Pain Experience Research Articles

Gynaecological cancer surveillance for women with Lynch syndrome: systematic review and cost-effectiveness evaluation.

Lynch syndrome is an inherited condition which leads to an increased risk of colorectal, endometrial and ovarian cancer. Risk-reducing surgery is generally recommended to manage the risk of gynaecological cancer once childbearing is completed. The value of gynaecological colonoscopic surveillance as an interim measure or instead of risk-reducing surgery is uncertain. We aimed to determine whether gynaecological surveillance was effective and cost-effective in Lynch syndrome. We conducted systematic reviews of the effectiveness and cost-effectiveness of gynaecological cancer surveillance in Lynch syndrome, as well as a systematic review of health utility values relating to cancer and gynaecological risk reduction. Study identification included bibliographic database searching and citation chasing (searches updated 3 August 2021). Screening and assessment of eligibility for inclusion were conducted by independent researchers. Outcomes were prespecified and were informed by clinical experts and patient involvement. Data extraction and quality appraisal were conducted and results were synthesised narratively. We also developed a whole-disease economic model for Lynch syndrome using discrete event simulation methodology, including natural history components for colorectal, endometrial and ovarian cancer, and we used this model to conduct a cost-utility analysis of gynaecological risk management strategies, including surveillance, risk-reducing surgery and doing nothing. We found 30 studies in the review of clinical effectiveness, of which 20 were non-comparative (single-arm) studies. There were no high-quality studies providing precise outcome estimates at low risk of bias. There is some evidence that mortality rate is higher for surveillance than for risk-reducing surgery but mortality is also higher for no surveillance than for surveillance. Some asymptomatic cancers were detected through surveillance but some cancers were also missed. There was a wide range of pain experiences, including some individuals feeling no pain and some feeling severe pain. The use of pain relief (e.g. ibuprofen) was common, and some women underwent general anaesthetic for surveillance. Existing economic evaluations clearly found that risk-reducing surgery leads to the best lifetime health (measured using quality-adjusted life-years) and is cost-effective, while surveillance is not cost-effective in comparison. Our economic evaluation found that a strategy of surveillance alone or offering surveillance and risk-reducing surgery was cost-effective, except for path_PMS2 Lynch syndrome. Offering only risk-reducing surgery was less effective than offering surveillance with or without surgery. Firm conclusions about clinical effectiveness could not be reached because of the lack of high-quality research. We did not assume that women would immediately take up risk-reducing surgery if offered, and it is possible that risk-reducing surgery would be more effective and cost-effective if it was taken up when offered. There is insufficient evidence to recommend for or against gynaecological cancer surveillance in Lynch syndrome on clinical grounds, but modelling suggests that surveillance could be cost-effective. Further research is needed but it must be rigorously designed and well reported to be of benefit. This study is registered as PROSPERO CRD42020171098. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129713) and is published in full in Health Technology Assessment; Vol. 28, No. 41. See the NIHR Funding and Awards website for further award information.

Characteristics of palliative care in the elderly

Palliative care for elderly, mostly multimorbid people is an integrative concept that is included at an early stage of illness in addition to curative and rehabilitative treatments. Goals of treatment and in the rest of life are regularly discussed during the course in order to set individual priorities and to plan or question clarifications, treatments and nursing measures. The prognosis, the patient's wishes and values, the possible benefits and burdens of an intervention play a central role in the decision-making process. Advance care planning makes it easier to make decisions at a later stage, especially in the case of dementia, which increasingly impairs the ability to make judgments. Older people suffer not only from destressing symptoms such as pain, but also from functional limitations that affect their quality of life. In addition to symptom-alleviating interventions, rehabilitative measures are also part of the palliative concept. In pain treatment, age-adapted adjustments to the medication are to be considered and the multidimensionality of the pain experience must be taken into account. In the case of cognitive impairment, appropriate observation tools help to identify possible pain. In the context of dementia, palliative treatment of neuropsychiatric symptoms should be considered if the patient suffers from them.

