Analgesic Therapy Research Articles

Validation of an UPLC-PDA Method for the Simultaneous Quantification of Phenol and Iomeprol in a Sterile Parenteral Preparation Used for Coeliac Plexus Block, and Its Application to a Pharmaceutical Stability Study

Objectives: A commonly applied analgesic therapy for patients with severe abdominal pain due to cancer-related pain in the upper abdomen, is coeliac plexus neurolysis (CPN). Herein, a combination product of phenol and an iodine contrast agent are injected simultaneously. The chemical stability of such a combination product is unknown, and no chromatographic method is yet available that describes the simultaneous quantification of phenol and iomeprol. The aim of this study was to develop and validate a stability-indicating UPLC method for the simultaneous quantification of both phenol and iomeprol and to determine the chemical stability of a sterile 100 mg/mL phenol in 350 mg I/mL iomeprol solution for injection during shelf life. Methods: The product was compounded and sterilized in a GMP certified facility. The pharmaceutical analysis was validated by determination of the accuracy, precision, specificity, selectivity, carry-over and linearity. Pharmaceutical product stability was determined before and after sterilization, and during shelf life of 36 months at 25°C ± 2°C. Results: The accuracy for phenol and iomeprol was 97.1% to 99.3% and 100.0% to 100.2%, respectively. The RSD for repeatability and reproducibility for phenol were 0.65% and 1.17%, and for iomeprol 0.61% and 1.49%, respectively. All other tested parameters met the predefined validation criteria. All concentrations at all tested time points remained within ±2% of the initial concentrations for phenol and ±4% for iomeprol. No additional peaks were visible on the chromatograms. Conclusion: A stability-indicating method for the simultaneous quantification of phenol and iomeprol in a parental pharmaceutical preparation was developed and validated. This method was used to demonstrate the chemical stability of a newly developed sterile solution of 100 mg/mL phenol and 350 mg I/mL iomeprol. Chemical product stability was demonstrated during shelf life of up to 36 months.

Pain Management in Knee Osteoarthritis: Insights from an Exploratory Online Survey of Italian Patients and Physicians.

In Italy, knee osteoarthritis (KOA) accounts for over 5 million prevalent cases and requires long-term multidisciplinary management. The most frequent KOA symptom is pain. The aim of the survey is to provide a national overview of the current management of moderate-to-severe pain associated with KOA from both clinicians' and patients' perspectives. An exploratory qualitative survey was conducted in Italy between July and October 2023. The survey participants were members of four national scientific societies and two patient associations who were invited to participate via email and given an online questionnaire. Questions included a mix of single and multiple responses and scalar items. In total, 1473 clinicians and 150 patients with KOA completed the questionnaire. Patients rated knee pain as both the most burdensome symptom and the most frequent reason for treatment dissatisfaction and seeking consultation. One in two patients declared that they were unsatisfied/little satisfied with the current prescribed analgesic treatments. The clinicians surveyed preferentially prescribed intra-articular hyaluronic acid, oral non-steroidal anti-inflammatory drugs/paracetamol, non-pharmacological intervention, and intra-articular corticosteroids. The clinicians' selection of analgesic therapy often failed to adequately meet patients' expectations for pain relief. Our findings highlight the current unmet needs of patients with KOA in Italy and call for new approaches to effectively optimize the management of KOA-associated pain.

"Voiceless Pain"-Assessment of Pain in Patients with Obstetric Brachial Plexus Injuries: A Retrospective, Single Center Analysis.

