Neuron-specific enolase (NSE) has been identified as a marker of neuronal damage in different clinical conditions. Percutaneous balloon compression (PBC) is a well-established palliative destructive procedure for the treatment of trigeminal neuralgia (TN). The aim of our study was to evaluate the prognostic role of NSE in predicting pain recurrence after PBC for drug-resistant TN. We retrospectively analyzed the prospectively collected data of 41 drug-resistant TN patients (21 M, 20 F; mean age 65 ± 13 years) who underwent PBC between December 2020 and June 2023. Serum levels of NSE and other biochemical parameters were collected preoperatively and postoperatively. Clinical factors, including age, sex, TN duration, pain type and side, previous operations, balloon morphology, were assessed. Outcomes included acute pain relief, recurrence rate, and Barrow Neurological Institute pain score at follow-up (FU). Of the 41 patients, 37 (90.2%) achieved acute pain relief. Barrow Neurological Institute pain score was significantly decreased at FU (median 19.00 [12.75-30.25] months) compared with the preoperative one (2.00 [1.00-3.00] and 4.00 [4.00-5.00], respectively; P < .0001). No major complications occurred in the whole cohort. Pain recurrence was observed in 17 patients (41.5%). Postoperative NSE levels significantly increased compared with preoperative levels ( P = .0301) especially in patients without recurrence ( P = .0057). Using receiver operating characteristic curve analysis, the following cutoff values were identified: Patients with postoperative NSE >10.5 ng/mL or perioperative (postoperative minus preoperative) NSE increase >0.5 ng/mL had significantly reduced recurrence rates ( P = .0004 and P = .0004, respectively). Multivariable analyses confirmed postoperative NSE value and perioperative NSE increase as independent negative predictors of pain recurrence ( P = .0420 and P = .0308). This study identified NSE as a key biomarker for predicting pain recurrence after PBC for drug-resistant TN. We identified clinically relevant cutoff values for postoperative NSE and perioperative NSE increase, which provide practical tools for risk stratification, allowing personalized FU strategies.

Patients with head and neck cancer commonly experience severe neuropathic pain. This pain is often challenging to treat and may be refractory to standard analgesic approaches. We describe the use of subcutaneous Botox injections to manage pain in such a patient. A patient with poorly differentiated carcinoma of the right base of skull with perineural invasion presented to the pain clinic with intractable facial pain. Subcutaneous Botox injections were performed. The patient experienced a significant reduction in the intensity of her pain following subcutaneous Botox injections. Subcutaneous Botox injections represent a safe and effective option for patients with head and neck cancer experiencing neuropathic pain refectory to standard analgesic medications.

Introduction Diagnosing autoimmune arthritis in patients with advanced osteoarthritis can be challenging, especially in the early stages of the disease. Overlapping symptoms often lead to delayed diagnosis and ineffective treatment focused solely on degenerative or mechanical changes. Case description We present the case of a 66-year-old female with a long-standing history of advanced osteoarthritis of the hands (Heberden’s and Bouchard’s nodes). The patient reported pain in the right heel (radiating to the Achilles tendon) for approximately 3 months and pain in the second left toe for 2 weeks. Laboratory tests, including rheumatoid factor (RF), antibodies to cyclic citrullinated peptide, and HLA-B27, were negative. A family history revealed psoriasis in the patient’s mother. Initially, the patient received orthopaedic treatment based on an ultrasound diagnosis of Achilles tendinopathy. Despite receiving a platelet-rich plasma injection and subsequent non-steroidal anti-inflammatory drugs therapy, no significant clinical improvement was observed. During a rheumatological consultation, an ultrasound was performed. The examination revealed clear signs of enthesitis of the right Achilles tendon (increased Power Doppler signal and thickening) and inflammation of the MTP-2 flexor pulley, accompanied by subcutaneous tissue inflammation consistent with dactylitis. Based on the CASPAR criteria (3 points: negative RF, family history of psoriasis, and dactylitis), psoriatic arthritis was diag nosed. Treatment with methotrexate (20 mg/week) and prednisone (10 mg/day) was initiated, and the patient remains under regular rheumatological follow-up to monitor treatment efficacy. Conclusions This case illustrates that autoimmune arthritis can pose significant diagnostic difficulties in patients with pre-existing musculoskeletal disorders. It highlights the necessity for clinical vigilance whenever new joint pain patterns emerge. Rheumatologist-performed ultrasound at the point of care remains a crucial diagnostic tool for differentiating inflammatory from mechanical pathologies.

