Chronic Head Pain Research Articles

Unlocking the Potential of the Superficial Cervical Plexus Block in Chronic Pain Management: A Narrative Review and Single-Center, Retrospective Case Series

Background/Objectives: The anesthetic block of the sensory branches of the superficial cervical plexus renders a specific area of the face, head, and anterior neck insensible and painless. Chronic pain in these areas can be difficult to diagnose and treat. In this report, we briefly review the existing evidence on the topic of the superficial cervical plexus block (SCPB) to set the context for our research. We then share our own clinical experience with the SCPB for managing chronic pain syndromes from both cancerous and non-cancerous etiologies. Methods: We first performed a comprehensive literature search and narrative review of clinical cases and studies that utilized the SCPB as an analgesic technique. We then conducted a retrospective case series of all patients who had received an SCPB at our pain clinic since 2020. Results: Our literature review found only a few cases reported, with most of them focusing on acute painful emergencies and perioperative pain syndromes and only very few addressing chronic pain. In our pain clinic, 14 patients received one or more SCPBs for chronic pain management. In 43% of these cases, the pain was related to cancer. The most common areas of pain corresponded to the regions supplied by the transverse cervical and great auricular nerves. The procedures were uneventful in all cases, and patients rated them as effective and worthwhile 71% of the time. Conclusions: Despite the lack of high-quality studies on SCPBs in pain management, the authors’ experience suggests that it is a valid minimally invasive alternative for managing chronic face, head, and neck pain.

Predicting chronic post-traumatic head and neck pain: the role of bedside parameters

Abstract Traumatic brain injury (TBI) annually impacts 69 million individuals worldwide. Mild TBI constitutes approximately 90% of all TBIs. Chronic pain post-mTBI occurs in 29% to 58% of patients. This study aims to introduce a predictive model for chronic pain development in individuals diagnosed with mild traumatic brain injury (mTBI) immediately postinjury. We included individuals who had sustained mTBI in motor vehicle accident (MVA). All patients had initial assessments within the first 72 hours (representing the subacute period) after the injury and performed follow-ups for 1 year. Machine learning model was applied to the integrated measures of clinical pain, pain-related psychological parameters, mTBI clinical signs, and sociodemographic information. This study included 203 patients experiencing acute head or neck pain attributable to mTBI post-MVA. We categorized these patients into 2 groups: patients who progressed to develop chronic head or neck pain (n = 89, 43.8%) and patients who recovered (low/mild pain) (n = 114, 56.2%). Severity of the subacute neck pain, number of painful body areas, and education years were identified as the most significant factors predicting chronic pain. The optimized predictive model demonstrated high efficacy, with an accuracy of 83%, a sensitivity of 92%, and an area under the receiver operating characteristic curve of 0.8. Our findings indicate feasibility in predicting chronic post-MVA pain within the critical 72-hour window postinjury using simple bedside metrics. This approach offers a promising avenue for the early detection of individuals at increased risk for chronic pain, enabling the implementation of targeted early interventions.

Predictors of Work Fulfillment and General Well-Being in Workers With Chiari Malformation: The Importance of Decent Work

This study extended research on Psychology of Working Theory (PWT) by examining the connection of decent work to work fulfillment and general well-being in 346 predominantly U.S. adult workers diagnosed with Chiari malformation (CM), a chronic health condition involving a structural malformation affecting the posterior region and base of the skull, and commonly presenting with chronic head and neck pain and related physical (e.g., fatigue) and psychological (e.g., anxiety, depression) complications. Participants completed an online survey containing measures of PWT’s outcomes of decent work constructs as well as the domain-specific marginalization constructs of condition severity and workplace limitations. Results of structural equation modeling analyses supported 12 of 19 hypotheses. Decent work directly and positively predicted survival, social contribution, and self-determination needs; social contribution and self-determination needs directly and positively predicted work fulfillment; survival and self-determination needs directly and positively predicted general well-being; decent work indirectly (via social contribution and self-determination needs) and positively predicted work fulfillment and indirectly (via survival and self-determination needs) and positively predicted general well-being; and condition severity directly and negatively predicted general well-being. Consistent with PWT, attaining decent work contributes to meeting needs for survival, social contribution, and self-determination, which in turn contributes to greater work fulfillment and general well-being in workers with CM.