Obstetric brachial plexus injuries (OBPIs) not only lead to severe and life changing sequelae regarding motor impairment but can also be responsible for multi-characteristic pain. In everyday routine, questions regarding pain of the developing child with an OBPI are often overseen and neglected. We aimed to elucidate this specific question and analyzed all patients with OBPI treated in our center to unmask initially non-observed pain and ultimately put pain in correlation to the surgical reconstructive treatment performed. This single center retrospective study analyzes patients with OBPI treated in our center over the past 20 years. Patients were surveyed by the adolescent pediatric pain tool assessment to evaluate pain over their entire life span by excluding potential postoperative pain episodes. A total of 95 patients were initially contacted of which 78 returned the questionnaire (53.8% female, 46.2% male). In our patient cohort, the vast majority constituting 84.6 percent did not experience pain in the affected upper extremity over the years up to the date of their examination. Most of the patients describing pain had not been microsurgically treated for brachial plexus reconstruction in their neonate period. Merely, 33.3 percent of all OBPI experiencing pain had been microsurgically reconstructed at a median age of 7 months. Pain interrogation in patients with OBPI is often overseen during daily clinical routine. Adequate age-appropriate analgesic therapy regimens adapted to the individual are highly recommended. Timely microsurgical brachial plexus reconstruction may result in reduced lifetime pain experiences.

Histological assessment of the effect of ginger on the healing of chemically-induced aphthous ulceration in rabbits

Background: An aphthous ulcer is a painful and recurrent oral mucosal inflammation that is retractable to treatments and resistant to healing. Conventional treatments include a variety of antiseptic, anti-inflammatory, and analgesic therapies, yet their efficacy remains inconsistent. Aim: The present study was conducted in order to evaluate the effects of ginger powder on the healing of chemically-induced aphthous ulcers in rabbits. Methodology: Twelve healthy rabbits were divided into control and ginger-treatment groups. Aphthous ulcers were induced in both groups. The treatment group received ginger powder topically in the socket every 24 h, for 7 days. Subsequently, all animals were sacrificed, and specimens were collected for macroscopic and histological examination. Results: Histological analysis of the ulcer sites on days 3 and 7 post-induction revealed that ginger-treated ulcers exhibited enhanced healing, as evidenced by increased collagen deposition, fibroblast proliferation, and re-epithelialization. Macroscopic observations also confirmed a faster regression of necrotic tissue and a reduced ulcer size in the ginger-treated group (as compared to the control group). Histological analysis has indicated significant differences in inflammation and blood vessel congestion between the two groups, particularly on day 7. Conclusion: The findings of this study reveal that locally applied ginger can enhance the healing in chemically-induced aphthous ulcers in rabbits, which may support its use in clinical practice.

Double Cervical Adjacent Hydrated Nucleus Pulposus Extrusion (HNPE) in a Yorkshire Terrier

A 9-year-old Yorkshire terrier was brought to the emergency department for inability to maintain the correct station with acute onset. Neurological examination showed a non-ambulatory tetraparesis, spontaneous proprioceptive deficit in all limbs, and decreased flexor reflex in the forelimbs. The neurological symptoms suggested a cranial cervical spinal cord with suspicion of spinal shock. The clinical differential diagnoses included degenerative (intervertebral disc extrusion), vascular, inflammatory, or neoplastic disease. No pathological findings were evident in the hematobiochemical tests or in the radiograph examination. MRI examination of the cervical spine showed the presence of two adjacent hydrated nucleus pulposus extrusions at C3-C4 and C4-C5 tracts. Treatment included analgesic and non-steroidal anti-inflammatory therapy; movement restriction was initially necessary, followed by physiotherapy. Follow-up at 4 weeks showed complete recovery. A telephone follow-up after 3 months with the owner confirmed the absence of symptoms. This article reports the first double cervical HNPE case in a dog, adding the possibility that the disease may present in this form and the success of conservative treatment as described in the literature.

