Diffuse Pain Research Articles

O USO DA TERMOGRAFIA NO DIAGNÓSTICO DA SÍNDROME FIBROMIÁLGICA

Fibromyalgia is a complex rheumatic disease characterized by diffuse pain, fatigue, insomnia and can be associated with emotional problems such as depression and anxiety. There is no validated method for accurate diagnosis. Thermography makes it possible to identify points of high sensitivity with a painful reaction using special cameras coupled to various thermometers. The aim of this study was to characterize the use of thermography as a diagnostic aid for FM. This is a bibliographic review, using databases (Scielo, Google Scholar, Pubmed, Portal BVsalud, and BDTD). It included research from 2014 to 2024 that was not a literature review. The results show that thermography has high specificity for identifying hot spots, but does not have high sensitivity for identifying chronic pain, so it was not possible to verify the presence of pain, but rather vasomotor changes in all areas of painful projection, identified on palpation. We conclude that thermography is viable for complementing and monitoring the treatment of a patient with fibromyalgia associated with other conditions and clinical findings, but it should not be used in isolation.

A case of spontaneous liver rupture and the role of imaging: from computed tomography to interventional treatment

Hepatic parenchymal rupture is a rare but potentially fatal condition that can be caused by trauma, iatrogenic factors, spontaneous causes, etc. This case report describes the diagnostic and therapeutic steps employed in a patient with spontaneous hepatic parenchymal rupture. An older woman came to the emergency department with diffuse stomach pain. After clinical evaluation, she underwent computed tomography. The first computed tomography did not reveal a full-blown parenchymal rupture. Owing to data ambiguity, indicating that the abdominal discomfort could be caused by renal or biliary colic, obtaining an early diagnosis was very difficult. In truth, only few hypodense oval shapes with characteristic suprafluid densitometry were found in the liver parenchyma. However, after a few days, the discomfort persisted, and as the condition worsened, the patient underwent additional radiological examinations, which revealed the rupture of the liver parenchyma that required arteriography, and a long hospital stay until clinical resolution.

Arthroscopic Dorsal Scapular Nerve Decompression for Painful Scapulothoracic Abnormal Motion: Technique and Indications

Patients with scapulothoracic abnormal motion can present with debilitating medial scapular border pain. In patients with scapulothoracic abnormal motion and evidence of diffuse medial scapular border pain along the dorsal scapular nerve (DSN) distribution, surgical release of the DSN is indicated. This Technical Note provides an all-arthroscopic approach to thoracic decompression of the DSN.

Diagnosing and treating cellulitis in horses

Background: Cellulitis is a commonly observed condition in horses, which often requires an urgent or emergency veterinary visit. The condition often presents with acute‐onset diffuse limb swelling, heat, pitting oedema and pain on palpation of the affected limb. Lameness is variable but can be severe and the horse may display signs of extreme discomfort, alongside tachycardia, tachypnoea and pyrexia. Risk factors such as blunt trauma, recent wounds, recent surgery or recent injections have been identified, and studies suggest that cellulitis is more common in the hindlimbs than forelimbs.Aim of the article: This article provides an overview of the physiology of oedema formation and discusses the diagnosis and treatment options available for cases of cellulitis in horses.