Abstract Objectives To determine if genicular artery embolization (GAE) is more effective in relieving pain symptoms after 12 months compared to a sham procedure in patients with mild to moderate knee osteoarthritis. A secondary aim was to investigate changes in synovitis observed at 4 months and the correlation with other clinical outcomes. Materials and methods A randomized controlled trial included patients with mild to moderate knee osteoarthritis unresponsive to conservative treatment, who were randomly assigned to receive either GAE or sham treatment. Follow-up was at 1, 4, 8, and 12 months. Pain was assessed using the Knee Injury and Osteoarthritis Outcome Score, and synovitis was imaged with contrast-enhanced MRI at baseline, 1, and 4 months. Outcomes were compared using generalized estimating equations. Results Fifty-eight patients were included (GAE group: 29, sham group: 29). Pain scores improved from 44.44 (95% CI: 38.87–50.02) at baseline to 65.61 (95% CI: 57.16–74.06) after 12 months in the GAE group and from 42.34 (95% CI: 36.45–48.22) to 58.15 (95% CI: 48.7–67.6) in the sham group. The between-group difference after 12 months was not significant (7.46; 95% CI: −13.63 to −28.56; p = 0.25). There were no significant within-group or between-group changes for synovitis. Conclusion Patients undergoing GAE and sham GAE both demonstrate an equal sustained pain reduction at 12 months follow-up, with no differences in synovitis reduction or other clinical outcomes. These results suggest a sustained placebo effect in the long term and do not support the clinical implementation of GAE as a treatment for KOA patients. Key Points Question Is GAE more effective than a sham procedure for mild-to-moderate knee osteoarthritis in the long term, and how does it affect synovitis? Findings There was no significant difference in pain reduction or synovitis between the two groups . Clinical relevance Pain reduction after GAE appears mainly placebo-driven. The placebo effect is sustained up to 12 months. Furthermore, synovitis was unaffected by the procedure. Therefore, our findings do not support clinical implementation . Graphical Abstract

Rapid access chest pain (RACP) clinics are designed to expedite cardiac assessment, but current pathways cause delays due to sequential consultations and testing. This pilot evaluated a novel direct-to-CT coronary angiography (CTCA) pathway to test the hypothesis that a 'test-first' model would reduce the time to diagnosis and clinic utilisation. This was a prospective single-centre pilot of consecutive primary care referrals to an RACP service (June 2024-January 2025). Eligible patients with suspected anginal symptoms, no known coronary artery disease (CAD) and no contraindications to CTCA were offered an opt-in to a direct-to-CTCA pathway. CTCA was performed using a prospective single-heartbeat acquisition. The primary outcome was referral-to-diagnosis interval. Secondary outcomes included need for face-to-face consultation, further investigations, incidental findings and theoretical cost savings. 149 patients (mean age 57±9 years, 34% female) underwent CTCA. Median referral-to-diagnosis interval was 29 days (IQR 21-41) vs 88 days (IQR 84-101) in the conventional pathway. CTCA revealed no or mild CAD in 104 (70%) patients; only 47 (32%) required subsequent face-to-face review. Follow-up testing included exercise ECG (17%), echocardiography (8%) and invasive coronary angiography (7%). Incidental findings were uncovered in 30%, with 3% leading to specialty referral. An estimated 102 outpatient visits were avoided, with a cost avoidance estimate of £32 620 per year. A direct-to-CTCA pathway for patients with suspected cardiac chest pain is feasible, reduces time to diagnosis and aligns with National Institute for Health and Care Excellence guidelines. The pathway enables early CAD exclusion in most patients, reduces unnecessary clinic visits and optimises resource use without compromising diagnostic quality.

Boredom lowers, but humor elevates pressure pain thresholds in pain-free humans: a randomized controlled trial.