Improving NSAID Safety: The Role of Transdermal Ketoprofen in the Management of Musculoskeletal Pain and Inflammation

Pain and inflammation affect patients both acutely and chronically across all patient demographics. Often, the medications which are used to target musculoskeletal conditions are poorly tolerated due to various contraindications, drug interactions, and troublesome adverse events. The investigation and development of localized, externally applied NSAIDs is on the rise among researchers and pharmaceutical manufacturers, but research is still inefficient in determining the role in therapy of transdermal analgesics and anti-inflammatories. Compounding Pharmacies and FDA 503b Outsourcing Facilities aid in this critical endeavor through endogenous compounding and manufacturing (respectively) of transdermal analgesic formulations. This review summarizes the currently available data supporting the implementation of transdermal ketoprofen preparations in the management of musculoskeletal pain and inflammation. Externally applied NSAIDs are crucial in the development of pain management modalities which reduce the risk of numerous complications, including drug-drug interactions, conflicting comorbidities, and harmful systemic adverse events.

Efficacy of pain treatment therapies for chronic pain among clients in assisted living facilities: A systematic review

Background: More than 60% of residents in assisted living homes experience pain, a complex and subjective emotion. Here, we examine the effectiveness of pain management treatments for residents in assisted living facilities who suffer from chronic pain. Method: In this review, the PRISMA Statement was adhered to. Included were intervention studies, whether or not they were randomized. Retrospective studies, studies without a control group, and studies without an intervention were among the studies that were excluded. Subjects having chronic pain who were 60 years of age or older, of any gender, and permanently residing in an institutional environment, such as a assisted living facilities or residential care facility, were included in studies that matched the qualifying requirements. Result: Eight papers total—three non-randomized and five randomized controlled trials—were included in our systematic review. Acupuncture, massage, music therapy, and analgesics are among the interventions employed. Analgesics was the most effective intervention. Exercise had similar effects to social interventions on neuropsychiatric symptoms, pain, and medication intake in older adults with chronic pain; Epsom salt hot fermentation is more effective than regular salt; and acupressure is anticipated to be a beneficial and effective nursing intervention for the elderly with chronic pain. Conclusion: The most beneficial treatment outcome was obtained from the analgesic medication therapy. Alternative therapies without the use of drugs provide modest to significant therapeutic results.

Impact of opioids on hospital stay and mortality in patients undergoing abdominal surgeries

PurposePostoperative pain management is a critical aspect of surgical care, significantly influencing patient recovery and outcomes. This study aims to evaluate the impact of opioid use on hospital stay and mortality rates among patients undergoing abdominal surgeries in Brazil, where healthcare disparities may affect postoperative outcomes.MethodsThis observational cross-sectional study was conducted at the University Hospital Onofre Lopes in Natal, Brazil. We included 385 patients aged 18 years or older who underwent abdominal surgery in 2023. Data were collected from medical records, focusing on analgesic therapy, opioid types, dosages, and patient demographics. Statistical analyses were performed using JAMOVI software.ResultsOpioid consumption was prevalent among the cohort, with 89.6% of patients receiving opioids postoperatively. Tramadol was the most frequently administered opioid, followed by nalbuphine and morphine. Patients treated with morphine had a significantly extended median hospital stay (15.5 days) compared to those receiving tramadol or nalbuphine (2 days). Morphine use was also associated with a higher mortality rate, with these patients being 16 times more likely to die compared to those on weaker opioids. Older age and extended hospital stays were additional risk factors for increased mortality.ConclusionOpioids were used extensively in this cohort as the main analgesic drug for postoperative pain management after abdominal surgeries. Use was associated with prolonged hospital stay and higher probability of death.

Multidimensional Analysis of Quality of Life in Patients with Chronic Non-Cancer Pain and Short- and Long-Term Intrathecal Analgesic Therapy.