GIANT LUMBO-SACRAL TUMORS

Objectives Despite comprising just 8% of all spinal tumors, sacral tumors present a long list of issues that should be taken in consideration when neurosurgical approach is tempted. Their unique anatomic location, close relation with neural structures and pelvic organs and high-vascularity are just a few nuances of these type of conditions. This paper outline the importance of a good preoperative and intraoperative management in order to facilitate the maximum recovery of the patients. Material and Methods This paper analyses retrospectively a series of 2 cases of giant sacral tumors (>100 cm3) that were operated in our clinic in 2024 by a multidisciplinary team (neurosurgeons and general surgeons). Follow-up data were obtained from the charts and medical records. All the lesions were localised under L4 vertebra with invasion of sacrum. Results Our first case was a 47-years old man who accused diffuse mild lumbar pain for more than 2 years, but acutely aggravated in the last months with lumbosacral radicular pain, palsy of the inferior lumbar nerves, urinary incontinence and paraesthesia. MRI showed a giant L5-S2 mass and biopsy diagnostic was myxopapillary ependymoma. Second case was of a young woman with lumbosacral radicular pain debuted a few months ago, whose clinical state worsened rapidly becoming paralytic of lower limbs. MRI showed a giant sacral mass with invasion of the pelvic musculature and surrounding the iliac vessels (intraoperative aspect: sarcoma). Both patients ameliorated postoperatively, and are currently enrolled in a recovery program. Sub-total resection and near-total resection were obtained. Conclusions Sacral tumors exhibit a challenge in the field of spine surgery being clinical silence over a period of months and years, and then followed by gross deficit. We diagnosed sacral tumors based on clinical, radiographic and laboratory aspects. Prognostic factors were preoperative clinical status and gross-total resection.

Neuro-leishmaniasis with cauda equina syndrome and cranial nerve palsy: a rare manifestation of recurrent atypical visceral leishmaniasis

BackgroundVisceral leishmaniasis (VL) is a neglected tropical disease primarily affecting Brazil, East Africa, and India, with India accounting for 18% of the global burden. While VL typically presents with systemic symptoms like fever, weight loss, and splenomegaly, it can occasionally manifest atypically, posing significant diagnostic challenges. Neurological presentations of VL are extremely rare, making them difficult to suspect and diagnose. Cases where VL predominantly presents with neurological symptoms are particularly novel, underscoring the need for heightened awareness of such atypical manifestations in endemic regions.Clinical caseA 38-year-old man with history of recurrent atypical VL presented with diffuse lower back pain, progressive tingling, numbness, weakness in the lower extremities, and double vision for one month. Clinical and radiological evaluations suggested cauda equina syndrome and cranial nerve palsy, accompanied by generalized lymphadenopathy, subcutaneous nodules, and skin papules. The differential diagnosis initially included disseminated tuberculosis, histoplasmosis, and lymphoma. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. Histopathology of lymph node and bone marrow revealed Leishmania amastigotes and subcutaneous nodule and skin biopsy revealed inflammatory cells with granulomas. Furthermore, the qPCR test on DNA from a subcutaneous nodule, lymph node, and CSF was positive for Leishmania kinetoplast DNA. The species was further confirmed as Leishmania donovani through ITS-based PCR amplification and sequencing. Finally, a diagnosis of relapse of VL with lymph node, cutaneous, and neurological involvement, including abducens nerve palsy and cauda equina syndrome, was established. He was treated with combination of liposomal amphotericin B and miltefosine, along with intrathecal hyaluronidase, resulting in significant improvement.ConclusionUnlike previously reported cases with both systemic and neurological symptoms, our patient predominantly presented with neurological manifestations, making this a unique and novel presentation of VL. This case highlights diagnostic challenges and management of atypical VL, emphasizing neurological involvement and successful therapeutic strategies.

O IMPACTO DO PILATES NO TRATAMENTO DA FIBROMIALGIA

Fibromyalgia is a chronic syndrome that causes diffuse muscle pain and increased sensitivity in specific points on the body. It mainly affects women between the ages of 30 and 60, but can occur in men and at younger ages. Symptoms include chronic pain, fatigue, sleep disturbances and cognitive difficulties. Pilates is adaptable to different populations and health conditions and can be customized to meet individual needs. This adaptability makes Pilates a versatile and inclusive therapeutic option, suitable for rehabilitation and health promotion programs. The objective, therefore, was to investigate the impact of the Pilates method in the treatment of fibromyalgia, evaluating its effects on reducing pain, improving physical function and quality of life for patients. Methodologically, a systematic review of the literature was incorporated, with a search for articles carried out in the PubMed and Google Scholar databases, starting from a period of 5 years (2019-2024). It was concluded, based on the available evidence, that Pilates can be considered as a complementary treatment option for patients with fibromyalgia. It is recommended that healthcare professionals consider including Pilates in multidisciplinary treatment programs for fibromyalgia, adapting intervention protocols as necessary to meet each patient’s specific needs. Even more so, the implementation of Pilates programs supervised by qualified professionals can guarantee the safety and effectiveness of this therapeutic intervention for patients with fibromyalgia.

