Episodes Of Pain Research Articles

Long-term outcomes of Gamma Knife radiosurgery in treating glossopharyngeal neuralgia.

Glossopharyngeal neuralgia (GPN) is an unusual disorder causing severe, brief pain episodes in the areas supplied by the glossopharyngeal nerve. Initial treatment involves medications like carbamazepine, but if these are ineffective or cause side effects, interventional pain management techniques or surgery may be considered. Gamma Knife radiosurgery is becoming popular in managing GPN due to its lower risk of complications than surgical interventions like microvascular decompression or rhizotomy. In this retrospective case series, we examined the outcomes of Gamma Knife radiosurgery in eight patients with GPN. The decision to utilize Gamma Knife radiosurgery was made following specific criteria, including failed surgical interventions, patient preference against surgery, or contraindications to surgical procedures. Patients were administered radiation doses within the range of 80 to 90 Gy, targeting either the cisternal glossopharyngeal nerve or glossopharyngeal meatus of the jugular foramen. Evaluations were conducted before the Gamma Knife radiosurgery; at 3, 6, and 12 months after Gamma Knife radiosurgery; and annually thereafter. Pain severity was assessed using the modified Barrow Neurological Institute scale grades, with patients achieving grade I-IIIa considered to have a good treatment outcome and grade IV-V to have a poor treatment outcome. Pain control and absence of radiosurgery-related complications were primary endpoints. The median age of the patients was 46.5 years, varying from 8 to 72 years. The median duration of pain was 32 months (range, 12-120 months). All patients, except one, were on polydrug therapy. All cases exhibited preoperative grade V pain. The median follow-up duration after Gamma Knife radiosurgery was 54.5 months, varying from 14 to 90 months. The overall clinical assessments revealed a gradual neurological improvement, particularly within the first 8.5 weeks (range, 1-12 weeks). The immediate outcomes at 3 months revealed that all patients (8/8, 100%) experienced pain relief, with 25% (2/8) achieving a medication-free status (Grade I). Three patients (37%) experienced a recurrence during the follow-up and were managed with repeat Gamma Knife radiosurgery (n = 2) and radiofrequency rhizotomy (n = 1). At the last follow-up, 88% (7/8) of patients had pain relief (Grades I-IIIa), with three (37%) achieving a medication-free status (Grade I). No adverse events or neurological complications occurred. The patient who underwent radiofrequency rhizotomy continued to experience inadequately controlled pain despite medication (Grade IV). Gamma Knife radiosurgery is a non-invasive, efficacious treatment option for idiopathic GPN, offering short- and long-term relief without permanent complications.

Perceptions and preferences for genetic testing for sickle cell disease or trait: a qualitative study in Cameroon, Ghana and Tanzania

Sickle cell disease (SCD) is a single gene blood disorder characterised by frequent episodes of pain, chronic anaemic, acute chest syndrome, severe disease complications and lifelong debilitating multi-system organ damage. Genetic testing and screening programs for SCD and the sickle cell trait (SCT) are valuable for early diagnosis and management of children living with SCD, and in the identification of carriers of SCT. People with SCT are for the most part asymptomatic and mainly identified as through genetic testing or when they have a child with SCD. This qualitative study explored perceptions towards genetic testing for SCD and SCT in Cameroon, Ghana, and Tanzania. The results show a general preference for newborn screening for SCD over prenatal and premarital/preconception testing, primarily due to its simpler decision-making process and lower risk for stigmatization. Premarital testing for SCT was perceived to be of low public health value, as couples are unlikely to alter their marriage plans despite being aware of their risk of having a child with SCD. Adolescents were identified as a more suitable population for SCT testing. In the case of prenatal testing, major concerns were centred on cultural, religious, and personal values on pregnancy termination. The study revealed a gender dimension to SCD/SCT testing. Participants mentionned that women bear a heightened burden of decision making in SCD/SCT testing, face a higher risk of rejection by potential in-laws/partners if the carriers of SCT, as well as the possibility of divorce if they have a child with SCD. The study highlights the complex cultural, ethical, religious and social dynamics surrounding genetic testing for SCD and emphasises the need for public education on SCD and the necessity of incorporating genetic and psychosocial counselling into SCD/SCT testing programs.