Background: Intrathecal drug delivery (IDD) is part of the fourth analgesic step. Evidence on the quality of life of patients with refractory chronic non-cancer pain (CNCP) using these devices and their long-term outcomes is scarce. This study aims to evaluate patients with IDD to assess their HRQoL. Additionally, the study seeks to understand the patients' satisfaction with the treatment and changes in pain magnitude over time. Methods: Adult patients with CNCP and intrathecal drug delivery systems (IDDS) were included. The study population was divided into two groups: less than and more than 15 years of treatment. HRQoL was analyzed using validated questionnaires. Pain reduction was assessed using the visual analog scale (VAS), and treatment satisfaction was evaluated using the Patient Global Impression of Improvement scale. Results: The results indicate a poor HRQoL in IDD patients, with better scores in the group with ≥15 years of treatment. Pain reduction was similar in both groups, and patients reported a positive satisfaction level with the treatment. Conclusions: HRQoL in CNCP patients is severely affected. Long-term IDD patients have a similar or even better HRQoL in some respects compared to those with shorter follow-ups. IDD patients experienced pain reduction, with most feeling better or much better.

Clinical presentation and treatment of herpes zoster and postherpetic neuralgia

Herpes zoster (HZ) is acommon disease caused by reactivation of varicella zoster virus. Diagnosis is usually based on the typical clinical presentation. Standard treatment includes antiviral, topical and analgesic therapies. As acomplication, postherpetic neuralgia (PHN) can result from acute HZ infection, particularly in older and/or immunocompromised people. This can seriously impair the quality of life of those affected and requires adequate analgesia. In addition to the genesis, clinical presentation and treatment recommendations for HZ and PHN, this article also deals in particular with the vaccination prophylaxis recommended by the standing vaccination commission of the Robert Koch Institute (STIKO).

Efficacy and safety of esketamine hydrochloride adjunct to sufentanil in non-surgical patients under mechanical ventilation in the ICU (SENSATION trial): protocol for a multicentre, single-blind, randomised controlled trial

IntroductionPain is common in patients receiving mechanical ventilation in the intensive care unit (ICU). Intravenous opioids are recommended as first-line therapy for pain management; however, opioids have adverse side effects....

Pharmacokinetic Evaluation of a Topical Extended-release Analgesic in Mice.

Mice often undergo painful procedures and surgeries as part of biomedical research protocols. Buprenorphine, a partial μ-opioid receptor agonist and κ receptor antagonist, is commonly used to alleviate the pain associated with such procedures. Due to its pharmacokinetic profile, buprenorphine requires frequent dosing, resulting in handling stress that can impact animal welfare and study data. A long-acting transdermal buprenorphine formulation (LA-bup) was recently approved for use in cats to provide up to 4 d of postoperative analgesia. In this study, we characterized the pharmacokinetics of a single topical dosing of LA-bup in male and female CD-1 mice administered a 0.36-mg or 18-μL topical dose at select time points. Plasma buprenorphine concentrations were evaluated at 0.25, 0.5, 1, 1.5, 2, 4, 8, 24, 48, and 72 h (n = 3 mice/time point) and remained above the purported therapeutic threshold (1 ng/mL) from 1 to 24 h postadministration. Repeated daily dosing at 24 and 48 h demonstrated plasma levels above 1 ng/mL for up to 72 h with minimal accumulation or changes in maximal concentrations over time. Inadvertent transfer of the topical drug to nondosed mice in the same cage was evaluated by measuring plasma buprenorphine concentrations in nondosed mice cohoused with a single-dosed mouse. Male mice did not demonstrate transfer of drug via grooming or interactions, yet 2 out of 26 nondosed female mice had detectable buprenorphine plasma levels indicating a relatively low incidence of cross-ingestion in cohoused female mice. This study demonstrates that LA-bup is a promising analgesic in mice that could be used for tailored analgesia strategies, depending on the surgical model or duration of analgesic therapy.

ICU patients receiving remifentanil do not experience reduced duration of mechanical ventilation: a systematic review of randomized controlled trials and network meta-analyses based on Bayesian theories.