Ochronotic Arthropathy of the Knee: A Case Report

Alkaptonuria (AKU) is a low-prevalence genetic inherited disease expressed in an autosomal recessive and monogenic manner, characterized by a tissue accumulation of homogentisic acid (HGA). It is more severe in male patients, with arthritic symptoms as the earliest clinical picture in most cases. This enzyme deficiency metabolic disorder causes an increase in HGA, an intermediary in the metabolism of amino acids normally excreted in the urine. Homogentisic aciduria can be observed in patients with alkaptonuria, manifested by darkening of the first-morning urine. Ochronosis, a tissue homogentisic acid accumulation, progresses with connective tissue pigmentation and severe ochronotic joints osteoarthropathy. Ochronosis can also occur in the eyes, ears, skin, and heart valves. Also, are seen blackened kidneys and prostate stones, injuries to muscles and tendons, as well as fractures. We present a case report of a 60-year-old male patient who previously underwent two arthroscopies of the left knee due to pain with no predefined etiology. After a year, he sought a referral orthopedic hospital complaining of diffuse pain and persistent edema due to severe lateral femolotibial and patellofemoral osteoarthritis and valgus deformity. Total arthroplasty of the left knee was indicated and performed, with a suspected diagnosis of ochronosis intraoperatively and confirmed with additional tests. The patient has been followed up for 2 years after left knee arthroplasty, with a favorable outcome.

O PAPEL DO RECUPERO COMO RECURSO FISIOTERAPÊUTICO EM PACIENTES FIBROMIÁLGICOS AFETADOS PELA COVID-19

Introduction: Fibromyalgia is a complex chronic syndrome, characterized by diffuse pain, fatigue and sleep disturbances. The COVID-19 pandemic has aggravated symptoms, leading to the need for new therapeutic approaches, such as the use of Recupero, which can offer relief and improve patients' quality of life. Justification: This study is based on the need for integrated therapies in physical therapy for fibromyalgia, aggravated by COVID-19. The Recupero program combines photobiomodulation and ultrasound, promoting analgesia and tissue regeneration. Research is essential to fill gaps in knowledge and improve the quality of life of vulnerable patients. Objectives: To evaluate the efficacy of Recupero in the treatment of fibromyalgia and the management of post-COVID sequelae in patients affected by the infection. Methodology: This study reviewed the literature on fibromyalgia and COVID-19, analyzing articles from 2014 to 2024 in MedLine, SciELO, LILACS, and PEDro. Using the PICO strategy, six relevant studies were included, focusing on physiotherapy and the use of the Recupero device to improve symptoms in patients. Results and Discussion: COVID-19 infection intensified fibromyalgia symptoms, such as pain and anxiety, due to social isolation and treatment interruption. Studies have shown that the Recupero device improved pain and quality of life in fibromyalgia patients, showing efficacy in post-COVID rehabilitation and highlighting the importance of non-invasive therapies. Concluding Remarks: The COVID-19 pandemic has significantly impacted fibromyalgia patients, intensifying pain and anxiety due to isolation and treatment disruption. Interventions such as telerehabilitation and photosonic therapy have shown lasting benefits, underscoring the importance of a biopsychosocial approach. There is a need for rigorous studies to validate these therapies in the post-pandemic context.

Neuroscience of the human thalamus related to acute pain and chronic "thalamic" pain.