Platelet-rich plasma (PRP) injections have been used to manage various chronic pain conditions. However, evidence remains limited due to poor standardisation across practices. In this descriptive study, we aimed to characterise current PRP practice patterns at a university-affiliated private pain clinic in Hong Kong, focusing on case mix and treatment outcomes in patients with chronic musculoskeletal pain. This retrospective descriptive study included patients with diverse chronic musculoskeletal pain conditions aged 18 years or older who attended the Peter Hung Pain Specialist Clinic and received PRP injection therapy between January 2023 and December 2024. Improvements in pain and changes in oral analgesic use were recorded. In total, 248 patients were included. Prior to PRP treatment, over 70% required multiple oral analgesics for pain control, including 55.6% taking antidepressants, 41.5% gabapentin or pregabalin, and 25.8% oral opioids. At first follow-up (median: 4 weeks, range: 1-20), more than 60% reported 'moderate' or 'much' improvement in pain symptoms. By 12 months post-treatment, fewer than 10% of patients in each category continued to require oral opioids, antidepressants, gabapentin, or pregabalin. Of the 26 patients (10.5%) who required a second PRP session, only one reported no improvement. These results highlight the potential utility of PRP in managing chronic musculoskeletal pain and underscore the need for randomised controlled trials to confirm its long-term impact on quality of life of patients.

Background: Burn-induced pain represents one of the most challenging clinical pain syndromes, characterized by persistent hyperalgesia and allodynia mediated in part through upregulation of Transient Receptor Potential Vanilloid 1 (TRPV1) channels. TRPV1, a non-selective cation channel activated by heat, acidic pH, and inflammatory mediators, plays a central role in nociceptive sensitization and the amplification of pain signals in both peripheral and central nervous system tissues. Current multimodal analgesia combining opioids and non-steroidal anti-inflammatory drugs (NSAIDs) remains the standard of care; however, concerns regarding adverse effects including gastric irritation, renal impairment, respiratory depression, and long-term dependence necessitate exploration of safer adjuvant alternatives. Cocoa (Theobroma cacao) contains bioactive flavanols, polyphenols, catechins, epicatechins, and methylxanthines with documented anti-inflammatory and analgesic properties, including reported suppression of TRPV1 expression in neuropathic pain models, making it a promising candidate as a natural analgesic adjuvant. This study aimed to compare the efficacy of cocoa extract versus ibuprofen as a tramadol adjuvant in a rat model of burn-induced pain, by assessing mechanical pain thresholds and TRPV1 protein levels in brain and spinal cord tissues. Methods: This experimental study utilized a randomized post-test only controlled design with 15 healthy male Wistar rats (Rattus norvegicus), weighing 140‒180 g and aged 4‒6 weeks, equally divided into three groups (n = 5). The control group received no analgesic therapy (placebo), the second group received tramadol 12.5 mg/kg intraperitoneally combined with ibuprofen 15 mg/kg orally, and the third group received tramadol 12.5 mg/kg intraperitoneally combined with cocoa extract 0.5 mg/kg orally. Following a 7-day acclimatization period, second-degree burn injuries were induced by immersing the right hind paw in a thermostatically controlled water bath maintained at 65°C for 3 seconds under ketamine-xylazineacepromazine anaesthesia. Treatments were administered immediately following burn induction. Mechanical pain thresholds were assessed using an electronic Von Frey anesthesiometer at 24 hours post-injury, while TRPV1 protein levels in brain and spinal cord tissues were quantified by enzyme-linked immunosorbent assay (ELISA). Statistical analyses included one- way ANOVA with Tukey HSD post-hoc for normally distributed data, Kruskal-Wallis with Mann-Whitney post-hoc for nonnormally distributed data, and Pearson correlation analysis, with significance set at p &lt; 0.05. Results: Von Frey test results at 24 hours post-injury revealed significant differences in mechanical withdrawal thresholds among the three groups (one-way ANOVA, p = 0.003). The control group exhibited the lowest withdrawal threshold (mean 4.92 g), reflecting significant burn-induced hyperalgesia, whereas the tramadol-ibuprofen group (mean 13.92 g) and tramadol-cocoa group (mean 14.84 g) both showed markedly elevated thresholds compared to control (p = 0.003 for each). No significant difference was observed between the two treatment groups (p = 0.769), indicating equivalent analgesic efficacy. Kruskal-Wallis testing demonstrated significant intergroup differences in brain TRPV1 levels (p = 0.018), with the control group exhibiting the highest concentrations (mean 0.293 ng/mL). Mann-Whitney post-hoc analysis revealed a significant difference between the control and tramadol-ibuprofen groups (p = 0.012), but not between the control and tramadol-cocoa groups (p = 0.151), nor between the two treatment groups (p = 0.143). Spinal TRPV1 levels also differed significantly among groups (p = 0.034), with the tramadol-cocoa group demonstrating the greatest spinal TRPV1 suppression (mean 0.287 ng/mL) compared to control (mean 0.497 ng/mL; p = 0.024), while no significant difference was found between the control and tramadol-ibuprofen groups (p = 0.095) nor between the two treatment groups (p = 1.000). Pearson correlation analysis revealed a significant negative correlation between Von Frey values and brain TRPV1 levels (r = −0.632, p = 0.012) as well as a very strong negative correlation with spinal TRPV1 levels (r = −0.822, p = 0.0002), confirming TRPV1 as a key mediator of burn-induced hyperalgesia Conclusion: Cocoa extract, when used as an adjuvant to tramadol, provides equivalent analgesic efficacy and TRPV1 suppression to ibuprofen in a rat model of burn-induced pain, supporting its potential as a natural NSAID alternative in multimodal burn pain management strategies.