ID: 213065 Neuromodulation for the Treatment of Trigeminal Neuropathy

Despite new therapeutic approaches and an improved understanding of the underlying pathophysiology, chronic (neuropathic) head and facial pain remains notoriously difficult to treat. We report on a series of patients from a specialized Neuromodulation unit. The key question of our analysis was, which neuromodulation approach yields the best results and pain relief based on the underlying condition.

ID: 211720 Treatment of Pain Using Cervical Radiofrequency Ablation: Outcomes From an International, Prospective Multicenter Study (RAPID)

Patients suffering from chronic head and neck pain who are refractory to conservative therapies often make efforts to avoid highly invasive surgical procedures.

Betydningen av personlighetstrekk ved langvarige hode- og ansiktssmerter

Aim: Knowledge about personality can support the choice of treatment of chronic head and facial pain. The aim of this literature review, which to our knowledge is the first of its kind, is to investigate the significance of personality in chronic head and facial pain. Method: Systematic search based on PRISMA guidelines in PsycInfo, MedLine, Embase and Web of Science databases. Results: 11 studies were included. The results indicated that there is a connection between specific personality traits and pain perception and pain behavior, where openness, neuroticism, and extroversion from the five-factor model (FFM) are most prominent. High openness was associated with lower pain perception, high neuroticism was associated with greater discomfort from pain and pain behavior, while high extroversion was associated with less discomfort from pain and pain behavior. Studies based on the Minnesota Multiphasic Personality Inventory (MMPI) found fewer clear associations between chronic head and facial pain and personality. Conclusion: This literature review indicates that openness, neuroticism, and extroversion are related to pain perception and that standard personality tests find higher levels of correlation. A potential clinical implication is that tests that measure personality traits based on FFM, and particularly on NEO-PI-R, may have greater clinical value in planning and customizing treatment. Keywords: personality, headache, facial pain, chronic pain

Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine

Post-traumatic rotational instability at the atlanto-axial (C1-2) joint is difficult to assess, much less quantify, due to the orientation and motion plane of the joint. Prior investigations have demonstrated that a dynamic axial CT scan, during which the patient maximally rotates the head right and left, can be used to evaluate and quantify the amount of residual overlap between the inferior articulating facet of C1 and the superior facet of C2, as an index of ligamentous laxity at the joint. We have previously demonstrated that a novel orthopedic test of rotational instability, the atlas-axis rotational test (A-ART), may have utility in identifying patients with imaging evidence of upper cervical ligament injury. In the present investigation, we assessed the correlation between a positive A-ART and a CT scan assessment of the relative quantity of residual C1-2 overlap, as a percent of the superior articulating facet surface area of C2. A retrospective review was conducted of the records of consecutive patients presenting to a physical therapy and rehabilitation clinic, over a 5-year period (2015-20) for chronic head and neck pain after whiplash trauma. The primary inclusion criteria were that the patient had undergone both a clinical evaluation with A-ART and a dynamic axial CT to evaluate for C1-2 residual facet overlap at maximum rotation. The records for a total of 57 patients (44 female/13 male) were identified who fit the selection criteria, and among these, there were 43 with a positive A-ART (i.e., "cases") and 14 with a negative A-ART (i.e., "controls). The analysis demonstrated that a positive A-ART was highly predictive of decreased residual C1-2 facet overlap: the average overlap area among the cases was approximately one-third that of the control group (on the left, 10.7% versus 29.1%, and 13.6% versus 31.0% on the right). These results suggest that a positive A-ART is a reliable indicator of underlying rotational instability at C1-2 in patients with chronic head and neck symptoms following whiplash trauma.

Efficacy and Safety of Cryoneurolysis for Treatment of Chronic Head Pain Secondary to Occipital Neuralgia: A Pilot Study.