Treatment of temporomandibular disorders-Beyond splints!

IntroductionTemporomandibular disorders are a group of neuro-musculoskeletal disorders that have a multifaceted causation. The current study was a retrospective study undertaken to evaluate the outcome of different modalities of treatment provided in one office. Materials and methodsOut of a cadre of 425 patients who had undergone TM joint treatment and had finished treatment at least 2 years before 2017, 171 patients were successfully recalled for the purpose of the study. The patients that were recalled were divided into groups based on the treatment they had received. The groups were 1. Splint only group. 2. Splint and Braces group. 3. Splint Braces and equilibration group, 4. Splint, Braces and Jaw surgery. 5. Splint braces Joint surgery and Jaw surgery. Pre-treatment Helkimo index scores of anamnestic score Ai, dysfunction scores Di were extracted from the medical records and compared to the Helkimo index scores at the time of recall appointments. Modification was made to the Helkimo index made to include the consistency of food the patient could eat without pain and was called the food index (Fi). This data was also extracted from the pre-treatment records and compared to the post treatment records. Data gathered was subjected to Pearson correlation and Kruskal Wallis analysis of variance. The test was considered significant at a p value of less than or equal to 0 .05. (95 percent confidence). Data was also gathered to evaluate the number of pain episodes post- treatment and compared to the per-treatment data from the chart. ResultsAll patients treated in the group showed both clinical and statistical significance is all parameters of Ai. Di, and Fi scores. Acute exacerbation of pain was also reduced. Ai, Di, and Fi, scores showed most improvement in the groups that had Splint, braces and jaw surgery and the group Splint braces joint surgery and jaw surgery. Acute exacerbations of pain was also least in the aforementioned groups. Patients treated with splint only showed the most amount of acute exacerbation in pain. Another interesting observation in the study was that a linear relation was present between Ai and Fi with a nonlinear relation between Ai and Di, and Di and Fi, indicating that it is lack of pain and not the degree of mouth opening that is important that allows the patient to consume the hard and chewy foods. Conclusion1. In our study all modalities of treatment gave an improvement in patient status pretreatment to post treatment periods. 2. Most relief was attained in the groups of Splint braces and jaw surgery and splint braces joint surgery and jaw surgery. 3. Linearity in relation between Ai and Fi, indicated that it is lack of pain and not the degree of mouth opening that allows patients to consume diet of chewy and hard consistency. 4. Although our study indicates that the surgical options gave the best results, surgical options should be considered after all options are tried. 5. Our study demonstrates TM joint problems cannot be cured but by controlling the contributing factors it can be managed very effectively.

Ultrasound Biofeedback Increases Abdominal Muscle Activation in Golfers With a History of Low Back Pain.

To compare activation ratios of the transverse abdominis (TrA) during an abdominal draw-in maneuver (ADIM) and abdominal obliques during a golf swing, with and without ultrasound biofeedback, and to determine intrarater reliability of these ultrasound thickness measures. Single-session crossover study. Laboratory. Sixteen adult golfers with 2 or more episodes of low back pain (LBP) in the past year. Verbal cueing alone and verbal cueing with ultrasound biofeedback. Bilateral TrA activation ratios were calculated during an ADIM with and without ultrasound biofeedback. Activation ratios of the abdominal obliques were calculated bilaterally during golf swings with and without ultrasound biofeedback. Intraclass correlation coefficients (ICCs) were calculated for average thickness across all muscles and conditions for the nonbiofeedback trials. Transverse abdominis activation ratios were significantly higher when ultrasound biofeedback was provided bilaterally ( P < 0.001). Abdominal oblique activation ratios during the golf swing were also significantly higher with ultrasound biofeedback for the lead ( P = 0.014) and trail ( P < 0.001) sides. Intraclass correlation coefficient values ranged from 0.92 to 0.97 ( P < 0.001). Ultrasound biofeedback can increase activation ratios of the TrA during a supine ADIM in adult golfers with a history of LBP. Postswing ultrasound biofeedback increases activation of the abdominal obliques during a golf swing in golfers with a history of LBP. Ultrasound thickness measures of the TrA and obliques have excellent intrarater reliability.