Mindfulness Meditation and Placebo Modulate Distinct Multivariate Neural Signatures to Reduce Pain

BackgroundRather than a passive reflection of nociception, pain is shaped by the interplay between one’s experiences, current cognitive-affective states, and expectations. The placebo response, a paradoxical yet reliable phenomenon, is postulated to reduce pain by engaging mechanisms shared with active therapies. It has been assumed that mindfulness meditation, practiced by sustaining nonjudgmental awareness of arising sensory events, merely reflects mechanisms evoked by placebo. Recently, brain-based multivariate pattern analysis has been validated to successfully disentangle nociceptive-specific, negative affective, and placebo-based dimensions of the subjective pain experience. MethodsTo determine whether mindfulness meditation engages distinct brain mechanisms from placebo and sham mindfulness to reduce pain, multivariate pattern analysis pain signatures were applied across 2 randomized clinical trials that employed overlapping psychophysical pain testing procedures (49 °C noxious heat; visual analog pain scales) and distinct functional magnetic resonance imaging techniques (blood oxygen level–dependent; perfusion based). After baseline pain testing, 115 healthy participants were randomized into a 4-session mindfulness meditation (n = 37), placebo-cream conditioning (n = 19), sham mindfulness meditation (n = 20), or book-listening control (n = 39) intervention. After each intervention, noxious heat was administered during functional magnetic resonance imaging and each manipulation. ResultsA double dissociation in the multivariate pattern analysis signatures supporting pain regulation was revealed by mindfulness meditation compared with placebo cream. Mindfulness meditation produced significantly greater reductions in pain intensity and pain unpleasantness ratings and nociceptive-specific and negative affective pain signatures than placebo cream, sham mindfulness meditation, and control interventions. The placebo-cream group significantly lowered the placebo-based signature. ConclusionsMindfulness meditation and placebo engaged distinct and granular neural pain signatures to reduce pain.

Desmoid Type of Fibromatosis of Ureter: A Rare Case

Abstract This study presents a rare case of desmoid-type fibromatosis (DTF) in the ureter of a young adult, highlighting its unusual occurrence within the urinary tract. The patient experienced right flank pain, leading to the discovery of gross hydroureteronephrosis with a suspicious distal ureteric mass. Surgical intervention revealed a well-defined tumor displaying characteristic histological features of DTF. Immunohistochemistry confirmed the diagnosis. Despite the absence of nuclear β-catenin expression, the patient underwent wide local excision. This case highlights the need for individualized treatment plans for DTF and emphasizes its consideration in cases of obstructive uropathy with atypical mass presentations.

Physical and Psychological Health Problems in the Elderly

Population Aging is a global phenomenon—almost every country in the world. With increasing age, there will also be an increase in various morbidity patterns in the elderly population. This study aims to determine the physical and psychological problems in the elderly and the factors related to the health problems of the elderly and appropriate interventions. The research method is descriptive with observational analytics using physical and psychological assessment tools. The measurement tools used were fall risk, cognitive impairment, sleep quality, insomnia, activities of daily living, joint pain, anxiety disorders and quality of life in the elderly. The number of respondents is 30 elderly who live in nursing homes and the technique used is interviews. The results of this study were 76.7% had a low risk of falling, 80% had no cognitive impairment, 73.33% had good sleep quality with a global value of 5.83, 46.67% had insomnia, 50% had anxiety disorders, 50% had independent activities, 66.67% had joint pain mild, and in general 83.33% quality of life is good. In conclusion, most of the respondents did not experience physical and psychological disorders, but most of the elderly experienced moderate joint pain and half of the respondents needed assistance to carry out their daily activities. Thus, it is necessary to have interventions that are in accordance with the needs of the elderly in nursing homes.