PurposeTreatment of chronic pain associated with occipital neuralgia (ON) is complex, and no consensus statement or guidelines have been published for ON management. This pilot study evaluated the efficacy and safety of cryoneurolysis for management of ON-associated chronic pain.Patients and MethodsThe study was a prospective, multicenter, nonrandomized cohort study assessing the degree and duration of clinical effect of cryoneurolysis therapy for reducing pain in patients diagnosed with unilateral or bilateral ON. The primary outcome measure was improvement in pain due to ON from baseline to day 7, measured on an 11-point numeric rating scale for pain. Secondary outcome measures included duration of treatment effects and safety events, including anticipated observations and adverse events. Treatment effect was assessed at days 7, 30, and 56 by asking the patient if they were continuing to experience a treatment effect, with potential responses of “effect,” “no effect,” or “no longer effective.” A posttreatment questionnaire evaluated patient satisfaction.ResultsTwenty-six patients (9 men, 17 women) with a mean age of 49.1 years enrolled and completed the study. A total of 64% (16/25) of participants reported a clinically important improvement of ≥2 points in numeric rating scale pain scores at day 7; similar results persisted to day 30. Treatment effects were reported by 50% (13/26) of participants at day 30, with a continued effect reported by 35% (9/26) of participants at day 56. Overall, ~70% of participants were satisfied with treatment at 7, 30, and 56 days. No serious anticipated observations, adverse events, or unanticipated adverse device effects were reported.ConclusionCryoneurolysis provided significant relief from pain associated with ON ≤30 days after treatment and had an acceptable safety profile.

Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study.

ObjectivesA large-scale retrospective analysis of veterans with chronic pain was conducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain.MethodsThis retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA in veterans with chronic headache and chronic headache concurrent with TBI as stratified by sex.ResultsVeterans with chronic headaches had the highest annual incidence of SA (329 to 491 per 100,000) each year among all identified types of chronic pain conditions. Compared to other non-headache chronic pain, chronic headache is associated with increased risk of SA [men RR (1.48), CI (1.37,1.59); women RR (1.64), CI (1.28,2.09)], after adjusting for demographic factors, TBI, and psychiatric comorbidities. The risk increased further when chronic headache is comorbid with TBI [men RR (2.82), CI (2.60, 3.05); women RR (2.16, CI (1.67–2.78)].ConclusionVeterans with chronic headache have a higher risk of SA than those with other chronic pain and women with chronic headache are at a higher risk than men with chronic headache. Chronic headache concurrent with TBI further heightened this risk, especially in men. Our data underscore the importance of identifying specific types of chronic pain in veterans with comorbid TBI and sex disparity associated with SA when targeting suicide prevention measures.

Treatment of temporomandibular dysfunction with jaw functional orthopedics: a retrospective study

What are my chances of getting better?” And “How long will it take for the discomfort to improve?” are the two basic questions asked by individuals after they know about the influence of the stomatognathic system (SS) on their discomfort. Despite the biological unpredictability and variation, these individuals need some information. When searching in MEDLINE, some parameters may be found, but there are none about Jaw Functional Orthopedics (JFO). This study sample was composed of 146 patients with TMD and/or headache/neck pains, who were treated with JFO and divided into three groups. Group 1 exclusively with TMD; Group 2 with head and/or neck pain without symptoms of TMD (pain on palpation or movement); and Group 3 with TMD and head/neck pain. The symptoms monitored were arthralgia, and myalgia of the temporal, masseter or suprahyoid muscles, neck pain on movement or palpation, headache and cervicalgia reported. Odontogenic pain and headache originating from other sources (sinusitis, flu, pre-menstrual period, photophobia, hangover, etc.) were excluded from the study. The sample was aligned with the literature relative to prevalence of age and sex. Results showed that JFO treatment was effective in patients of the three groups. There was no statistical difference in mean time for remission among the groups. The results and conclusions should be analyzed with caution since there was no control group, and long term follow up is needed to check the behavior of the symptoms. However, the data from this study suggested that JFO was an efficient tool for treatment of patients with occlusal and biomechanical alterations of the SS, with chronic TMD, head and/or neck pain in a short period of time.

Review of the pathology underlying benign paroxysmal positional vertigo.

The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere’s disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.

Emerging Novel Pharmacological Non-opioid Therapies in Headache Management: a Comprehensive Review.