Degeneration of the intervertebral disc as an interdisciplinary clinical problem in the context of neurosurgery - a summary of the state of knowledge - part I

Background: Degeneration of the intervertebral disc (IVD), resulting from various factors including both genetic and environmental, is a significant musculoskeletal disorder. It is characterized by a gradual deterioration of the structure and weakening the function of IVD, leading to a decline in the quality of life (QOL) or disability.Aim of the study: The aim of the study was to perform the review of scientific reports and summary of current knowledge regarding IVD degeneration in terms of etiopathogenesis, clinical symptoms, and various diagnostic methods.Materials and Methods: The literature review was based on searching key medical databases such as PubMed, MEDLINE, Scopus. A search strategy was defined, encompassing keywords, synonyms, and controlled keywords (MeSH terms). The search covered the last 20 years and focused on aspects of etiopathogenesis, clinical symptoms, and diagnostic methods. Papers meeting the inclusion criteria underwent a full-text analysis. Data and information gathered from the literature analysis were synthesized to provide a comprehensive overview of the current state of knowledge on the researched subject. Results: The process of IVD degeneration is extremely complex, involving biochemical, metabolic, and morphological changes that impact its structure and function. It entails a gradual loss of water in the nucleus pulposus (dehydration), resulting in impaired shock-absorbing function and leading to the formation of breaks in the annulus fibrosus, where the nucleus pulposus herniates. For years, mechanical injuries, especially work-related, were considered the primary factors causing IVD degeneration. Recent findings emphasize the significant role of genetic factors, with several genes encoding structural proteins of the IVD identified. Mutations in these genes may accelerate degeneration. Current clinical research results indicate a correlation between aortic calcifications and episodes of low back pain (LBP) and between lumbar artery stenosis, IVD degeneration, and subsequent LBP.Conclusions: Understanding the complexity of IVD degeneration and their neurological consequences is a crucial in planning effective treatment. It is essential to monitor the results of the latest research for the systematic updating of knowledge and practical guidelines in the discussed area. Collaboration between an experienced neurosurgeon and an interdisciplinary team of medical specialists can lead to achieving the best therapeutic outcomes.

Familial effects account for association between chronic pain and past month smoking.

Smoking is associated with chronic pain, but it is not established whether smoking causes pain or if the link is due to familial effects. One proposed mechanism is that smoking strengthens maladaptive cortico-striatal connectivity, which contributes to pain chronification. We leveraged a twin design to assess direct effects of smoking on pain controlling for familial confounds, and whether cortico-striatal connectivity mediates this association. In a population-based sample of 692 twins (age = 28.83 years), we assessed past-month smoking frequency (n = 132 used in the past month), presence and severity of a current pain episode (n = 179 yes), and resting-state functional connectivity of the nucleus accumbens and medial prefrontal cortex (NAc-mPFC). Smoking was significantly associated with pain, but the association was not significantly mediated by NAc-mPFC connectivity. In a co-twin control model, smoking predicted which families had more pain but could not distinguish pain between family members. Pain risk was 43% due to additive genetic (A) and 57% due to non-shared environmental (E) influences. Past-month smoking frequency was 71% genetic and 29% non-shared environmental. Smoking and pain significantly correlated phenotypically (r = 0.21, p = 0.001) and genetically (rg = 0.51, p < 0.001), but not environmentally (re = -0.18, p = 0.339). Pain and smoking are associated; however, the association appears to reflect shared familial risk factors, such as genetic risk, rather than being causal in nature. The connectivity strength of the reward pathway was not related to concurrent pain and smoking in this sample. Smoking does not appear to directly cause chronic pain; rather, there may be shared biopsychosocial risk factors, including genetic influences, that explain their association. These findings can be integrated into future research to identify shared biological pathways of both chronic pain and smoking behaviours as a way to conceptualize pain chronification.