CT-guided steroid injections for the diagnosis and management of piriformis syndrome

Objectives: Piriformis syndrome (PS) is an extra-spinal tunnel neuropathy affecting the sciatic nerve. While typically diagnosed clinically, with confirmation through exclusion of other conditions, accurate diagnosis remains challenging. This study assesses the clinical outcomes of computed tomography (CT)-guided corticosteroid injection for suspected PS, considering its potential role as both a diagnostic and a therapeutic intervention. Materials and Methods: We conducted a retrospective review of 32 patients suspected to have PS, based on clinical presentation and examination findings, who underwent CT-guided steroid injections between July 2013 and February 2020. Effectiveness was evaluated qualitatively through clinic letters from patient reviews with a mean follow-up of 5 months (range 3–7) Results: Thirty-two patients received 44 injections. The cohort had an average age of 45 years, with many being physically active. Initial follow-up showed that 56% experienced pain relief, though 16% of these cases were short-lived. About 19% reported partial benefit, while 31% reported no improvement. Repeat injections were performed on nine patients, with some undergoing up to two repeat procedures. About 47% of patients were discharged following injections, repeats, or surgery, while 53% required further specialist input. Conclusion: CT-guided corticosteroid injections appear to be a valuable management tool for diagnosis and treatment of PS, particularly when conservative management fails. However, the long-term benefits are inconsistent, highlighting the need for a more standardized treatment pathway. Given the high degree of diagnostic uncertainty and lack of accurate diagnostic tools for PS, we propose the use of local anesthetic and steroid injections as a diagnostic approach, as well as a management option.

Experiences of Discrimination and its Impact on the Intensity of Pain: A Study in the Elderly Brazilian Population

Background: The experience of pain is multifactorial and may be exacerbated by everyday stressors like discrimination leading to a poor quality of life. Perceived discrimination has been associated with the presence and increased intensity of pain. The elderly population may be more likely to experience discrimination making them vulnerable to external stress factors that can make managing pain more difficult. We aimed to explore the influence of discrimination and stress on pain intensity in an elderly Brazilian population. Methods: In this cross-sectional study design, we analyzed the data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) in which participants answered the revised everyday discrimination questionnaire stating their pain intensity and perceived stress level. The effect of discrimination and stress on pain intensity was assessed using a multivariable-adjusted ordinal logistic regression. Sensitivity analysis with multiple imputations for missing data was also conducted to assess the robustness of the findings. Results: In the elderly Brazilian population, discrimination and perceived stress had a significant association with pain intensity. The odds of experiencing strong intense pain were 7% higher in an adult experiencing everyday discrimination (OR= 1.07, 95% CI: 1.03-1.11, p<0.001). Stress was also significantly associated with pain intensity (OR 1.05, 95% CI 1.05 - 1.06). This finding emphasizes the need to address the influence of such societal factors on the psychological and physical aspects of pain. Conclusion: Our study found that there is a significant association between experiences of discrimination and stress with pain intensity in a large population from Brazil in accordance with previous studies despite differences in population demographics and cultural contexts. These findings provide evidence of the generalizability of these associations and underscores the detrimental health consequences associated with perceived discrimination.

Grief Accompanied by Suicidal Thoughts After Traumatic Loss in Adolescent: A Case Report

Grief is a normal process that occurs following the irreversible loss of a loved one. This process, characterized by painful experiences, varies widely and is influenced by numerous factors, including the identity of the deceased, the circumstances of their death, the individual characteristics of the bereaved, and the availability of support systems. The suddenness and violence of a loss can disrupt the normal grieving process, leading to the manifestation of traumatic symptoms. This phenomenon, referred to as “traumatic grief” in the literature, is associated with an increased risk of various psychiatric disorders, including major depression, anxiety disorders, and post-traumatic stress disorder. The death of a parent represents a profound loss for an adolescent, complicating their coping mechanisms and significantly impacting their psychological well-being. Parental loss alone is a significant risk factor for suicidal behavior in adolescents. When a parent’s death is traumatic, it can further exacerbate this risk, leading to suicidal thoughts and behaviors by disrupting the normal grief process, even in adolescents who were previously mentally healthy. This article presents the diagnosis and treatment of a 17-year-old girl who exhibited active suicidal thoughts and behaviors after her father was killed with a firearm. The objective of this case report is to explore the atypical grief symptoms that can follow traumatic losses during adolescence and to assess the effectiveness of holistic approaches that combine supportive psychotherapy with pharmacotherapy in treating such cases.

Breast Cancer Screening among African Immigrants in the United States: An Integrative Review of Barriers, Facilitators, and Interventions.