The association of posterior thalamic strokes with the presence of chronic "thalamic" pain was described in the early 1900s and revisited in a recent review of these patients. Acute pain in corporal structures is associated with the spinothalamic tract (STT), which originates in the dorsal horn of the spinal cord, whereas that associated with cranial structures is associated with the spinal division of the trigeminal nucleus. These pathways terminate in the ventral posterior nucleus (VP), including its posterior and inferior subnuclei and its core, which is classically associated with tactile and haptic functions. In medial nuclei (medial dorsal and intralaminar) receptive fields are large and stimulation evokes diffuse unpleasant sensations and pain while neurons in these nuclei subserve cognitive processes of attention, alerting, and conditioning. In the lateral nuclei neurons have small receptive and projected fields and high resolution of responses to somatic stimuli. Neurons in the lateral nuclei respond to stimuli producing pain, temperature, and visceral sensations while stimulation evokes similar sensations. Small strokes in VP core versus structures located inferior and posterior are associated with thalamic pain and decreased tactile, painful, and cold sensations and with decreased evoked potentials for painful (laser) heat and median nerve stimulation (electrical). Lesions of VP, but not ventral medial posterior nucleus (VMpo), are associated with thalamic pain, contrary to the recent "disinhibition" model. We review the evidence that the lateral nuclei are associated with multiple processes including tactile, nociceptive, visceral, and thermal content of stimuli, whereas the medial nuclei are related to cognitions about those stimuli.

12472 Clinical Features Of Adult Hypophosphatasia And Correlation Between Laboratory Findings And Patient’s Symptomatology: A Retrospective Review At The Penn Bone Center

Abstract Disclosure: J. Ocampo Mascaro: None. R. Tran: None. S. Kallish: Consulting Fee; Self; Sanofi, Amicus. Research Investigator; Self; Ipsen, Sanofi, Incyte, Idorsia. Speaker; Self; Sanofi, Amicus. J. Berman: None. M. Al Mukaddam: Grant Recipient; Self; Ipsen, Incyte Research Funding. Hypophosphatasia (HPP) is an inborn error of metabolism resulting in low activity of the enzyme tissue non-specific alkaline phosphatase (ALP). It primarily involves bone and teeth mineralization. HPP has a wide clinical spectrum. It may present with rickets, fractures, failure to thrive, weakness, respiratory complications, and seizures in its more severe perinatal/infantile forms. Childhood forms tend to be milder but may have substantial musculoskeletal complications and early teeth loss. The clinical picture in adults is extremely variable too. It is usually mild with stress fractures and/or teeth loss in most individuals but can be debilitating in others due to musculoskeletal pain and recurrent fractures. This retrospective study describes the characteristics of 35 adult patients (ages 22-74 years) with HPP based on clinical presentation +/- molecular testing at the Penn Bone Center, located at a US-based large academic hospital. Out of 35 patients, 26 had an ALPL variant in genetic testing (12 pathogenic, 5 likely pathogenic, and 9 of uncertain significance), 3 were negative, and 6 did not undergo testing yet. ALP values ranged from 11 to 39 U/L (N: 38-126). Serum fasting vitamin B6 levels (off supplements) ranged from normal range to 18 times the upper limit of normal. Main symptoms reported were fractures (74%), arthralgias/myalgias (51%), diffuse bone pain (29%), atraumatic teeth loss (20%), muscle weakness (14%), and nephrolithiasis (9%). We found no significant negative correlation between ALP levels and number of symptoms (rs -0.026) or age of first symptom occurrence (rs 0.205). We also found no significant positive correlation between B6 elevation and number of symptoms (rs 0.236) or age of first symptom occurrence (rs -0.175). Six patients within our cohort had previous or current treatment with asfotase alfa. This is an FDA-approved therapy for the treatment of perinatal, infantile, and childhood HPP and has been used in adult patients if one of the presenting symptoms was before age 18 years. Response to therapy in our patient cohort was mixed. Three out of six patients discontinued treatment due to lack of clinical benefit. Continued research of the clinical characteristics of adult HPP is needed to better understand its natural history, markers of severity of disease, and how to determine who may potentially benefit from asfostase alfa therapy. Presentation: 6/1/2024