Automated pain detection models rely on large, diverse facial expression datasets; yet pain expression data are scarce due to privacy concerns and ethical constraints. This study explores synthetic pain expression generation as a potential solution, investigating whether expression transfer methods are sufficiently accurate to expand training sets by transferring expressions from a limited set of real data to a virtually unlimited set of identities. This work represents an initial step toward the use of privacy-preserving generative AI for synthetic data generation to improve in pain detection. We introduce PainControl, a novel facial landmark-guided method for identity-preserving pain expression transfer. Rather than using motion signals from video, as in prior methods, our method adapts a ControlNet approach, using text and dense facial landmarks to control fine-grained facial muscle activations while maintaining identity consistency through image embeddings. Identity preservation enables the generation of demographically diverse datasets, improving generalizability across populations. We compare PainControl to existing expression transfer methods and evaluate (i) perceptual realism, (ii) identity preservation, (iii) facial action unit (AU) transfer accuracy, and (iv) downstream pain detection performance. Our model produces realistic synthetic pain expressions, outperforming baselines in human-rated Likert-scale assessments. However, AU transfer analysis reveals challenges in accurately synthesizing expression intensities-particularly for AU4 (Brow Lowering) and AU43 (Eye Closure), which are crucial for pain recognition. When used to augment real pain datasets, synthetic images did not improve classifier performance, likely due to artifacts, AU misalignment, and the lack of temporal motion cues. Critically, however, our experiments in data-scarce regimes, where real pain expressions are extremely limited, demonstrate that synthetic augmentation through PainControl provides significant and consistent performance gains for pain detection models. These results validate that our ControlNet-based approach has reached sufficient maturity and accuracy to serve as a reliable data augmentation tool in pain detection domains, particularly in scenarios, where acquiring real data are prohibitively difficult or ethically constrained. This finding establishes the practical viability of expression transfer methods for addressing the fundamental data scarcity challenge in affective computing and clinical pain assessment. These results highlight both the promise and current limitations of generative models for pain expression, pointing to future research in AU alignment and temporal modeling for clinical-grade applications.