The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, and Google Scholar. Studies were included if they were published in English language journals after 1 January 2000 and reported data on breast cancer-screening barriers, facilitators, or interventions among U.S. African immigrants. Barriers and facilitators reported by studies were descriptively examined and synthesized by two authors and classified as aligning with one of the three levels of influences based on the social-ecological model (intrapersonal, interpersonal, and community). Interventions promoting breast cancer screening were narratively summarized. Search procedures retrieved 1011 articles, with 12 meeting the criteria for inclusion in the review (6 qualitative and 6 quantitative). Intrapersonal barriers included limited awareness, fear of pain, language barriers, health concerns, transportation issues, costs, and negative past experiences. Interpersonal barriers involved modesty, spiritual beliefs, and lack of support, while community-level barriers included provider and healthcare-system challenges. Regarding facilitators, past screening experiences and health insurance were the most commonly reported intrapersonal facilitators. The only interpersonal facilitator identified was observing other women experience a breast cancer diagnosis and undergo treatment. Community-level facilitators included appointment reminders, scheduling assistance, culturally congruent interpreters, transportation to screening facilities, and patient navigators. Three articles reported outcomes of breast cancer-screening interventions. All three were pilot studies and reported increased knowledge and attitudes regarding breast cancer screening following the respective interventions. One study examined the uptake of breast cancer screening following the intervention, with results indicating an increase in screening. Findings provide a comprehensive synthesis of factors influencing breast cancer screening among African immigrants and highlight the need for future research on the topic. This review was registered with Prospero (CRD42024502826) before the initiation of search procedures.

Addressing Psychosocial Care Needs in Women with Peripheral Artery Disease.

Peripheral artery disease (PAD) is a growing global epidemic. Women with PAD are at elevated risk of experiencing psychosocial stressors that influence the diagnosis, management, and course of their illness due to unique sex- and gender-based factors. We review existing evidence for increased psychosocial risk in women with PAD with a focus on mood disorders, chronic stress, pain experiences, substance use disorders, health behaviors and illness perceptions, and healthcare access. We discuss how these factors exacerbate PAD symptomatology and lead to adverse outcomes. Existing gaps in women's vascular care are reviewed and potential solutions to bridge these gaps through psychosocial care integration are proposed. Current care paradigms for women's vascular care do not adequately screen for and address psychosocial comorbidities. Clinician education, integration of evidence-based psychological care strategies, implementation of workflows for the management of individuals with PAD and mental health comorbidities, reform to reimbursement structures, and further advocacy are needed in this space. This review provides a construct for integrated behavioral health care for women with PAD and advocates for further integration of care.

Establishing a standardised approach for the measurement of neonatal noxious-evoked brain activity in response to an acute somatic nociceptive heel lance stimulus