Predicting long-term pain by combining brain imaging, genetics and health questionnaire data with Swedish national registries using a prospective superstruct design.

Long-term pain is a common health problem that results in disability for patients of all ages, leading to an enormous economic burden. Over 20% of the population suffer from long-term pain. Unfortunately, there are no clinical tests that predicts who will develop long-term pain. The overall aim is to predict future pain incidence based on brain function, pain behavior, health status, and genetic variability. PrePain utilizes a superstruct design, which involves recruiting participants from ongoing research projects. Eligible individuals for participation in PrePain were over 18 years old and free from long-term pain. During the baseline visit, participants provide pain and health-related questionnaires, undergo structural and functional MRI scans, and provide a saliva sample for DNA extraction. Individual baseline measures are then routinely followed-up via national registries. We present quality-assessed data from over 300 participants. The average age was 34 years, and most participants were women (75%). Participants rated their pain sensitivity above average and reported low avoidance. Catastrophizing thoughts during painful episodes were rated as moderate. Assessments of (f)MRI data indicated generally good image quality. In this first follow-up, we found that 45 participants had a pain-related diagnoses. Results indicate that a superstruct design is feasible for collecting a large number of high-quality data. The incidence of long-term pain indicates that a sufficient number of participants have been recruited to complete the prediction analyses. PrePain is a unique prospective pain database with a fair prognosis to determine risk factors of long-term pain.

A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes.

Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes. To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals' perspectives on analgesic use. Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N = 550) in 2019 and four nursing homes in Tokyo (N = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing. Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes. Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference.

Transdiaphragmatic rupture of hydatid cyst: A rare case report

Hydatid disease is a major zoonotic disease worldwide. It remains a serious health problem in developing countries and in countries where animal husbandry is common. Here, we report the case of a 40-year-old male who presented with chief complaints of pain in the right upper quadrant of the abdomen and swelling of the right side lower chest for 2 days. He mentioned intermittent episodes of pain within the past 7 days, the frequency and severity of which is increasing in the past 2 days. Chest X-ray suggestive of opacity of the right lower hemithorax with blunting of cardiophrenic angle seems like pleural effusion with opacity in the right upper lobe but on ultrasound, cystic area with multiple septations found in right lung parenchyma likely suggestive of hydatid cyst.

The Neuropeptide Substance P is Elevated in Sickle Cell Disease and is a Marker of Severity of Vaso-occlusive Crisis.

Acute episode of pain is the most frequent symptom for which patients with sickle cell disease (SCD) seek medical attention. The neuropeptide Substance P (SP) has been suggested as a possible aetiologic factor. This study compared the serum levels of SP in SCD subjects in painful vaso-occlusive crisis with those in steady state and normal HbAA subjects. This case-controlled study investigated eighteen SCD patients in vaso-occlusive crisis (VOC) and eighteen in steady state, while fourteen HbAA subjects were recruited as controls. Blood was collected in plain bottles and subsequently, the serum was separated for SP assay using the ELISA technique. Each sample was run, and results were confirmed in duplicate. Optical density was read at an absorbance of 450nm. The study showed that SP was significantly higher in SCD patients in steady state (184.79±18.67ng/L versus 104.17±19.24ng/L) compared to the controls (t=2.97, p=0.006); while the values obtained in those in VOC (375.78±76.21ng/L) were also significantly higher (t=2.433, p=0.02) than those in steady state (184.79±18.67ng/L). The SP value in the SCD patients in VOC was almost twice as much as those in steady state and about three times as much as the value in the controls and the differences were statistically significant (t=7.72, p=0.001). The study showed significantly higher SP levels in VOC compared to steady state or HbAA subjects suggesting that SP may be a marker for pain sensitisation.