Background: Low back pain is a common musculoskeletal complaint frequently evaluated with plain lumbosacral radiography, although the relationship between radiographic abnormalities and clinical symptoms remains uncertain. Objective: To assess lumbosacral structural changes on plain X-ray in patients with low back pain and determine their association with clinical findings and pain characteristics. Methods: This cross-sectional observational study was conducted in the Radiology Department of Gurkee Hospital, Lahore, and included 150 patients aged above 20 years presenting with low back pain and referred for lumbar spine X-ray. Demographic and clinical variables were recorded, including radiating pain, numbness/tingling, pain duration, onset, pain type, and pain severity. Radiographic assessment included disc space narrowing, osteophyte formation, spondylolisthesis, facet joint degeneration, sacroiliac joint changes, vertebral body deformity, and spinal level involvement. Data were analyzed using descriptive statistics and chi-square testing. Results: The mean age of participants was 46.8 ± 15.7 years, and 53.3% were male. Radiating pain to the legs was reported by 48.7%, while 51.3% had numbness or tingling. Vertebral body deformity was the most frequent radiographic finding (57.3%), followed by spondylolisthesis (53.3%). No statistically significant association was observed between the most prevalent radiographic findings and pain severity or pain duration. Conclusion: Lumbosacral structural changes are common in patients with low back pain, but plain X-ray findings alone do not reliably correspond to symptom severity or duration.

Intervertebral disc degeneration (IVDD) is a major cause of chronic low back pain and disability worldwide. Growing evidence highlights oxidative stress as a key driver of disc degeneration; however, the integrated relationships between gene expression, regulatory microRNAs (miRNAs), and protein-level changes across disease stages remain insufficiently understood. This study aimed to identify oxidative stress-related molecular signatures in IVDD and to explore their miRNA-mediated regulation across degeneration grades.The study included 200 patients with lumbosacral IVDD undergoing microdiscectomy and 100 postmortem control samples without spinal pathology. Degeneration severity was classified using the Pfirrmann scale, and pain intensity was assessed with the Visual Analog Scale (VAS). Gene expression of oxidative stress markers was evaluated using RT-qPCR, while protein levels were quantified by ELISA. Additionally, bioinformatic prediction and RT-qPCR validation were used to analyze mRNA-miRNA interactions.Gene expression analysis revealed progressive downregulation of antioxidant genes CAT (FC ≈ -6.40) and GPX1 (FC ≈ -9.56), alongside upregulation of MAPK8 (FC ≈ 8.18) and IL6 (FC ≈ 8.18), with a moderate increase in NRF1 expression. These values reflect comparisons between advanced degeneration (G5) and controls. In contrast, protein analysis showed an inverse trend, with increasing levels of CAT, GPX1, and NRF1 and decreasing levels of MAPK8 and IL6 as degeneration progressed.miRNA profiling demonstrated significant dysregulation, including downregulation of miR-3163 and miR-196a-1-3p and upregulation of miR-665-3p and miR-4686. Correlation analysis indicated that molecular alterations were more strongly associated with structural degeneration than with pain intensity, as VAS-related differences were generally weak and non-significant.Overall, the results reveal a complex regulatory network in IVDD, characterized by discordant mRNA-protein expression and significant miRNA involvement. Oxidative stress and inflammatory pathways appear tightly regulated at transcriptional and post-transcriptional levels and are more closely linked to structural degeneration than clinical pain.

Chronic pain is associated with maladaptive reorganization of brain networks, particularly in the anterior cingulate cortex (ACC), contributing to the affective dimension of pain. Although peripheral capsaicin administration relieves neuropathic pain in clinics, its effects on central pain networks remain unclear. In this study, we determined the resting-state functional connectivity of ACC (ACC FC) rearrangement after infraorbital nerve chronic constriction injury (ION-CCI) and subsequent peripheral administration of capsaicin through longitudinal resting-state functional magnetic resonance imaging (fMRI) in male rats. We also conducted functional silencing of the ACC using inhibitory chemogenetic receptors to determine ACC networks commonly reversed by peripheral capsaicin and chemogenetic silencing. Infraorbital nerve chronic constriction injury produced orofacial mechanical allodynia accompanied by ACC FC changes compared to sham. A single injection of capsaicin into the maxillary skin decreased mechanical allodynia. Five days after capsaicin injection, CCI-enhanced ACC FC was significantly reduced compared to the time point before the injection in the same rats or to the rats with vehicle injection. Subsequent chemogenetic silencing of ACC in the previously vehicle-treated CCI rats reduced mechanical allodynia and suppressed CCI-enhanced ACC FC. Peripheral capsaicin and chemogenetic inhibition of ACC commonly reversed approximately one-third of the CCI-enhanced ACC FC. Affected regions included the bilateral cingulate areas, primary and secondary somatosensory cortex, primary and secondary auditory areas, hippocampus, and temporal association cortex. We conclude that peripheral capsaicin administration reverses maladaptive ACC networks in male rats with nerve injury and that peripheral nociceptors contribute to the maintenance chronic pain and peripherally targeted treatment can produce long-lasting analgesia.