The purpose of this network meta-analysis (NMA) was to evaluate the efficacy of intravenous opioid μ-receptor analgesics in shortening the duration of mechanical ventilation (MV) in ICU patients. Randomized controlled trials comparing the efficacy of remifentanil, sufentanil, morphine, and fentanyl on the duration of MV in ICU patients were searched in Embase, Cochrane, Pubmed, and Web of Science electronic databases. The primary outcome was MV duration. The Bayesian random-effects framework was used to evaluate relative efficacy. In total 20 studies were included in this NMA involving 3,442 patients. Remifentanil was not associated with a reduction in the duration of MV compared with fentanyl (mean difference (MD) -0.16; 95% credible interval (CrI): -4.75 ~ 5.63) and morphine (MD 3.84; 95% CrI: -0.29 ~ 10.68). The secondary outcomes showed that, compared with remifentanil, sufentanil can prolong the duration of extubation. No regimen significantly shortened the ICU length of stay and improved the ICU mortality, efficacy, safety, and drug-related adverse events. Among these analgesics, remifentanil did not appear to be associated with a reduction in MV duration. Clinicians should carefully titrate the analgesia of MV patients to prevent a potentially prolonged duration of MV due to excessive or inadequate analgesic therapy. https://www.crd.york.ac.uk/prospero/, CRD42021232604.

Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models

BackgroundThoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population.MethodsA retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity.ResultsGender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week.ConclusionsThe study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.

Selective opioid agonist Taphalgin® as a component of postoperative analgesia in various surgical areas: “NIKITA” observational multicenter study

Introduction. The role of peptides in antinociceptive system regulation has became a subject of interest for scientists worldwide. The first registered peptide analgesic tyrosyl-D-arginyl-phenylalanyl-glycinamide acetate which currently can be used in clinical practice was developed in Russia under the name Taphalgin® (PharmFirma “Sotex”, Russia). The effectiveness and safety of this pharmaceutical in postoperative pain management was evaluated in the all-Russia multicenter prospective observation program NICITA (Non-interventional Clinical Trial of Taphalgin ®).Aim. To analyze the effectiveness and safety of Taphalgin® in postoperative pain management in various surgical fields.Materials and methods. The observational program NICITA included 887 patients including patients with malignant tumors of various locations from 15 study centers in different Russian cities. All patients underwent surgical interventions in various anatomical areas under general, regional and combination anesthesia. The principal scheme of postoperative pain management was based on the multimodal approach which included peptide opioid agonist alongside acetaminophen, cyclooxygenase inhibitors in combination with regional anesthesia or without it. The study also included patients who underwent small-volume surgeries, and pain was managed through Taphalgin® monotherapy with subsequent switch to cyclooxygenase inhibitors. The primary endpoint of the NICITA observational program was response to therapy after the first Taphalgin® administration. Decreased pain syndrome per the numerical rating scale 15–60 min after subcutaneous injection and maintenance of analgesic effect 3 h later were considered treatment response. The secondary endpoints included mean time to analgesia start after administration of the 1st single drug dose (in min), duration of effect, types and frequency of adverse reactions including serious in the central nervous system, pulmonary system, gastrointestinal tract developed during the observational program, as well as patient and research physician satisfaction with pain management. To evaluate the significance of pain intensity change at rest and in motion in time, analysis of variance with repeat measurements was used; for pairwise comparison of two time periods, Student’s t-test for dependent samples was used. The differences were considered significant at p = 0.05.Results. Statistically significant decrease in pain intensity in the total patient group was observed 15 minutes after Taphalgin® administration; it reached its minimum 40 min after the injection (р <0.05). The percentage of patients responding to analgesic therapy with Taphalgin® was 96.5 %. During administration of the drug, insignificant decrease (10–15 mmHg) in arterial blood pressure (1.7 % of cases) and vertigo (1 % of cases) were observed. In some patients, several adverse reactions were observed. Satisfaction with analgesic effect of Taphalgin® was relatively high both in patients and research physicians.Conclusion. Taphalgin® has pronounced analgesic effect and is effective for pain management after surgical interventions of various volumes and injury level. The use of this drug is associated with low rate of adverse reactions and absence of pulmonary depression characterizing opioid agonists. Therefore, Taphalgin® can be recommended for clinical use for postoperative pain management after various types of surgical interventions.

