Burning Pain Research Articles

Defining numerical cut points for mild, moderate, and severe pain in adult burn survivors: A northwest regional burn model system investigation

IntroductionPain is a common and often debilitating sequela of burn injury. Burn pain develops following damage to peripheral sensory nerves and the release of inflammatory mediators from injury. Burn pain is complex and can include background and procedural pain that result from the injury itself, wound care, stretching, and surgery. Clinicians and researchers need valid and reliable pain measures to guide screening, treatment, and research protocols. Unlike other conditions, visual analog, or numeric pain rating scale (VAS/NRS) scores that represent mild, moderate, and severe pain among people with burn injury have not been established. The aim of this study was to identify the most suitable average pain intensity rating scores for mild, moderate, and severe pain in adult burn survivors using a PROMIS Pain Interference (PROMIS-PI) short form. MethodsAn average pain intensity VAS/NRS score (0−10) and customized PROMIS-PI short form were administered to adults with burn injury treated at a regional burn center at hospital discharge (baseline) and at 6, 12, and 24-months after injury. To identify pain intensity scores that represent mild, moderate, and severe pain, we computed F values and Bayesian Information Criterion (BIC) statistics associated with multiple ANOVA comparisons for mean pain interference scores by various pain intensity cut points. Six possible cut points (CP) were compared: CP 3,6; 3,7; 4,6; 4,7; 2,5; and 3,5. Optimal cut points were considered those with the highest ANOVA F statistics. Models with similar F statistics were also compared with BIC. ResultsData from a sample of 253 participants (83% white, 66% male, mean age 47 years) with VAS/NRS pain intensity and PROMIS-PI scores at one or more timepoints were analyzed. The optimal classification for mild, moderate, and severe pain was CP 2,5 at baseline and 12-months. Although CP 3,6 had the highest F value at 6-months, there was not strong evidence to support CP 3,6 over CP 2,5 (BIC difference: 2.9); similarly, CP 3,7 had the highest value at 24-months, but the BIC difference over CP 2,5 was only 2.2. ConclusionsVAS/NRS scores for pain among adults with burn injury can be categorized as mild (0−2), moderate (3−5), and severe (6−10). These findings advance our understanding regarding the meaning of pain intensity ratings after burn injury, and provide an objective definition for clinical management, quality improvement, and pain research.

Comparative Study between Yoni Dhavan, Oral Medicine and both therapy in the treatment of Swetapradara

Swetapradara is a common and major problem in our country of female especially reproductive age. Total patients (60) were divided into three group i.e. Gr-A, Gr- B and Gr- C with clinical features of white vaginal discharge, itching of vulva, burning pain in vagina, low back pain, general weakness.Gr-A was treated with Yoni Dhavan (Vaginal irrigation) by a compound decoction. Gr- B was treated with oral medicine by Pusyanuga Churan.Gr- C was treated with both therapies i.e., Yoni Dhavan & Oral medicine. This comparative clinical trial was conducted to evaluate the efficacy of Gr-C which were confirmed that the effectiveness was better than other groups in the management of Swetapradara. This study observe a highly significant reduction in mean scores of clinical feature and overall compliance to the treatment was excellent in the Gr-C and p value of < 0.001 was considered highly significant.

Assessment of Knowledge, Attitude, and Practices Related to Sun Exposure among University Students of Rawalpindi and Islamabad

Objective: To assess the knowledge and attitude towards sun exposure related practices among university students of twin cities.
 Study Design: Quantitative analytical cross-sectional study.
 Place and Duration of Study: A Quantitative analytical cross-sectional study was carried out in the university students of Rawalpindi and Islamabad Pakistan, from Jan till Apr 2022.
 Methodology: Total participants were 317. Participants were university students, who were studying during 2021-2022 under registered universities within the twin cities. The data was gathered through online Google Forms. IBM SPSS version 25 was used for analysis.
 Results: 42.5% participants exposed themselves to the sun doing outdoor activities for over 90 days a year, while 49.3% did so for 1-2 hours a day. 29% of the people got painful burns at least once or twice this year. Only 20% participants took shelter in shade or used umbrellas, 14.5% used hats. 20.4% never used sunscreen, while 22.6% did, and among them, 44.3% were unaware of the SPF they used. 48% do not like using sunscreen. 65.4% believed sun protection creams were the best way to protect themselves. 81.1% think at least 30 minutes of sun a day are advisable for adequate Vitamin D levels. (p<0.05)
 Conclusion: It was found that people does have knowledge about the importance of shade and clothing material, such as hats,to avoid the harmful effects of sun exposure but they do not practice it. When it comes to sunscreen, most do not use it and those who do, do not possess significant knowledge about its SPF.