8031 Pelvic Fracture Related to Brown Tumor in Severe Secondary Hyperparathyroidism

Abstract Disclosure: M. Bodenstab: None. M. Lieberman-Ulm: None. V.S. Lagari-Libhaber: None. Background: Severe hyperparathyroidism can result in end-organ damage to the skeleton, known as osteitis fibrosa cystica (OFC). Histologically, OFC manifests as “Brown tumors”, which are so named due to the hemosiderin deposition that occurs from recurring microtraumas with subsequent hemorrhage. Typical sites of presentation include the mandible, clavicle, ribs, or pelvis, but can occur anywhere in the body. Patients can present with diffuse bone pain, pathological fracture, or bone deformities, though some may be asymptomatic and diagnosed incidentally. While these tumors do not have malignant potential, they can become debilitating in their burden and mimic malignant disease. Treatment focuses on treating the underlying cause of the hyperparathyroidism. Clinical Case: A 52-year-old female with ESRD on thrice weekly hemodialysis secondary to T2DM and HTN presented with right thigh pain and difficulty bearing weight, which began one week after a mechanical fall from standing. X-ray on admission revealed acute nondisplaced pathologic fracture of the right superior pubic ramus related to an underlying 4.7 x 2.2 cm expansile osteolytic lesion. Calcium level corrected for albumin on admission was 9.3 mg/dL, phosphorous 5.6 mg/dL, and PTH 563 pg/mL. Review of our institution’s electronic medical record revealed a maximum PTH level of 1,808 pg/mL three months prior. On CT pelvis, the patient was found to have multiple osteolytic lesions also involving the sacrum, multiple vertebral bodies, and the left pubic ramus, concerning for metastatic disease. Patient underwent pelvic rami bone biopsy resulting as osteoclast type giant cells, hemosiderin deposition and fibrosis in keeping with "brown tumor" of hyperparathyroidism. The patient was started on Cinacalcet 30 mg daily, with plans to titrate as outpatient to target PTH levels. She was also instructed to continue calcium, vitamin D and calcitriol to treat the underlying condition of metabolic bone disease from CKD. Referrals were given for both orthopedic spine and orthopedic oncology for surgical evaluation of her lesions. Discussion: Osteitis fibrosa cystica has become exceedingly rare in the United States and occurs in about 2% of patients with hyperparathyroidism. Due to their low prevalence and radiologic similarity to neoplasm, “Brown tumors” may be mistaken for metastatic disease and can lead to delay in diagnosis. Histology reveals collections of osteoclasts due to excess activity intermixed with fibrous tissue and poorly mineralized woven bone, which will differentiate brown tumor from malignancy. However, further correlation with hypercalcemia and hyperparathyroidism is imperative as brown tumors and other giant cell-containing lesions may be difficult to differentiate histologically. We present this case due to its rarity in clinical practice. Presentation: 6/2/2024

Fibromyalgia progression and association with other diseases and inheritance with management practices in humans

Fibromyalgia is a widespread pain disorder characterized by chronic, diffuse pain, about 1 to 5% around world. While more prevalent in women and adults, it can also manifest in children and adolescents. The specific pathophysiology of fibromyalgia remains unclear, but it is associated with neuronal over sensitization, reduced conditioned pain modulation, cognitive dysfunction, memory loss, and impaired information processing. It has now been categorized as a somatic symptom disorder. This study aimed to investigate fibromyalgia, focusing on its potential hereditary connections and management practices. A key pathophysiological aspect of fibromyalgia is central sensitization, marked by increased functional connectivity with pre-receptive brain areas, decreased connectivity with antinociceptive areas, and alterations in central nervous system neurotransmitters, also in size and shape of specific brain areas. Fibromyalgia is not directly inherited from parents to offspring, it does exhibit a tendency to cluster within families. The serotonin transporter gene, characterized by single nucleotide polymorphism with "S" (short) allele, is more prevalent in individuals with fibromyalgia and psychological distress. In conclusion, fibromyalgia is a widespread pain disorder with a substantial impact on the central nervous system, resulting in significant disability and an elevated risk of chronic diseases. Early diagnosis and intervention can minimize the impact of fibromyalgia. Physical therapy and non-drug therapies should be customized for each patient. The FDA has approved three drugs including pregabalin, duloxetine, and milnacipran for fibromyalgia treatment.