Pain therapy in palliative care

Complex pain is common in palliative care. The bio-psycho-social and spiritual model is important for understanding and treatment. Differentiation according to nociceptive, neuropathic and mixed pain should be considered. Analgesic therapy is based on the WHO guidelines and the extended WHO analgesic ladder. The pain management plan includes pharmacological and non-pharmacological interventions with involvement of the private and professional network.

Novel chimeric peptides based on endomorphins and ghrelin receptor antagonist produced supraspinal antinociceptive effects with reduced acute tolerance in mice

It is widely recognized that developing bi- or multifunctional opioid compounds could offer a valuable approach to pain management with fewer side effects compared to single-target compounds. In this study, we designed and characterized two novel chimeric peptides, EM-1-DLS and EM-2-DLS, incorporating endomorphins (EMs) and the ghrelin receptor antagonist [D-Lys3]-GHRP-6 (DLS). Functional assays demonstrated that EM-1-DLS and EM-2-DLS acted as κ-opioid receptor (κ-OR)-preferring agonists, weak μ-opioid receptors (μ-OR) and ghrelin receptor (GHSR) agonists. Upon intracerebroventricular (i.c.v.) administration in mice, both EM-1-DLS and EM-2-DLS exhibited dose- and time-dependent antinociceptive effects in the tail withdrawal test. EM-1-DLS demonstrated the highest antinociceptive potency among the peptides, with an ED50 approximately 8-fold greater than EM-1, while EM-2-DLS showed comparable effects to EM-2. The antinociceptive actions of EM-1-DLS involved activation of GHS-R1α, μ-OR, and κ-OR, whereas EM-2-DLS acted via GHS-R1α, δ-OR, and κ-OR pathways. Additionally, acute antinociceptive tolerance was investigated, revealing that EM-1-DLS induced a tolerance ratio of 2.33-fold, significantly lower than the 5.19-fold ratio induced by EM-1. Cross-tolerance ratios between the chimeric peptides and EMs ranged from 0.92 to 1.76, indicating reduced tolerance compared to EMs alone. These findings highlight the potential of these chimeric peptides to mitigate pain with diminished tolerance development, suggesting a promising strategy for the development of new analgesic therapies with improved safety profiles.

Progress in the validation of nociception monitoring in guiding intraoperative analgesic therapy.

This article summarizes the current level of validation for several nociception monitors using a categorized validation process to facilitate the comparison of performance. Nociception monitors improve the detection of a shift in the nociception and antinociception balance during anesthesia, guiding perioperative analgesic therapy. A clear overview and comparison of the validation process for these monitors is missing. Within a 2-year time-frame, we identified validation studies for four monitors [analgesia nociception index (ANI), nociception level monitor (NOL), surgical pleth index (SPI), and pupillometry]. We categorized these studies in one out of six mandatory validation steps: developmental studies, clinical validation studies, pharmacological validation studies, clinical utility studies, outcome improvement studies and economical evaluation studies. The current level of validation for most monitors is mainly focused on the first three categories, whereas ANI, NOL, and SPI advanced most in the availability of clinical utility studies and provide confirmation of a clinical outcome improvement. Analysis of economical value for public health effects is not yet publicly available for the studied monitors. This review proposes a stepwise structure for validation of new monitoring technology, which facilitates comparison between the level of validation of different devices and identifies the need for future research questions.

Clinical evaluation of the efficiency of combined phytotherapy in the postoperative period in patients with uterus cancer