Demographic patterns in quantitative sensory testing and clinical pain among former professional American-style football players

Background:Knee pain is one of the most prevalent musculoskeletal complaints globally, particularly affecting individuals in rural and labor-intensive settings. Despite its widespread occurrence, epidemiological data from rural India remain limited. This study aimed to analyze the demographic and clinical trends of knee disorders among patients attending a Knee Clinic in a tertiary care hospital serving a predominantly rural population. This study aimed to identify the prevalence and pattern of traumatic and non-traumatic knee disorders, assess demographic characteristics, and explore contributing occupational and lifestyle factors. Methods:A retrospective observational study was conducted using registry data from 4,485 patients who visited the Physiotherapy Department of Vitthalrao Vikhe Patil Memorial Hospital, Ahmednagar, between January 2023 and June 2025. Data were categorized into traumatic and non-traumatic knee conditions and analyzed based on gender, diagnosis, and type of injury. Results: Of the total patients, 58% were male and 42% female. Non-traumatic conditions accounted for a larger proportion, with osteoarthritis (74.9%) being the most common diagnosis, followed by patellofemoral pain syndrome (16.6%). Among traumatic injuries, ACL injuries (44%) were the most prevalent, followed by joint effusion (21%) and meniscal injuries (11%). The patterns observed suggest occupational overuse, biomechanical stress, and delayed access to care as major contributing factors. Conclusion:The study highlights a significant burden of both degenerative and traumatic knee conditions in rural populations. It underscores the need for early screening, structured physiotherapy, ergonomic education, and improved access to rehabilitation. The Knee Clinic model proves to be an effective multidisciplinary framework for the timely management of knee disorders in resource-constrained settings.

Complementary, alternative, and integrative medicine (CAIM) has gained popularity among patients experiencing pain, used alongside conventional medical treatments. This study aimed to explore the perceptions of pain clinicians and researchers on CAIM interventions. An anonymous, online survey was distributed to 46,223 authors who had published pain-related research in MEDLINE-indexed journals. The survey included multiple-choice questions and open-ended sections to gather detailed opinions. A total of 1024 participants responded, 900 of which were eligible to participate; most identified as either pain researchers (n = 435/900, 48.33%) or both researchers and clinicians (n = 398/900, 44.22%). Many held senior positions (n = 549/892, 61.55%). Among the CAIM modalities, mind-body therapies such as meditation, yoga, and biofeedback were viewed as the most promising for pain prevention, treatment, and management, with 68.47% (n = 569/831) of participants endorsing these approaches. While (n = 341/777, 43.89%) of the respondents believed that most CAIM therapies are safe, only 25.55% (n = 198/775) disagreed with the idea that such therapies are effective. There was broad agreement on the need for more research into CAIM therapies, with 45.88% (n = 356/776) agreeing and 42.53% (n = 330/776) strongly agreeing that further investigation is valuable. Additionally, many respondents supported the inclusion of CAIM training in clinician education, either through formal programs (n = 361/778, 46.40%) or supplementary courses (n = 409/776, 52.71%). Mind-body therapies received the most positive feedback, while biofield therapies were met with the most skepticism. These findings highlight the interest in CAIM among pain researchers and clinicians and emphasize the need for more research and education tailored to this area.