Biobehavioral Predictors of Pain Intensity, Pain Interference, and Chronic Pain Episodes: A Prospective Cohort Study of African-American Adults

Racial disparities in pain experiences are well-established, with African-American (AA) adults reporting higher rates of daily pain, increased pain severity, and greater pain-related interference compared to non-Hispanic Whites. However, the biobehavioral factors that predict the transition to chronic pain among AA adults are not well understood. This prospective cohort study provided a unique opportunity to evaluate predictors of chronic pain onset among 130 AA adults (81 women), ages 18 to 44, who did not report chronic pain at their baseline assessment and subsequently completed follow-up assessments at 6- and 12-months. Outcome measures included pain intensity, pain-related interference, and chronic pain status. Comprehensive assessments of sociodemographic and biobehavioral factors were used to evaluate demographics, socioeconomic status, stress exposure, psychosocial factors, prolonged hypothalamic-pituitary-adrenal secretion, and quantitative sensory testing responses. At baseline, 30 adults (23.1%) reported a history of prior chronic pain. Over the 12-month follow-up period, 13 adults (10.0%) developed a new chronic pain episode, and 18 adults (13.8%) developed a recurrent chronic pain episode. Whereas socioeconomic status measures (ie, annual income, education) predicted changes in pain intensity over the follow-up period, quantitative sensory testing measures (ie, pain threshold, temporal summation of pain) predicted changes in pain interference. A history of chronic pain and higher depressive symptoms at baseline independently predicted the onset of a new chronic pain episode. The present findings highlight distinct subsets of biobehavioral factors that are differentially associated with trajectories of pain intensity, pain-related interference, and onset of chronic pain episodes in AA adults. PerspectiveThis prospective study sought to advance understanding of biobehavioral factors that predicted pain outcomes over a 12-month follow-up period among AA adults without chronic pain at their initial assessment. Findings revealed distinct subsets of factors that were differentially associated with pain intensity, pain-related interference, and onset of chronic pain episodes.

Eligibility for hematopoietic stem cell transplantation in a cohort of children with sickle cell disease: a single-center report

BackgroundHematopoietic stem cell transplantation (HSCT), is the only currently available curative option for SCD. Yet, the eligibility of SCD patients for HSCT is always limited by the significant associated toxicity and lack of suitable donors. At Cairo University’s pediatric hematology outpatient clinic, we aimed to determine hematopoietic stem cell transplantation (HSCT) candidates among a sickle cell disease (SCD) cohort, estimate the number of possible donors, and analyze the differences between patients with and without an HSCT indication.MethodsThis study was a cross-sectional analytic study including 128 SCD children. Their demographic, clinical, and laboratory profiles, total number, and number of siblings with SCD were obtained from their medical records.ResultsSixty-nine (53.9%) had at least one HSCT indication. Recurrent severe pain episodes despite hydroxyurea were the most common indication. Hemoglobin was lower, while reticulocyte count, serum ferritin, and aspartate aminotransferase were higher in HSCT candidates (p value < 0.001). Additionally, the prevalence of splenomegaly, the dose of hydroxyurea, and the number of transfusions were noticeably higher in HSCT candidates (p value = 0.013, 0.005, and < 0.0001 respectively). Among those indicated for HSCT; 75.3% had at least one healthy sibling who might be a potential donor.ConclusionMore than half were eligible for HSCT which should always be considered to provide a possible cure for the disease. Of the transplantation-eligible cases, about two-thirds had at least one healthy sibling who might potentially serve as a donor. Those meeting the requirements for HSCT eligibility should routinely undergo human leukocyte antigen (HLA) testing of their unaffected siblings.

Individualized Homeopathic and Organopathic Supportive Management of Sickle Cell Disorder: A Case Series of Six Patients from a Particularly Vulnerable Tribal Group in India.