Exploring combat stress exposure effects on burn pain in a female rodent model

In the military, constant physiological and psychological stress encountered by Soldiers can lead to development of the combat and operational stress reaction (COSR), which can effect pain management. Similar effects are seen in other populations subjected to high levels of stress. Using a model of COSR, our lab recently showed that four weeks of stress prior to an injury increases pain sensitivity in male rats. With the roles of women in the military expanding and recent studies indicating sex differences in stress and pain processing, this study sought to investigate how different amounts of prior stress exposure affects thermal injury-induced mechanosensitivity in a female rat model of COSR. Adult female Sprague Dawley rats were exposed to the unpredictable combat stress (UPCS) procedure for either 2 or 4 weeks. The UPCS procedure included exposure to one stressor each day for four days. The stressors include: (1) sound stress for 30 min, (2) restraint stress for 4 h, (3) cold stress for 4 h, and (4) forced swim stress for 15 min. The order of stressors was randomized weekly. Mechanical and thermal sensitivity was tested twice weekly. After the UPCS procedure, a sub-set of rats received a thermal injury while under anesthesia. The development of mechanical allodynia and thermal hyperalgesia was examined for 14 days post-burn. UPCS exposure increased mechanosensitivity after two weeks. Interestingly, with more stress exposure, females seemed to habituate to the stress, causing the stress-induced changes in mechanosensitivity to decrease by week three of UPCS. If thermal injury induction occurred during peak stress-induced mechanosensitivity, after two weeks, this resulted in increased mechanical allodynia in the injured hind paw compared to thermal injury alone. This data indicates a susceptibility to increased nociceptive sensitization when injury is sustained at peak stress reactivity. Additionally, this data indicates a sex difference in the timing of peak stress. Post-mortem examination of the prefrontal cortex (PFC) showed altered expression of p-TrkB in 4-week stressed animals given a thermal injury, suggesting a compensatory mechanism. Future work will examine treatment options for preventing stress-induced pain to maintain the effectiveness and readiness of the Warfighter.

Targeted dorsal root entry zone stimulation alleviates pain due to meralgia paresthetica

Objective. Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain. Approach. A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments. Main results. Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities. Significance. We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort.

COMPARISON BETWEEN EFFECT OF INTRAVENOUS LIGNOCAINE AND KETAMINE IN ALLEVIATING PROPOFOL INJECTION PAIN IN PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

Background: Propofol is the most commonly used intravenous inducing agent. Sharp, burning or aching pain on injection is a major problem. The cardiovascular response to the pain can aggravate adverse events in patients with history of coronary artery disease Small boluses of ketamine, magnesium, dexmedetomidine, ondansetron, dexamethasone, lignocaine hydrochloride, ketorolac, metoclopramide and opioids have been tried. To compare analgesic effe Aim: cts of using intravenous ketamine and lignocaine in alleviating pain following propofol injection. A prospective randomized double blinded st Methods And Material: udy was conducted in Chettinad Hospital and Research Institute, Kelambakkam among 50 participants undergoing surgeries under general anesthesia. Tourniquet was applied midarm ,Group L was given 21.3mg of 2% lignocaine and Group K was given 15mg of ketamine. Tourniquet was removed after 30seconds and then 1/3rd dose of total dose of 2mg/kg propofol was given. Degree of injection pain was evaluated using Mccririck Hunter scale. Results: Pain score on propofol injection was similar in both groups. Among the patients, 54% reported no pain,in that 76% patients were in Group L and 52% patients in Group K. McCRIRICK AND HUNTER PAIN SCALE rating between two groups are similar with the p value of more than 0.05. The pre-treatment of 15mg ketamine is as effective as 21.3mg 2% l Conclusions: ignocaine in reducing the severity of propofol injection pain.