Chronic headache is a significant worldwide problem despite advances in treatment options. Chronic headaches can have significant a detrimental impact on the activities of daily living. Patients who do not obtain relief from chronic head and neck pain from conservative treatments are commonly being managed with interventional treatments. These interventional treatment options include botulinum toxin A, injections, local occipital nerve anesthetic and corticosteroid infiltration, occipital nerve subcutaneous stimulation and occipital nerve pulsed radiofrequency (PRF), sphenopalatine ganglion block, and radiofrequency techniques. Recently, evidence has emerged to support non-opioid-based drug and interventional approaches. Overall, more research is necessary to clarify the safety and efficacy of interventional treatments and to better understand the pathogenesis of chronic headache pain.

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.

The Opioid Challenge.

The Opioid Challenge.

Evaluation of chronic head and neck myofascial pain control with Yamamoto New Scalp Acupuncture in eight weeks follow-up period

BACKGROUND AND OBJECTIVES: Chronic pain is a common complaint in health assistance settings, so this study aimed at evaluating the analgesic efficacy of an acupuncture technique to relieve pain in patients with chronic head and neck myofascial pain. METHODS: Participated in the study 20 volunteers (aged between 23 and 46 years) with head and neck pain for more than 3 months who presented tense myofascial bands diagnosed by the evaluator. Pain intensity at the beginning of the study was recorded by the verbal numeric scale, as well as mean pain during each week among 8 applications. Acupuncture needle 0.25x30 mm was used on cranial points to the right or left side of the face, determined by Yamamoto’s ScalpAcupuncture technique and was maintained for 20 minutes. RESULTS: Mean pain at beginning of treatment was 7.9 and after 8 weeks it had decreased to 0.8, which is a significant result with p<0.05. Pain improvement evaluation at consultation moment was also relevant because 100% of participants have reported pain improvement immediately after needle application. CONCLUSION: Our results show the effectiveness of one of different possibilities provided by acupuncture for pain relief, especially when the aim is immediate pain decrease. Although promising, results of Yamamoto New Scalp Acupuncture still need further studies to evaluate this acupuncture modality to expand its application and reliability of the technique.

Tratamento com radiofrequência pulsada para gânglio esfenopalatino em pacientes com dor crônica de face e cabeça

PurposeThere are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. MethodsInfrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25‐0.5ms pulse width was applied for sensory stimulation at frequencies from 50Hz to 1V. Paraesthesias were exposed at the roof of the nose at 0.5–0.7V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120s at a temperature of 42°C. ResultsPain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion‐pulsed radiofrequency treatment. ConclusionPulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain

PurposeThere are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. MethodsInfrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25–0.5ms pulse width was applied for sensory stimulation at frequencies from 50Hz to 1V. Paraesthesias were exposed at the roof of the nose at 0.5–0.7V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120s at a temperature of 42°C. ResultsPain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. ConclusionPulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

The Emerging Specialty of Orofacial Pain

The Emerging Specialty of Orofacial Pain

Novel Animal Models of Acute and Chronic Cancer Pain: A Pivotal Role for PAR2

Targeted therapy to prevent the progression from acute to chronic pain in cancer patients remains elusive. We developed three novel cancer models in mice that together recapitulate the anatomical, temporal, and functional characteristics of acute and chronic head and neck cancer pain in humans. Using pharmacologic and genetic approaches in these novel cancer models, we identified the interaction between protease-activated receptor 2 (PAR2) and serine proteases to be of central importance. We show that serine proteases such as trypsin induce acute cancer pain in a PAR2-dependent manner. Chronic cancer pain is associated with elevated serine proteases in the cancer microenvironment and PAR2 upregulation in peripheral nerves. Serine protease inhibition greatly reduces the severity of persistent cancer pain in wild-type mice, but most strikingly, the development of chronic cancer pain is prevented in PAR2-deficient mice. Our results demonstrate a direct role for PAR2 in acute cancer pain and suggest that PAR2 upregulation may favor the development and maintenance of chronic cancer pain. Targeting the PAR2-serine protease interaction is a promising approach to the treatment of acute cancer pain and prevention of chronic cancer pain.

Central Sensitization: Clinical Implications for Chronic Head and Neck Pain

Chronic clinical pain associated with CS, is a potentially progressive, devastating, multimodal disease with a significant worldwide economic and social burden. Effective intervention is dependent upon recognizing the fundamental differences in acute and chronic pain, the effects on and by the neuromatrix upon the biopsychosocial health of the individual patient, and integrating that knowledge into a comprehensive multidisciplinary therapeutic plan.