As it is well known, that operative procedures which influence on ovary functions and relieve the patient of some suffering and danger from diseases, are realized by pronounced changes in hormonal self-regulation, homeostasis disturbance, deep psycho-emotional disorders, which leads to a change in the quality of life, an increased risk of long-term complications development (cardiac vascular pathology, osteoporosis, etc.).Some authors explain the changes in neurovegetative and endocrine homeostasis after hysterectomy not only by the insufficient development of collateral blood flow, but also by the removal of one of the links of the self-regulatory system – APUD – the uterine system, which causes the disorders in hypothalamic-pituitary-ovarian relationships. Menopausal symptoms with the appearance of neurovegetative, psychoemotional disorders, urological disorders, sexual dysfunction, as well as metabolic manifestations do not always provide an opportunity to assess the parameters of a woman’s health, which are combined into the concept of quality of life.The article presents the results of a study on the use of Cimicifuga racemosa for the treatment and prevention of post-hysterectomy syndrome in patients with uterine cancer in the postoperative period.The objective: to study the clinical effectiveness of the drug, which contains the estrogen receptor modulator Cimicifuga racemosa, in patients after surgical treatment for hormone-dependent uterine tumors.Materials and methods. The study included 50 uterine cancer patients after hysterectomy. 30 patients (main group) of them had rehabilitation therapy in the postoperative period (postoperative antibacterial prophylaxis, analgesic therapy, vaginal sanation) and, starting from the second month, they additionally received a herbal preparation with an extract of Cimicifuga racemosa, 1 tablet 1 time a day for 4 months.The control group included 20 women who received only rehabilitation therapy after surgery.Quality of life was assessed after 6 months of therapy based on a comprehensive assessment using the modified MENQOL scale and the study of such important indicators as energy, sleep, emotional reactions, social isolation, physical activity, and pain.All types of statistical processing were performed using the standard package «Statistica for Windows – 10».Results. The use of selective combined herbal therapy of the post-hysterectomy syndrome in patients with hormone-dependent tumors after 6 months of treatment leads to a decrease in the frequency of hot flashes by 63.3%, profuse sweating by 63.4%, sleep disturbances by 43.3%, increased fatigue by 40.0%, depressive disorders – by 36.7% and irritability – by 33.3%.Additional use of the herbal preparation with Cimicifuga racemosa extract reliably (p<0.05) reduces the manifestations of post-hysterectomy syndrome, improves the quality of life, is well tolerated and has no side effects.Conclusions. The use of selective combined herbal therapy in the postoperative period in patients with cancer of the uterine body allows to reliably improve the quality of life of patients and reduce the clinical manifestations of post-hysterectomy syndrome, which is especially relevant in patients with cancer of the uterine body, for whom replacement hormone therapy is contraindicated. Selective herbal therapy is well tolerated by patients and can be used for a long time.

Use of Bedinvetmab (Librela®) for Canine Osteoarthritis in France, Germany, Italy, Spain, and the UK: Quantitative Analysis of Veterinarian Satisfaction and Real-World Treatment Patterns.

Bedinvetmab (Librela®) represents a new class of canine osteoarthritis pain therapy. The aim of this study was to understand patient selection, usage behaviours, and satisfaction amongst veterinarians using bedinvetmab. Overall, 1932 patient record forms (PRF) were collected from 375 veterinarians across five countries in Europe. Veterinarians were asked to provide 5-7 PRF representing an average patient prescribed bedinvetmab. Veterinarian satisfaction with bedinvetmab usage averaged 8.0 out of 10.0 across all countries. Dissatisfaction as a reason for discontinuation was less than 1% for veterinarians. Veterinarians prescribed bedinvetmab broadly, across patient severity stages, weights, and ages. Adherence to monthly dosing per the product label was over 99%, and compliance with bedinvetmab treatment regimens was 85%. Following initiation of bedinvetmab, the proportion of patients requiring multiple pharmacological therapies for osteoarthritis pain fell from 47% to 31% (p < 0.05). After initiation of bedinvetmab, the mean total number of pharmacological therapies per patient across the population was 1.3, a reduction from 1.9 pre-treatment (p < 0.05). This investigation provides evidence on the benefit of bedinvetmab use post-launch in a broad population of dogs across the five most populous countries in western Europe. Compliance and satisfaction appear high and the use of other analgesic therapies to treat osteoarthritis pain is reduced in most cases following administration of bedinvetmab.