Thyroid Dermopathy and Acropachy

A 58-year-old man with a 9-year history of gradually worsening and disabling hand and feet swelling, with associated burning pain, is followed in Dermatology. He developed Graves disease 20 years ago, treated with radioactive iodine, and Graves ophthalmopathy treated with surgical decompression and tarsorrhaphy 8 years ago. He is a former smoker. Examination revealed disfiguring hypertrophic, firm, skin-colored overgrowth, and nonpitting edema of hands (Figure 1; Supplemental Figure, available online at http://www.mayoclinicproceedings.org) and feet (Figure 2).

Bilateral Sphenopalatine Ganglion Blocks for Refractory Burning Mouth Syndrome

BACKGROUND: Burning mouth syndrome (BMS) is a debilitating condition that produces a burning pain of the oral cavity and does not have identifiable inciting factors. There are no established treatments, but neuropathic medications have been trialed with variable efficacy. Utilizing targeted nerve blocks could provide therapeutic benefit when treating patients with refractory BMS symptoms. CASE REPORT: This case describes the treatment of a 61-year-old woman with BMS who presents with refractory symptoms despite maximum dose trials of neuropathic medications. She was successfully treated using bilateral sphenopalatine ganglion blocks. The patient reported a decrease in pain from 7/10 to 1/10 one day after the procedure and described a 90% benefit. CONCLUSIONS: Bilateral sphenopalatine ganglion blocks should be considered to treat refractory BMS. KEY WORDS: Refractory burning mouth syndrome, burning tongue, stomatodynia, nerve block, local anesthesia, pain management

Ayurvedic Management of Vatarakata (Gout) - A Case Report

Vatarakta (gout) is a common metabolic disorder. It is a Vatapradhana Tridoshaj Vyadhi caused by both, Vata Dosha and Rakta Dushti is called Vatarakta. Vatarakta (Gout) is an inflammatory disorder, which causes swelling including burning pain in metatarso-phalangeal joints and other joints and eventually it leads to inability to walk. At first it settles in its root (initial involvement) in hands and feet and then spread all over the body. According to modern science Vatarakta can be correlated with Gouty arthritis. This leads to increase in blood and serological parameters like serum uric acid. Here is a single case report of patient who got better results with Ayurvedic medication like Guduchyadi Kashaya, Guduchi Ghana vati, Kaishora Guggul, Eranda tail (castor oil) and Panchkarma therapy such as Oleation therapy (Snehan), Sudation therapy (Swedan) and Enema therapy (Basti) Jalaukavacharana. Ayurvedic oral medicines and Panchkarma therapy alleviate Vata by bringing back its normal function and obstruction in Raktavaha Srotas by Kaphamedoghna action. After 35days of treatment patient got symptomatic relief and also decrease level of serum uric acid in blood.