BackgroundElectroencephalography (EEG) can be used in neonates to measure brain activity changes that are evoked by noxious events, such as clinically required immunisations, cannulation and heel lancing for blood tests. EEG provides an alternative approach to infer pain experience in infants compared with more commonly used behavioural and physiological pain assessments. Establishing the generalisability and construct validity of these measures will help corroborate the use of brain-derived outcomes to evaluate the efficacy of new or existing pharmacological and non-pharmacological methods to treat neonatal pain. This study aimed to test whether a measure of noxious-evoked EEG activity called the noxious neurodynamic response function (n-NRF), that was originally derived in a sample of term-aged infants at the Oxford John Radcliffe Hospital, UK, in 2017, can reliably distinguish noxious from non-noxious events in two independent datasets collected at University College London Hospital and at Royal Devon & Exeter Hospital. We aimed to reproduce three published results that use this measure to quantify noxious-evoked changes in brain activity. We used the n-NRF to quantify noxious-evoked brain activity to test (i) whether significantly larger noxious-evoked activity is recorded in response to a clinical heel lance compared to a non-noxious control heel lance procedure; (ii) whether the magnitude of the activity evoked by a noxious heel lance is equivalent in independent cohorts of infants; and (iii) whether the magnitude of the noxious-evoked brain activity increases with postmenstrual age (PMA) in premature infants up to 37 weeks PMA. Positive replication of these studies will build confidence in the use of the n-NRF as a valid and reliable pain-related outcome which could be used to evaluate analgesic efficacy in neonates. The protocol for this study was published following peer review (https://doi.org/10.17605/OSF.IO/ZY9MS). ResultsThe n-NRF magnitude to a noxious heel lance stimulus was significantly greater than to a non-noxious control heel lance stimulus in both the UCL dataset (n = 60; mean difference .88; 95% confidence interval (CI) .64–1.13; p < .0001) and the Exeter dataset (n = 31; mean difference .31; 95% CI .02–.61; p = .02). The mean magnitude and 90% bootstrap confidence interval of the n-NRF evoked by the heel lance did not meet our pre-defined equivalence bounds of 1.0 ± .2 in either the UCL dataset (n = 72; mean magnitude 1.33; 90% bootstrapped CI 1.18–1.52) or the Exeter dataset (n = 35; mean magnitude .92, 90% bootstrapped CI .74–1.22). The magnitude of the n-NRF to the noxious stimulus was significantly positively correlated with PMA in infants up to 37 weeks PMA (n = 65; one-sided Pearson's R, adjusted for site: .24; 95% CI .06–1.00; p = .03). ConclusionsWe have reproduced in independent datasets the findings that the n-NRF response to a noxious stimulus is significantly greater than to a non-noxious stimulus, and that the noxious-evoked EEG response increases with PMA. The pre-defined equivalence bounds for the mean magnitude of the EEG response were not met, though this might be due to either inter-site differences such as the lack of calibration of devices between sites (a true negative) or underpowering (a false negative). This reproducibility study provides robust evidence that supports the use of the n-NRF as an objective outcome for clinical trials assessing acute nociception in neonates. Use of the n-NRF in this way has the potential to transform the way analgesic efficacy studies are performed.

Unraveling pain experience and catastrophizing after cognitive behavioral therapy

Pain experiences are often complex with catastrophic cognitions, emotions, and behaviors. Cognitive behavioral therapists share the work of unraveling these complex experiences with their patients. However, the change process underlying the unraveling of the pain experience have not yet been quantified. We used an interrelationship-focused network model to examine the way an undifferentiated conceptualization between cognition and pain experience changed via group cognitive-behavioral therapy (CBT). Overall, 65 participants (77.4% of all patients who entered the intervention) were included in the analysis; they attended the total of 12 weekly group CBT and filled the Short-Form McGill Pain Questionnaire and the pain catastrophizing questionnaire. Before treatment, there were no edges in the partial correlation-based network because of large covariation across items. After treatment, many edges appeared and, particularly strong couplings were found between items within the same subscale. The formative shift from a non-edged pre-treatment network to a mature post-treatment network may indicate that patients were able to conceptualize these symbolic constructs better. These results are probably of interest to clinicians and would be consistent with the fundamental monitoring process of CBT.

Is the Compassion of Anesthesiologists Associated With Postoperative Pain and Patient Experience? A Prospective Cohort Study.

Patient perception of physician compassion may be associated with improved health outcomes, yet it is unclear whether it is associated with postoperative pain reduction or improved patient experience metrics in same-day surgery patients. We hypothesized that higher anesthesiologist compassion during the preanesthesia interview, rated by patients, is associated with lower postoperative pain via the anxiety pathway in same-day surgery patients. We also performed exploratory correlation analysis to assess whether compassion was associated with less opioid consumption and improved patient experience in same-day surgery patients. We conducted a single-center, prospective, observational cohort study in American Society of Anesthesiologists (ASA) physical status I to III patients scheduled to undergo same-day surgery with anesthesia. Compassion was scored using a validated 5-item tool. State anxiety (SA) and trait anxiety (TA) were measured using the State-Trait Anxiety Inventory. Pain scores were obtained using a 0 to 10 Likert scale. Daily opioid use was recorded. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) and the Surgical Care CAHPS. Mediation analysis was used to assess the association between compassion and pain scores via the anxiety pathway. Spearman correlation was performed to test for association between the compassion score and the secondary outcomes. A total of 147 subjects completed the study with a median age of 50 years and 81% female. Fifty percent underwent breast surgery, 35% abdominal surgery, and the rest underwent gynecological and urological surgeries. The median (Q1-Q3) postoperative pain scores on postoperative days 0 and 3 days later were 4 (1.5-6) and 3 (1-5), respectively.Mediation analysis results showed a same-day anxiety-mediated effect (95% confidence interval [CI]) of compassion on pain of -0.08 (-0.13 to -0.02), attributing to 9% of the total effect. On postoperative day 0, an increase in compassion was associated with a significant average drop in pain of between 0.02 and 0.13. In addition, higher compassion was correlated with better patient experience metrics (ρ= -0.53 [95% CI, -0.64 to -0.39]). The study results suggest that an anxiety-mediated pathway exists through which compassionate care may help improve the patient's perception of postoperative pain on the day of surgery (before discharge from the hospital). Higher compassion was also associated with better patient experience metrics.