Postoperative pain after video-assisted thoracoscopic surgery affects 43%-99% of patients and is associated with prolonged hospital stay. Pre- and intraoperative risk factors can help identify patients at higher risk of postoperative pain. This study aimed to assess if quantitative sensory testing, psychological factors, and patient characteristics can predict postoperative pain. Patients undergoing elective video-assisted thoracoscopic surgery for confirmed or suspected lung cancer were included. Pain sensitivity was evaluated by quantitative sensory testing using cuff algometry, and psychological factors were assessed by the pain catastrophizing scale, and the hospital anxiety and depression scale. Clinical pain was assessed bidaily and summarized as time-weighted pain and opioid consumption was measured as cumulative dose, both within 48 h of surgery. Prediction models using pre- and intra-operative variables were established, and backward elimination was applied to identify independent predictors. Domain-specific models were constructed within five domains of predictors (i.e., quantitative sensory testing, psychological factors, demographics, perioperative, and tumour pathology). Subsequently, independent variables from the five domain-specific models were combined into a multifactorial model. Domain-specific models explained between 5.1%-12.8% of variance except the demographics model which explained 39.5% of opioid consumption. The multifactorial models for pain intensity and opioid consumption explained 20.3% and 40.4%, respectively. This study suggests that pre- and intra-operative factors contribute to the prediction of postoperative pain intensity and opioid consumption with varying precision. Demographic variables proved to be best and predicted 39.5% of postoperative opioid consumption. The multimodal models explained 20.3% of postoperative pain and 40.4% of postoperative opioid consumption. This assessment and analysis presents factors that are associated with how patients who have undergone video-assisted thoracosopic surgery as a group report post-operative pain. Both patient-specific factors and perioperative management details appear to contribute.

Chronic overlapping pain conditions (COPCs) affect young adults and pose significant challenges in medical care. This study aimed to describe the types and number of current and past medical providers and medications used by young adults with COPCs and to explore associations between healthcare utilization, clinical pain, and psychosocial factors. Fifty young adults (mean age 27.16 years) with COPCs were recruited and completed online questionnaires assessing demographics, pain intensity and interference, number of pain conditions, healthcare providers consulted, medication use, and psychosocial characteristics. Relationships among healthcare utilization, clinical pain measures, and psychosocial variables were analyzed using Pearson correlations and linear regression models. Participants reported an average of 4.40 COPCs, with fibromyalgia, chronic low back pain, and chronic fatigue syndrome being the most common. Most (72%) were currently receiving medical treatment, with primary care physicians being the most frequently consulted providers. The average number of current providers was 2.82, while the number of past providers was 4.28. Despite extensive healthcare engagement, 77.7% reported no improvement or worsening of their condition. No significant associations were found between the number of providers or medications and clinical or psychosocial outcomes. The findings highlight gaps in the effectiveness of healthcare utilization for young adults with COPCs. The high prevalence of provider visits and medication use without substantial symptom improvement suggests a need for more integrated, multidisciplinary care approaches. Future research should focus on optimizing treatment strategies and identifying opportunities for early intervention.

WCN26-3533 CARBON-MONOXIDE ULTRAFINE BUBBLES SUPPRESS THE PROGRESSION OF PERITONEAL MEMBRANE DYSFUNCTION IN A MOUSE MODEL OF PERITONEAL FIBROSIS

Gynaecological chronic pelvic pain (CPP) has a high prevalence among adult women. This pain can be debilitating and life-impacting, affecting quality of life across all dimensions of health. Many barriers to specialised care exist, leading women to rely on unscheduled general care like emergency departments or in the out-of-hospital. The review aimed to investigate evidence regarding pain management for women presenting to acute, non-specialist settings for gynaecological CPP. Secondary aims were to identify areas of suboptimal care and potential for improvement of patient outcomes. A scoping review was conducted using the Joanna Briggs Institute scoping review framework with the PRISMA extension. Academic and grey literature were searched. Initially, 1563 records were identified, with 50 from grey literature and 801 from citation screening. Nineteen were included for descriptive analysis. Key themes were pharmacological agents, holistic care and ongoing care. Appraisal of the literature showed varying quality. This scoping review highlights the need to define clinicians' roles in managing gynaecological CPP exacerbations in acute, non-specialist settings. It identifies gaps in best-practice pain assessment, management and clinician education, with guidelines and recommendations often of poor quality. Effective CPP management requires a multidisciplinary and biopsychosocial approach and, despite limitations, clinicians can enhance knowledge and practice scope to improve patient outcomes.

Effect of perioperative preemptive analgesia on hippocampal GABAA receptor α1/α5 balance in aged mild cognitive impairment rats.