Sickle cell disorder (SCD) is a hereditary blood disease characterized by an abnormality in the oxygen-carrying protein hemoglobin present in red blood cells. Genetic abnormality causes these cells to become sickle-shaped, with shorter lifespan. Vaso-occlusive crisis is a major symptom of SCD: it is a sudden and severe episode of pain, and occurs when sickle-shaped cells block blood flow. This blockage can lead to tissue damage, inflammation and pain. This case series aims to observe the clinical outcomes from prescribing individualized homeopathic medicines along with organopathic supportive medicine in the management of SCD through the analysis of case studies of six patients from a particularly vulnerable tribal group (PVTG) in India that manifests genetic predisposition for the disease. The patients were administered individualized homeopathic and organopathic supportive medicines, after a comprehensive door-to-door survey and subsequent screening, conducted between October 2020 and May 2023 in the Dindori and Mandla districts of the central Indian state, Madhya Pradesh. Clinical symptoms, laboratory parameters including hemoglobin, along with scores from a visual analogue scale (VAS) for pain and from the World Health Organization Quality of Life (WHOQoL) Questionnaire, were determined. Individualized homeopathic and organopathic supportive management led to improvements in clinical symptoms for all six patients. Laboratory test results showed a statistically significant increase in hemoglobin level associated with treatment. The VAS for pain indicated decreased pain frequency and severity. WHOQoL scores also improved, indicating enhanced well-being for each patient. No adverse effects were reported during treatment. This study suggests that individualized homeopathic medicine and organopathic supportive management have a beneficial role in managing SCD and may be valuable in the context of PVTGs in India. To establish a more comprehensive understanding of its efficacy, further studies should involve larger cohorts to allow for a thorough evaluation, including comparative analyses with standard therapies.

P723 Upadacitinib in Crohn’s disease: Real world experience from an early access program in Greece

Abstract Background Upadacitinib is a novel selective Janus kinase 1 inhibitor, recently approved for the management of Crohn’s disease (CD) by Food and Drug Administration. In Greece, upadacitinib is available through an early access program for refractory patients who have exhausted their therapeutic options. Our goal was to describe our real practice experience. Methods This is a multicenter retrospective cohort study of adult patients with moderate to severe CD, who received upadacitinib. The primary endpoint was clinical response, defined by a reduction ≥3 in Harvey-Bradshaw index (HBI). Clinical remission was defined as HBI ≤4. Secondary endpoints included endoscopic and biochemical improvement based on physician’s assessment and CRP measurement, respectively. Outcomes were assessed at 12 weeks and at patient’s latest follow up. All patients received 45mg upadacitinib for 3 months and then 30mg for another 3 months, whereas the maintenance dose (30mg or 15mg) was based on the patient’s response. We also evaluated short -term safety. Results A total of 22 CD patients (12 female) received upadacitinib and were included in the analysis. Mean age 42.2 years (24-63). Five patients were active smokers. Mean treatment duration was 5.4 months (1-20). Two patients have not yet reached 12 weeks of treatment and were excluded from the efficacy analysis. Ten patients (45.4%) had ileocolonic Crohn’s, seven (31.8%) ileal disease and five (22.7%) Crohn’s colitis. Four patients had perianal disease and seven patients Crohn’s related surgery (5 ileocecal resection, 2 seton placement). Four patients had active extraintestinal manifestations: Three inflammatory arthritis and one atopic dermatitis. The majority of patients (15/20) had failed ≥ 3 biologics. All of them failed treatment with anti-TNF and 15 (75%) with ustekinumab. Six patients have just completed the induction period of 12 weeks, ten are on 30mg upadacitinib and four on 15mg. At 12 weeks, 18 patients achieved clinical response (90%). CRP was normal for 15/20 (75%) patients at 12 weeks. At last follow-up (mean 5.9 months, 3-20), all patients were in clinical remission. Endoscopy was available for six patients and improvement was documented for all of them. Adverse events occurred in 3 patients (15.7%): An episode of abdominal pain, a skin infection and a case of neutropenia. All adverse events resolved without discontinuing treatment. Conclusion In a small cohort of medically resistant Crohn’s patients, the short- term clinical efficacy of upadacitinib was high. No serious safety issues were recorded.