Role of dairy proteins in the reduction of capsaicin-induced oral burning pain

Capsaicin-induced burning sensation in the oral mucosa can be relieved by skimmed and whole milk. The mechanism behind this effect, however, is unknown. This study aimed to asses the role of milk proteins in reducing capsaicin-induced oral burning sensation. 24 healthy participants were included in this single-blinded cross-over study consisting of four sessions. In each sessions, mucosal burning sensation was evoked by having the participants dip their tongues in a cup containing 0.1% capsaicin gel for a total of 8 min. The perceived levels of unpleasantness and burning intensity were scored on two different numerical rating scales. After capsaicin exposure, the participants rinsed their mouth for 10 s with a different solution in each session (3.5% casein, 3.5% whey, 3.5% lactose (non-protein control) and skimmed milk (active/positive control)). Mechanical (64, 128 and 256 mN pinprick) and thermal (5, 40, 45 and 50 ̊C) sensitivity of the tongue was measured using semi-quantative sensory testing at baseline, immediately after capsaicin exposure and when the scores for unpleasantness and burning intensity reached the minimum value of 0. Thermographic images of the tongue were taken at the same time-points. Overall, no statistically significant difference in unpleasantness and burning intensity was found between the four sessions (P ≥ 0.070). Explorative pair-wise comparisons, however, showed slight short-term reduction in unpleasantness and burning intensity when comparing the casein solution with the lactose solution (P ≤ 0.020). Scores for burning intensity and unpleasantness varied over time (P ≤ 0.001). Statistically significant changes in heat and mechanical sensitivity was observed between time-points (P < 0.001) but not sessions (P ≥ 0.410). An increased sensitivity towards heat and a decreased sensitivity towards mechanical stimuli was observed after capsaicin exposure compared with baseline (P < 0.001). Similarly, changes in thermographic temperature of the tongue was observed between time-points (P < 0.001), but not sessions (P ≥ 0.827). An increased maximum, minimum and average temperature of the tongue was observed immediately after capsaicin exposure compared with baseline (P < 0.001). In conclusion, short-term rinsing with room temperature milk proteins did not robustly alter capsaicin-induced oral burning sensation, unpleasantness, somatosensory changes or tongue temperature compared with control. Further studies exploring the effects of increased rinsing time and concentrations are needed in the future.

The effect of mirror therapy on joint movement, pain and functionality in acute upper limb burns

ObjectiveMirror therapy is aimed at developing a normal proprioceptive perception for the area with pain or movement restriction by making use of the person's monitoring of the healthy side movements thanks to the mirror's reflective feature. The aim of this study is to investigate the effect of mirror therapy on joint range of motion, pain and functionality in acute upper extremity burn injuries. MethodsDemographic and burn-specific data of individuals with upper extremity burns were recorded. Individuals were divided into two groups. Standard treatment was applied to the first group, and mirror treatment in addition to the standard treatment was applied to the second group for 30 sessions, 5 days a week for 6 weeks. In the standard treatment program, passive, active-assisted and active ROM, strengthening, stretching, resistant and functional exercises were applied. In the mirror therapy group, active exercises were performed on the healthy side by covering the burn area in the mirror box. Before and after the treatment, joint range of motion(ROM) was evaluated with Universal Goniometer, pain intensity was evaluated with Visual Analog Scale and upper extremity functions were evaluated with QuickDASH. ResultsA total of 32 (23 Male, 9 Female) individuals between the ages of 18–65 were included. The mean total burn surface area was 12.93 ± 9.80 in the standard treatment and 6.12 ± 2.96 in the mirror treatment. The groups were similar in terms of ROM change (p > 0.05). The pretest/posttest pain scores of both the standard therapy and mirror therapy groups were similar (p > 0.05). There was no statistically significant difference in terms of pretest and posttest QuickDASH scores according to the groups (p > 0.05). The difference between the pretest/posttest QuickDASH scores of both Standard treatment and Mirror treatment groups was statistically significant. ConclusionThis study showed that the standard physiotherapy and rehabilitation program applied in the acute period in upper extremity burns and the mirror treatment applied in addition to this program provide similar improvements in joint range of motion and pain.

Rare presentation of Waldenström’s macroglobulinaemia requiring bilateral above-knee amputations: a case report

BackgroundWaldenström’s macroglobulinaemia is a rarely encountered B-lymphocytic malignancy. Waldenström’s macroglobulinaemia-associated paraproteinaemia is linked to an increase in serum viscosity, which results in a hypercoagulable state. Burning bilateral foot pain in a man with alcohol dependence and controlled atrial fibrillation presenting to the emergency department was attributed to peripheral neuropathy, given satisfactory angiographic evidence of bilateral foot arterial blood supply. Subsequently, his presentation as an emergency with acute bilateral critical lower limb ischemia that was managed by bilateral above-knee amputations, prompted a wider search for other etiologies. We present a hitherto unreported case of Waldenström’s macroglobulinaemia-related acute bilateral lower limb ischemia, which required bilateral above-knee amputations.Case presentationA 50-year-old Caucasian man, who was an alcohol dependent heavy smoker, presented with burning pain in his right foot that was deemed to be related to alcoholic neuropathy. A computerized tomographic angiogram demonstrated an occluded right distal anterior tibial artery but a patent posterior tibial artery supplying the foot arch, findings that were associated with noncritical ischemia. After multiple presentations within a week, he was admitted following sudden clinical deterioration with acute confusion, hyponatremia, and bilateral foot pain. Over the course of 24 hours, the patient deteriorated rapidly, with bilateral lower limb ischemia requiring bilateral above-knee amputations. Subsequent investigations revealed a diagnosis of Waldenström’s macroglobulinaemia.ConclusionsTo the best of our knowledge, this is the only reported case of Waldenström’s macroglobulinaemia-induced bilateral lower limb ischemia requiring major bilateral amputations.