Descending facilitation from rostral ventromedial medulla mu opioid receptor-expressing neurons is necessary for maintenance of sensory and affective dimensions of chronic neuropathic pain.

Pharmacological ablation of rostral ventromedial medulla (RVM) mu opioid receptor-expressing cells before peripheral nerve injury prevents the development of neuropathic pain. However, whether these neurons are required for the expression of established neuropathic pain is not known. Male Oprm1Cre heterozygous (MORCre) or wild-type (MORWT) mice received AAV8-hSyn-DIO-hM4D(Gi)-mCherry in the RVM. After partial sciatic nerve ligation (PSNL), we evaluated pain behaviors and descending control of nociception in response to acute or sustained chemogenetic inhibition of RVM-MOR cells expressing hM4D(Gi). A single systemic administration of hM4D(Gi) agonist clozapine-N-oxide (CNO) reversibly inhibited hind paw tactile allodynia and produced conditioned place preference only in MORCre mice with PSNL. Intrathecal CNO also reversibly inhibited PSNL-induced hind paw allodynia, suggesting that the spinal projections from these RVM-MOR cells are critical for manifestation of pain behaviors. Consistent with enhanced descending facilitation from RVM-MOR cells, MORCre-hM4D(Gi) mice with PSNL showed diminished descending control of nociception that was restored by systemic CNO. Sustained CNO in drinking water before PSNL prevented expression of chronic pain without affecting acute surgical pain; however, relief of chronic pain required sustained CNO treatment. Thus, in male mice, activity of spinally projecting RVM-MOR cells is required (1) for expression and manifestation of both sensory and affective dimensions of established neuropathic pain and (2) to promote descending facilitation that overcomes apparently intact descending inhibition to maintain chronic pain. Enhanced descending facilitation likely regulates the output signal from the spinal cord to the brain to shape the pain experience and may provide a mechanism for nonopioid management of pain.

Aversive memories can be weakened during human sleep via the reactivation of positive interfering memories

Recollecting painful or traumatic experiences can be deeply troubling. Sleep may offer an opportunity to reduce such suffering. We developed a procedure to weaken older aversive memories by reactivating newer positive memories during sleep. Participants viewed 48 nonsense words each paired with a unique aversive image, followed by an overnight sleep. In the next evening, participants learned associations between half of the words and additional positive images, creating interference. During the following non-rapid-eye-movement sleep, auditory memory cues were unobtrusively delivered. Upon waking, presenting cues associated with both aversive and positive images during sleep, as opposed to not presenting cues, weakened aversive memory recall while increasing positive memory intrusions. Substantiating these memory benefits, computational modeling revealed that cueing facilitated evidence accumulation toward positive affect judgments. Moreover, cue-elicited theta brain rhythms during sleep predominantly predicted the recall of positive memories. A noninvasive sleep intervention can thus modify aversive recollection and affective responses.

"What script am I meant to use?": a qualitative study in chronic primary pain.