Characterising concurrent pain experience and dietary patterns in people with chronic musculoskeletal pain: a feasibility study protocol

IntroductionNutrition-related factors linked to pain chronicity and disability include weight status and dietary behaviours. Dietary patterns associated with concurrent pain episodes, however, remain poorly characterised. This paper outlines the protocol for a feasibility study that aims to characterise pain-related dietary and lifestyle behaviours in people experiencing chronic musculoskeletal pain.MethodsThe study will recruit participants who experience musculoskeletal pain on 5 or more days of the week for at least 3 months. Participants will attend two in-person clinic visits where physical measurements and a series of pain and lifestyle questionnaires will be completed. Visits will be conducted pre and post a 2-week self-monitoring period where participants will self-report concurrent diet, sleep, mood, and pain on four days and will wear a wrist-worn activity monitor (GENEActiv). Key feasibility metrics will evaluate participant recruitment, enrolment and retention rates, and compliance with the study data collection protocol.DiscussionThere remains a lack of evidence behind dietary advice as an adjunct pain management tool. Upon completion of the protocol, feasibility outcomes will identify challenges to guide the design and delivery of a dietary intervention for chronic musculoskeletal pain.

Efficacy of Angiotensin-Converting Enzyme Inhibitors in Coronary Microvascular Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Coronary microvascular dysfunction (CMD) is becoming increasingly recognized as an important contributor to the development of ischemic heart diseases. Without obstructive coronary artery disease, the physiological function of the coronary microcirculation can be altered by structural, functional, and molecular factors, leading to myocardial ischemia. CMD can significantly impact the quality of life and prognosis and imposes a huge financial burden on healthcare systems and people. This meta-analysis aims to investigate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) for treating CMD. A systematic literature review identified randomized controlled trials (RCTs) comparing ACEIs with placebo in CMD patients. Review Manager, 5.3 for Windows, was utilized. Using the Mantel-Haenszel (M-H) method, improvement in coronary flow reserve (CFR) and systolic blood pressure events was pooled as mean difference (MD) in a meta-analysis model with a fixed effect model, whereas the number of chest pain episodes was pooled as MD with a random effect model. Five randomized controlled trials involving 209 patients were included in the analysis. The analysis demonstrated a statistically significant improvement in CFR in the ACEIs group compared to the placebo group (MD -0.3, 95% CI -0.61 to 0.01, P = 0.05). However, there was no significant difference in the number of chest pain episodes between the ACEIs and placebo groups (MD 1.79, 95% CI -3.99 to 7.58, P = 0.54). Similarly, no significant difference in blood pressure change was observed between the two groups (MD 4.02, 95% CI -3.25 to 11.28, P = 0.28). In conclusion, the appropriate treatment for CMD is a source of contention because adequate data is lacking. Our findings suggest that ACEIs may have a positive effect on improving CFR in patients with microvascular angina. However, ACEIs did not demonstrate a significant impact on the number of chest pain episodes or systolic blood pressure in this patient population. Further research, including RCTs with larger sample sizes and longer follow-up durations, is warranted to provide more conclusive evidence on the role of ACEIs in CMD management.