PO09: Treatment of Facial Folliculotropic Mycosis Fungoides with High Dose Rate Brachytherapy in Two Fractions

<h3>Purpose</h3> To describe the treatment and outcomes for the treatment of folliculotropic mycosis fungoides (FMF) with high dose rate (HDR) brachytherapy in the facial area with complex topography. <h3>Materials and Methods</h3> A 68-year-old male with past medical history of morbid obesity status post gastric bypass, diabetes mellitus, hypertension, and atrial fibrillation was diagnosed with FMF of the face, scalp, trunk and extremities. Patient was referred to radiation therapy due to severe burning pain and pruritus of facial lesions on the nose, upper lip, and left temple after no response with UVA therapy. Electron beam therapy was initially chosen with a prescription of 3600 cGy in 20 fractions, but the resulting treatment plans were highly non-conformal with large dose heterogeneity and poor target coverage. HDR brachytherapy was pursued as an alternate treatment option with a prescription dose of 800 cGy in 2 fractions. Patient setup for simulation included a custom Freiburg flap applicator on an Aquaplast mask using 18 catheters to cover all lesions. Patient was scanned with pink bolus in the nostrils, a lead shield under the lip, and a bite block. Treatment planning was performed using Oncentra (Elekta, Stockholm, Sweden). HDR treatment was delivered using an Elekta Flexitron remote afterloader unit. Bilateral internal tungsten eye shields (Civco, Orange City, IA) were placed prior to treatment to reduce ocular dose. <h3>Results</h3> The drawn target was 25.2cc along the upper lip, bilateral nose, right medial canthus, and left temple. Achieved target coverage was V90% = 98.6%, D90% = 100.5%, and D95% = 95.9%. Skin V150% was 0.12cc. Without eye shield placement, right and left eye D0.01cc were 117.9% and 78.2%, respectively. Right and left lens doses were 99.1% and 69.4%, respectively. Average fractional delivery time was 603.5 seconds with an air kerma strength of 39.0 mGy*m²/s (apparent activity 9.7 Ci). Patient tolerated treatment without complications. At two week follow up, patient showed grade 1 dermatitis of the treatment area with erythema and mild desquamation. Patient has been asymptomatic six months post treatment. <h3>Conclusions</h3> Low dose HDR brachytherapy can be an effective treatment for facial FMF lesions with complex topography. It allows for suitable target coverage and normal tissue sparing, a shorter treatment course when compared to electron beam radiotherapy, and is associated with minimal adverse effects and rapid clinical response. It also allows sparing total skin electron therapy for the future in case of disease progression as the volume of tissue receiving radiation is very small. Figure 1a: Oncentra treatment plan in axial, sagittal, and coronal planes, with 3D rendering show in bottom right. Target volume in light blue, right eye in green, and left eye in blue. 1b shows wires outlining the target volume (top); pre-mask setup with pink bolus, bite block, gauze in the nostrils, and bilateral eye shields (middle); and final treatment setup with mask (bottom). 1c shows the pre-treatment lesions, and 1d shows the same area four months post treatment.