Hypercalcemia in Hodgkin’s Lymphoma – A Case Report

Hypercalcemia, though rare is an important cause of diffuse aches and pains. More relevant is the cause, which can sometimes be treatable and at other times not. Here, we present a case of 48-year-old man with lymphadenopathy, hypercalcemia and acute kidney injury who was diagnosed with Hodgkin’s lymphoma. This case is about a 48-year-old man who presented with symptoms of hypercalcemia and generalised lymphadenopathy. With a predisposition of EBV infection, Hodgkin’s lymphoma was identified to be the source of hypercalcemia, leading on to the hypercalcemic nephropathy. Hypercalcemia is usually seen with non-hodgkins lymphoma and only a few reports of hypercalcemia associated with Hodgkins lymphoma had been published. The usual mechanism is Vit D dependent, however, in our patient hypercalcemia was probably mediated by PTHrP; since both the vit D and activated vit D levels were normal. The presence of PTHrP mediated hypercalcemia Hodgkin’s lymphoma makes our case rare, as an uncommon presentation of a disease with yet another uncommon mechanism underlying.

Utilization of Whole-Body Magnetic Resonance Imaging in Challenging Diagnoses in Pediatric Rheumatology.

The aim of this study was to investigate the use of whole-body magnetic resonance imaging (WBMRI) in cases where we suspected rheumatic disease in our pediatric rheumatology clinic. We conducted a retrospective analysis of demographic, clinical, laboratory, and imaging data pertaining to pediatric patients who presented at our clinic and underwent WBMRI over the last 5 years. Our investigation targeted children experiencing diffuse musculoskeletal pain, where precise localization was challenging and suspicion of rheumatological pathology persisted despite inconclusive results from conventional diagnostic modalities. A total of 87 patients (33 female) underwent WBMRI at our clinic, with a median age (minimum-maximum) of 11.3 (0.5-18) years. Whole-body magnetic resonance imaging was performed in 4 patients suspected with dermatomyositis (DM) where muscle biopsy was not feasible, revealing muscle involvement and myositis. Additionally, WBMRI was utilized in 4 patients diagnosed with chronic nonbacterial osteomyelitis (CNO) to assess recurrence, identifying new active lesions in 3 patients. Among the remaining 79 patients, 34 received a new diagnosis of CNO. Clinically, supported by additional findings in laboratory and WBMRI, 18 were diagnosed with juvenile idiopathic arthritis (JIA), 5 with protracted febrile myalgia syndrome (PFMS), 5 with acute osteomyelitis, and 1 with viral myositis. The results were normal for 17 patients. Most of the WBMRIs conducted at the clinic under study were primarily performed on patients suspected of having CNO. Additionally, WBMRI was found to be supportive and beneficial in cases of suspected DM, PFMS, and JIA during the diagnosis.

A Successful Laparoscopic Appendectomy for an Adult Male Patient with Osteogenesis Imperfecta.

