. PSPS applies to any spinal level. There are multiple underlying mechanisms and treatments within PSPS. Therapeutic choices are not based on a common nomenclature. One consequence is that the desired outcomes of interventions are not reliably achieved. There is a need to redefine diagnostic clusters of PSPS based on the pain mechanism rather than just anatomic factors or a history of previous surgery. This manuscript provides mechanism‐based recommendations to improve treatment selection through the use of the PSPS concept.MethodsAn international task force of pain and neurosurgical specialists was established and met at the International Neuromodulation Society Congress 2024, at the North American Neuromodulation Society Congress 2024, and online.ResultsAn overview of classification systems (i.e., PSPS; P), anatomical structure (A), neural mechanism (M), and degree of certainty (C), is discussed and combined to generate a novel categorization approach to assist with PSPS classification and diagnosis. The PAMC scale was developed to assist with the diagnosis clustering and consequently to improve treatment selection.ConclusionThe proposed recommendations should support future research by better defining study populations and by assisting the clinician to select the appropriate therapy.

ABSTRACTBackgroundCluster headache (CH) is a rare but severe primary headache disorder characterized by recurrent attacks of unilateral, typically periocular pain lasting 15 min to 3 h, accompanied by ipsilateral autonomic symptoms and restlessness or agitation. Attacks may occur multiple times daily and present in clusters lasting weeks to months, interspersed with remission periods in episodic CH, or without remission in chronic CH.MethodsThis review summarizes the clinical evidence supporting the use of transcutaneous cervical vagus nerve stimulation (tcVNS) for both the acute and preventive treatment of CH. Relevant clinical trials, real‐world studies, and guideline recommendations are discussed.ResultsPharmacological therapy for CH includes triptans and high‐flow oxygen for acute management, and verapamil, corticosteroids, or galcanezumab for prevention. For patients with inadequate response or intolerance to these options, neuromodulation may be required. TcVNS has emerged as a noninvasive, safe, and effective alternative to invasive neuromodulation. Clinical trials have demonstrated significant reductions in attack frequency and intensity, leading to U.S. Food and Drug Administration (FDA) clearance and UK National Institute for Health and Care Excellence (NICE) approval for both acute and preventive treatment of CH.ConclusionsTcVNS represents a well‐tolerated, noninvasive neuromodulatory option for patients with cluster headache, offering both acute and preventive benefits. This paper provides an overview of the current evidence, mechanisms of action, and practical guidelines for incorporating tcVNS into clinical management.

ABSTRACTBackgroundThis study aimed to conduct a comprehensive bibliometric analysis of the global scientific literature on botulinum toxin from 1991 to 2024, evaluating publication performance, citation impact, and emerging research foci.MethodsData were retrieved from the Science Citation Index Expanded (SCI‐EXPANDED) of the Web of Science Core Collection. The data extraction procedure included titles, abstracts, author keywords, and Keywords Plus. Publication and citation metrics (TP, IP, CP, FP, RP, SP, CPP2024) were analyzed across countries, institutions, authors, and journals. Trends in document types, language, categories, and keywords were also examined.ResultsA total of 25,522 relevant documents were identified, with a marked increase in publications over time. The United States led in publication output and citation impact, followed by Germany, the United Kingdom, and China. Notably, countries such as South Korea, Italy, France, and Turkey showed a recent surge in output. Allergan Pharmaceutical Inc. demonstrated the highest citation performance among all institutions. Three primary research themes were identified: clinical indications, administration and formulations, and evaluation of efficacy and safety. The findings also highlighted increased international and interdisciplinary collaborations over time, as well as growing interest in surgical and aesthetic applications.ConclusionBotulinum toxin research has grown significantly in both scope and volume over the past three decades, with notable contributions from both academic and industrial institutions. Understanding global research performance and thematic trends provides a foundation for future clinical, academic, and commercial development in the field.

ABSTRACTObjectiveTraditional therapies for postherpetic neuralgia (PHN) and postherpetic itch (PHI) often yield unsatisfactory outcomes. Previous investigations on extracorporeal shockwave therapy (ESWT) have demonstrated positive outcomes in pain and itch reduction in conditions resembling PHI and PHN, exhibiting neuropathic mechanisms. This study aims to evaluate the impact of ESWT on pain and itch associated with PHN and PHI.MethodInclusion criteria encompassed individuals aged 50 to 80 displaying symptoms indicative of PHN or PHP (persistent pain duration exceeding 3 months), undergoing conventional conservative therapies like combination medication and nerve blocks, with reported pain or pruritus scores surpassing 3 on a numerical rating scale (NRS) (treatment group, n = 10; sham stimulation group, n = 9). The experimental group received 2000 shock waves per treatment, with each shock wave comprising 100 impulses/cm2, characterized by low‐energy flux density (0.07–0.20 mJ/mm2), administered with a 1‐week interval between treatments over 6 weeks.ResultAfter two sessions of ESWT, pain scores significantly decreased (p = 0.04), with continued reduction through six sessions (p < 0.001) and at 1‐month follow‐up (p < 0.001). Pruritus scores also improved from session two (p = 0.03) and remained significant (p < 0.001, p = 0.001). Between‐group differences became apparent after four sessions for pruritus (p = 0.06) and after six sessions for the 5‐D Itch scale (p = 0.007). Pregabalin dosage was significantly reduced in the ESWT group (p = 0.04). No adverse effects were reported.ConclusionESWT, as a noninvasive therapeutic approach, significantly alleviated PHN‐associated pain and pruritus.