Farmaci antiemetici e bilancio tra benefici e rischi: il caso della metoclopramide

An 8-year-old girl arrived in the Emergency Department presenting with sudden unilateral right trismus, deviation of the jaw, burning pain in the neck with dystonic deviation of the same backwards and dyskinesia. The mother reported that the child started vomiting and that three days before she had started therapy with metoclopramide 0.5 mg/kg/day IM following her paediatrician’s indication. In the suspicion of metoclopramide-induced extrapyramidal symptoms, blood chemistry tests were performed showing normal results and midazolam 0.2 mg/kg was administered leading to regression of symptoms. After twenty minutes symptoms recurred with pain-induced sinus tachycardia (HR 180 BPM). Therefore, she was administered a second dose of midazolam EV at 0.15 mg/kg that led to a complete and definitive regression of symptoms. Metoclopramide is a neuroleptic drug indicated only for the treatment of post-operative vomiting or chemotherapy in children over one year. The most common adverse reaction is the onset of extrapyramidal symptoms. A careful risk-benefit balance must always be performed before deciding whether to administer an antiemetic drug.

A Multimodal Pain Management Strategy for Burn Patients

BackgroundAcute burn pain is difficult to manage, and poorly managed pain can lead to deleterious consequences such as post-traumatic stress disorder, prolonged recovery, chronic pain and long-term dependence on opioids. Understanding the role of nursing in promoting self-efficacy and minimizing opioid use is valuable. It is unknown whether strategic efforts aimed at enhancing patient self-efficacy will improve pain managment and lessen opioid requirements in the adult burn population. AimThe aim of this study was to examine the effect of a multi-modal, interdisciplinary pain management strategy on coping self-efficacy, pain scores, and opioid use in adult burn patients in the acute care setting. MethodA quasi-experimental pre-test/post-test design was employed in an American Burn Association (ABA) verified burn center in the Pacific Northwestern United States. Data were collected prospectively for a 6-month period on 44 burn patients. The comparison group received usual care (n = 28), and the intervention received a pain management protocol (n = 16). Coping self-efficacy was measured on admission and at discharge in both groups using the Coping Self-Efficacy Scale. Numeric pain scores and opioid use in morphine milligram equivalents were averaged for each participant. Burn nurse perceptions were gathered via an anonymous electronic survey post data collection in February 2021. ResultsThere were no significant differences in measured coping self-efficacy, pain scores, or opioid use between the intervention and comparison groups. A significant positive correlation was found between length of stay, size of burn, and coping self-efficacy and problem focused self-efficacy. Burn nurses reported increased use of nonpharmacologic adjuncts since protocol implementation. ConclusionNonpharmacologic adjuncts are more likely to be used consistently when protocolized. There is also evidence to support that certain aspects of self-efficacy may be enhanced during acute phase of burn care.

Management of formocresol burn-case report

&lt;p&gt;Formocresol is widely used in pediatric endodontics as a pulpotomy medicament. Formocresol helps to fix soft tissues in oral cavity such as pulp. Care should be taken while using formocresol proper isolation techniques should be used during its application as an endodontic material, because of its hazardous effects on soft tissue. This article elaborates the case of chemical burns due to improper handling of formocresol during dental treatment. It demonstrates the underlying effect such as moderate pain burning sensation and patchy dark discoloration of skin and its resolution.&lt;/p&gt;

Why the lightest touch can cause burning pain

Why the lightest touch can cause burning pain

AYURVEDIC MANAGEMENT OF VISARPA WITH SPECIAL REFERENCE TO HERPES ZOSTER: A CASE STUDY

All ages, from neonates to elderly persons, suffer from skin disorders. Though skin lesions are visible, they have cosmetic importance also. The pathophysiology and management of skin disorders are explained in Ayurved Samhitas as Raktavaha srotasa dushtijanya vikara and its chikitsa. Among them, ‘Visarpa’ is one of the most typical acute skin disorders. It is explained in detail apart from ‘Kushta’ vyadhi in all the Ayurvedic Samhitas. According to Ayurveda, visarpansheel (spreading), sukshma pidaka (tiny rash) with shoola (pain), kandu (itching), and daah (burning) are present in Visarpa. The signs and symptoms of Visarpa are correlated with a modern skin disorder called Herpes zoster. Herpes zoster is an actively transmitting viral disease causing localized painful skin rashes, blisters, and burning sensations. A case of 23 years old male who came with complaints of shirogaurav (heaviness of head) and jwarprachiti (mild fever), angamarda (body ache), visarpansheel sukshma pidaka with kandu, daah for two days. The patient was treated with raktamokshan by jalauka and shaman chikitsa. He was advised for pathyakar aahar (dietary modification) and vihar (lifestyle modification). He got relief within seven days.