Orbital myositis in a patient with Crohn's disease: A case report of two episodes

To describe a case report of a 34 years-old patient with Crohn's Disease and two episodes of Ocular Myositis. The research methodology employed in this study consisted of a retrospective review of the patient's complete medical history. Crohn's Disease is a chronic inflammatory bowel disorder known to be associated with a wide range of extraintestinal manifestations. Ocular abnormalities, such as episcleritis and uveitis, are commonly observed. However, orbital myositis is an extremely rare ocular extraintestinal manifestations characterized by acute ocular pain that worsens with eye movements and is often accompanied by diplopia. In this case report, we present the case of a 34-year-old woman with a confirmed diagnosis of Crohn's Disease, who experienced two episodes of acute orbital pain exacerbated by ocular movements and diplopia. The diagnosis was established through clinical evaluation and radiologic imaging, with confirmation after a good response to systemic corticosteroids. She responded favorably to systemic corticosteroid therapy on both episodes, and no additional treatment was required. As of now, she remains stable without any ocular sequelae. It is important to note that orbital myositis is an uncommon ocular manifestation associated with Crohn's Disease, and prompt recognition and management are crucial to achieve successful outcomes.

Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain – findings from the BACE-N cohort

BackgroundBack pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes’ first point-of-contact.MethodsThe study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care.ResultsFour latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the “positive” class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the “fearful” class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the “distressed” class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the “hopeful” class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists.ConclusionsThe identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity.Trial registrationClinicaltrials.gov NCT04261309.

Roles of Pharmacists in the Management of Sickle Cell Disease in Adults: A Narrative Review.

Background: Sickle cell disease (SCD) is an autosomal, recessive, genetic condition of the sickle cell genes. It affects about 100 000 people in the United States where an estimated 1 out of every 365 black children and 1 out of every 13 black children will be born with SCD and sickle cell trait, respectively. Severe and unpredictable pain crisis are the leading cause of emergency department visit for adult patients with SCD and account for 90% of inpatient hospitalizations and 85% of all acute medical care, as well as high usage of medical resources. The care of patients with SCD is complex and requires a multidisciplinary approach. With a few pharmacotherapeutic options to reduce SCD complications and pain episodes, the role of pharmacists in the medication management is unclear. This article aims to outline the potential role of pharmacists in SCD management. Data sources: The authors searched Medline, PubMed, EMBASE, and Scopus from January 1, 1990 to August 31, 2022, for primary literature that assessed the role of pharmacists in managing patients with SCD. Results: The authors identified relevant studies and summarized the role of pharmacists in SCD management. Conclusions: Access to comprehensive health care is essential to ensure that patients with SCD have decreased hospitalizations and good health-related quality of life. Pharmacists are an integral part of the multidisciplinary health-care team and can help patients with SCD navigate the complexities of health care. Pharmacists are medication experts who are positioned to ensure comprehensive care in the acute and chronic SCD management.

Laparoscopic Tumorectomy for an Unusual Pelvic Retroperitoneal Leiomyoma: A Case Report

Leiomyomas are benign tumors, mostly located in the uterus. The pelvic localization is quite rare, and it is associated with unusual growth patterns. It is important to make an adequate differential diagnosis between malignant and benign retroperitoneal neoplasm because treatment is different. When it is not possible to have a precise preoperative diagnosis, a laparoscopic or laparotomy surgical tumorectomy is often required. To obtain a certain diagnosis, the goal of surgery is ensuring the complete excision of neoplasms and preservation of urination, defecation, and sexual function. We report a rare case of a 58-year-old woman who underwent a laparoscopic tumorectomy for a pelvic retroperitoneal leiomyoma. The patient reported occasional episodes of dull pain in the pelvic region. Pelvic contrast CT scan and magnetic resonance imaging (MRI) showed a retroperitoneal solid mass in contiguity with the posterior wall of the uterine body-isthmus, to be referred to as a pedunculated uterine fibroma strictly posteriorly adherent to the sigma. She first underwent to explorative laparoscopy by a gynecologist who did not find any uterine mass. The patient was subsequently admitted to the department of general surgery and has done a second operative laparoscopy which highlighted the presence of an extra-peritoneal para-rectal mass which was completely excised. The histological examination of tumor indicated that it was a leiomyoma. The postoperative course was uneventful, and the patient was discharged in III post-operative day (POD).