Osteogenesis imperfecta (OI) is a genetic connective tissue disease defined by the loss of bone mass and density, which makes the bones more brittle and more likely to fracture over time. Bone deformity and articular instability are the subsequent symptoms. This 25-year-old man had malformed lower limbs and trouble walking due to OI and dwarfism. He arrived complaining of fever, nausea, vomiting and diffuse peri-umbilical pain. During ultrasonography a blinded, oedematous lobe formation containing an appendicolith was discovered. Acute suppurative appendicitis was diagnosed, necessitating a laparoscopic appendectomy. Because the patient had previously undergone general anaesthesia, anaesthesia was thought to be attainable. Pneumoperitoneum and a 10 mm optical port inserted into the umbilicus were used in the surgical procedure. A diagnostic laparoscopy revealed faecolith obstruction and an acute suppurative appendicitis. After an hour, a laparoscopic appendectomy was performed effectively with little blood loss. Without experiencing any difficulties because of the surgery position, the patient was discharged. We present a case of an OI dwarf patient with acute suppurative appendicitis. It highlights the possibility of performing laparoscopic surgery in general and a laparoscopic appendectomy in particular on OI patients. In rare instances involving OI, laparoscopic surgery in general and laparoscopic appendectomy in particular are practical and efficient options.

Significance of Inflammatory Markers in Primary Fibromyalgia Syndrome and Their Relation in Assessing the Disease Severity

Abstract Background Fibromyalgia syndrome (FMS) is a musculoskeletal disorder characterized by diffuse chronic musculoskeletal pain associated with various other symptoms. Although the etiology and pathogenesis of FMS are still unclear, it was reported to have possible inflammatory basis. No laboratory marker is currently available to diagnose the disease. Aim of the Work to assess the serum levels of ESR, CRP, NLR, MPV and PDW in primary Fibromyalgia syndrome patients and their relation with the disease severity and depression scores. Patients and Methods The study included 30 FMS patients, diagnosed according to the 2010 ACR (American Colleague of Rheumatology) criteria who presented to Ain Shams University Physical Medicine and Rehabilitation clinic as well as 30 healthy volunteers who served as a control group. The following laboratory tests were assessed among both groups: Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Neutrophil Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). FMS patients filled out The Revised Fibromyalgia Impact Questionnaire (FIQR) and Montgomery Asberg Deprssion Score (MADRS) as well. Results MPV, NLR, ESR and CRP values were significantly higher among the patients’ group (p < 0.05). Statistically positive correlation was found between FIQR and each of CRP (p = 0.021) and ESR (p = 0.027) levels. Another statistically significant positive correlation was found between MADRS and CRP (p = 0.01). The NLR showed marginal positive significance with FIQR. Conclusion In the light of these previous results, we can state that the serum levels of the tested inflammatory markers being mainly the acute phase reactants, have a positive relation with disease severity and depression scores, which in turn affect the quality of daily living. Accordingly, we arise the possibility of using those markers as good indicators of ongoing inflammatory process among FMS patients reflecting the severity of the disease.

Predictive Value of Preoperative Pain Sketches in Lower Extremity Amputees Undergoing Secondary Targeted Muscle Reinnervation for Treatment of Neuropathic Pain.

Targeted Muscle Reinnervation (TMR) is an effective surgical treatment for neuropathic pain in amputees. Qualitative descriptions of pain, depicted by pain sketches, could enhance the understanding of symptomatic improvement following surgery. Our aim is to assess whether pre-operative pain sketches, drawn by lower extremity (LE) amputees, can predict surgical outcomes following Secondary TMR surgery. Eligible patients were LE amputees who underwent Secondary TMR surgery between 2017 and 2023. Pain sketches and pain scores were prospectively collected both before and after surgery. The pain trajectory, as categorized by pre-operative pain sketches, was analyzed and assessed for improvement, defined as reaching the Minimal Clinically Important Difference (MCID). The transition into different pain sketches and the occurrence of phantom drawings were evaluated for their association with improvement. Fifty-eight patients were included, of which 18 (31.1%) depicted diffuse pain (DP), 26 (44.8%) depicted focal pain (FP), and 18 (24.1%) depicted radiating pain (RP) in their pre-operative sketch. FP sketches were associated with the lowest pre- and post-operative pain scores and most frequently developed into sketches indicating "no pain". RP sketches were associated with the least pain improvement, the lowest likelihood of achieving the MCID, and were more prevalent in patients with diabetes or depression. RP sketches were associated with phantom drawings; no other sketch types developed into RP sketches at the final follow-up. In LE amputees who underwent Secondary TMR, pre-operative pain sketches could serve as a helpful tool in predicting pain outcomes. RP sketches seemed to be associated with worse outcomes, and FP sketches with the most improvement.

Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder.

To compare the efficacy of intra-articular steroid injection with ultrasound-guided supra-scapular nerve block in the management of frozen shoulder in terms of shoulder pain and disability index score and range of motion. This randomized controlled trial was conducted in orthopedic department, PIMS, Islamabad from 1st January, 2020 to 30th June, 2020. A total of 72 patients were randomly equally (n=36 each) allocated to Group-A (intra-articular steroid injection) and Group-B (supra-scapular nerve block). Adults above 18 years of both genders having diffuse shoulder pain were included. Cases of shoulder pain localized because of bicipital tendinitis, rotator cuff tear, pain due to acute trauma and those with osteoarthritis were excluded. Data was analyzed in SPSS version 22.0. Patients average age was 60.1 ± 6.29 in IASI and 58.0 ± 5.83 years in SSNB Group-And there were 19 (52.8%) males in IASI group compared to 15 (41.7%) in SSNB. At three weeks mean pain was significantly less in SSNB (57.1 ± 9.53 vs 49.4 ± 9.02) compared to IASI group (p-value, <0.001). The mean disability index was significantly low in SSNB (51.5 ± 5.10 vs 63.9 ± 5.14) versus IASI group (p-value, <0.001). At one week, three weeks and six weeks, mean external rotation was better in SSNB than IASI group (p-value, <0.001). The mean abduction was also better in SSNB group. Ultrasound guided supra-scapular nerve block is better than intra-articular steroid injection in managing frozen shoulder.

MAMSAGATA VATA W.R.T MYALGIA/IDIOPATHIC MUSCULOSKELETAL PAIN IN CHILDREN: A CASE STUDY

Introduction: A 13-year-old male patient reported to the Outpatient Department (OPD) of Kaumarabhrithya at Shree Swaminarayan Ayurvedic College and Hospital with complaints of diffused (un-localized) severe muscle pain, slurred speech and sleeplessness from the past one year. Another associated complaint was the inability to pronounce the word ‘r’. The main complaint, though, was the muscular pain throughout the body. Though the patient was previously diagnosed and treated for pain as per the conventional science/medical hospitals, the pa-tient and his parents did not have the records. They were unable to recall the names of the medicines prescribed. At Swaminarayan Ayurvedic Hospital, he was diagnosed with Mamsagata Vata and treated with a combination of internal medications and Panchakarma procedures. Methods- The patient was treated with internal medica-tions Brahmi vati Swarnauyukta (250 mg/BD), Brahmi Gritha (5 ml/BD) and Dashamularishta (10 ml with 20 ml water/BD); Panchakarma therapies of Sarvanga Abhyanga (full body therapeutic massage therapy), Sarvanga Swedana (full body fomentation therapy) and Matra Basti (therapeutic enema with medicated oil with low quan-tity) for seven days. The primary objective was to treat Mamsagata Vata and associated symptoms with Snehana, Vatagna dravyas and Medhya rasayana. Results- The patient was treated with internal medications and Panchakarma therapies for seven days. There was a significant reduction in muscular pain and an improve-ment in sleep. No adverse effects were reported. This case study elucidates Snehana's (Matra Basti) efficacy in managing Mamsagata Vata. Discussion- The clinical data from this study suggests that Ayurvedic treatment in managing Mamsagata Vata w.r.t Myalgia/Idiopathic musculoskeletal pain in Children can provide effective re-sults.