The nonopioid cholinergic agonist GTS-21 mitigates morphine-induced aggravation of burn injury pain together with inhibition of spinal microglia activation in young rats

BackgroundRepetitive opioid use does not always alleviate basal pain, procedural pain, or both after burn injury. Mitigation of burn injury-site pain can be achieved by GTS-21 stimulation of α7-acetylcholine nicotinic receptors (α7AChRs) and reduced microglia activation in rat. We tested the hypothesis that morphine exaggerates burn injury-site pain and GTS-21 alleviates both morphine-induced aggravated burn injury pain and microglia activation. MethodsYoung rats with dorsal paw burn injury or sham-burn received intraperitoneal saline, morphine, GTS-21, or a combination twice daily for 14 days. Ipsilateral plantar pain thresholds were tested every other day before morning drugs from days 0–20. Spinal microglia activation, evidenced as pain-transducer (tumour necrosis factor-α [TNF-α], interleukin [IL]-6, IL-1β, nuclear factor kappa B [NF-κB], Toll-like receptor 4 [TLR4]) expression, was examined using immunohistochemistry and immunoblot. In cultured microglia, morphine-induced cytokine expression was measured (quantitative polymerase chain reaction/enzyme-linked immunosorbent assay [qPCR/ELISA]). ResultsMorphine aggravated allodynia at day 5 in sham-burn (P=0.039, n=8–11) but significantly aggravated burn injury site allodynia by day 3 (P=0.010, n=8–11). Microgliosis paralleled nociceptive behaviour changes where burn injury with morphine had highest microgliosis compared with burn injury, morphine alone, or controls (number of cells per field [SD]: 33.8 [2.4], 18.0 [4.1], 8.2 [1.9], and 4.8 [2.0], respectively; P<0.001, n=4–5]. GTS-21 reversed the morphine-induced pain component in sham-burn and burn injury rats together with reduced microgliosis and spinal pain-transducer expression (TNF-α, IL-6, IL-1β, NF-κB, and TLR4). Morphine-exposed microglial cells showed increased cytokine expression, which was mitigated by GTS-21. ConclusionsMorphine or burn injury alone increases pain together with microgliosis and pain-transducer expression. Morphine administration augments burn injury-site nociception sooner and aggravated spinal microgliosis and inflammatory pain-transducer expression. GTS-21 has the potential to treat morphine-induced pain in burn injury.

Descriptive Analysis of Current Burn Care for Plain Communities in Ohio and Pennsylvania: A Qualitative Study of Strengths and Needs in a Hospital-Community Partnership.

Plain communities present with a higher risk of sustaining burn injuries. Yet, little is known about the hospital-community partnerships with Plain caretakers to facilitate culturally competent burn care. The current study provides a qualitative analysis of Plain caretakers' perspectives on an existing hospital-community partnership for facilitating culturally sensitive burn care and their perspectives on the ongoing physical, structural, and behavioral health needs of this population. Twelve Plain community caregivers who serve on a burn wound treatment team or an oil therapy team within their community took part in a focus group interview. Caretakers identified as White, were majority male (83%), and resided in Plain communities. Retrospective thematic analysis was used to analyze the data. Five major themes (ie, informational needs, strengths of Plain community burn care, behavioral health concerns, behavioral health resources, and preferred teaching methods) evolved. Results revealed that Plain caregivers displayed an openness to learning about recommended burn care from the medical providers. Caretakers also cited their traditional (homeopathic) burn care procedures as perceived strengths, while simultaneously maintaining that their relationship with the hospital is a valuable part of life-saving burn care. Regarding their behavioral health needs, caretakers highlighted difficulties in helping their children cope with burn injuries and pain during rehabilitation and treatment. Other topics discussed included social support and cultural factors that impact the delivery of burn care to Plain communities from non-Plain providers. These results provide important considerations that other burn centers may consider when establishing similar partnerships to deliver of culturally competent medicine for Plain burn survivors.