Chronic primary pain (CPP) as a diagnosis has been introduced in the recent International Classification of Diseases, 11th Revision (ICD-11). CPP captures the experience of pain as the primary problem, without an underlying attributable cause. Dissemination of UK guidance regarding CPP represents the first time it has been recognised as a condition in its own right. Little is known regarding General Practitioner (GP) views concerning caring for patients with CPP and how related guidance is viewed and applied in practice. To explore GP perspectives in relation to caring for people with CPP, including challenges encountered and use of related guidelines in practice. A UK-wide qualitative interview study in primary care. Purposive and snowball sampling were used to recruit 15 GP participants from England, Northern Ireland, Wales and Scotland. Semi-structured interviews were undertaken and analysed using reflexive thematic analysis. Three main themes were generated: (1) "How to start? Problematic beginnings" referred to difficulties regarding diagnosis; (2) "Where to go? Mapping the management challenge" and (3) "How to get there? Navigating strategies and response", explored GP awareness and acceptability of UK guidelines for chronic pain. Areas identified for potential improvement included increased access to NPM and secondary care services, support with de-prescribing and an expanded multidisciplinary team input. CPP is complex to both diagnose and manage. Although guidelines provide a useful framework, they pose challenges when translating into day-to-day practice.

Estimation of Patellofemoral Joint Dysfunction in Obese Post menopausal Women

Purpose: The purpose of this research was to estimate Patellofemoral Joint Dysfunction in obese postmenopausal women. Methods: Depending on selection criteria, 100 obese postmenopausal women were selected by simple random sampling method. Written consent was taken and a detailed outcome assessment was done by using a Numerical Pain Rating Scale for pain assessment, Range of motion of hip, knee, ankle joint, Waldron Test, Eccentric Step-down Test, and Quadriceps angle. Statistical analysis was done and results were obtained. Findings: Among the 100 participants, 63% of women experienced pain during their daily activities. The mean pain intensity at rest was 2.25 ± 1.91, and during activity, it increased to 3.28 ± 6.60 (p value &amp;lt; 0.0001). The range of motion in the hip, knee, and ankle joints was reduced compared to that of individuals in the same age group without pain. Specifically, Hip extension-adduction, knee extension, and ankle plantarflexion-inversion-eversion had a p value of &amp;lt;0.0001. For hip flexion-abduction-medial and lateral rotation, knee flexion, and ankle dorsiflexion, the p values were 0.0003, 0.1952, 0.0001, 0.003, 0.0392, and 0.0333. Additionally, 35% of women had quadriceps angles greater than 180 degrees, while the remaining 65% had angles less than 180 degrees. 63% of women exhibited crepitus during activities like stair climbing and walking. 52% of women tested positive on the Waldron Test. 60% of women showed positive findings on the Eccentric Step-down Test. Conclusion: It concluded that there is significant Patellofemoral Joint Dysfunction in obese postmenopausal women.

The Influence of Social Media on Millennial Generation Community Participation in Sports Activities

Purpose: The purpose of this research was to estimate Patellofemoral Joint Dysfunction in obese postmenopausal women. Methods: Depending on selection criteria, 100 obese postmenopausal women were selected by simple random sampling method. Written consent was taken and a detailed outcome assessment was done by using a Numerical Pain Rating Scale for pain assessment, Range of motion of hip, knee, ankle joint, Waldron Test, Eccentric Step-down Test, and Quadriceps angle. Statistical analysis was done and results were obtained. Findings: Among the 100 participants, 63% of women experienced pain during their daily activities. The mean pain intensity at rest was 2.25 ± 1.91, and during activity, it increased to 3.28 ± 6.60 (p value &amp;lt; 0.0001). The range of motion in the hip, knee, and ankle joints was reduced compared to that of individuals in the same age group without pain. Specifically, Hip extension-adduction, knee extension, and ankle plantarflexion-inversion-eversion had a p value of &amp;lt;0.0001. For hip flexion-abduction-medial and lateral rotation, knee flexion, and ankle dorsiflexion, the p values were 0.0003, 0.1952, 0.0001, 0.003, 0.0392, and 0.0333. Additionally, 35% of women had quadriceps angles greater than 180 degrees, while the remaining 65% had angles less than 180 degrees. 63% of women exhibited crepitus during activities like stair climbing and walking. 52% of women tested positive on the Waldron Test. 60% of women showed positive findings on the Eccentric Step-down Test. Conclusion: It concluded that there is significant Patellofemoral Joint Dysfunction in obese postmenopausal women.

Minimally Invasive Extraction System Benex-Clinical Evaluation and Comparison.

Tooth extraction is one of the oldest and most well-known surgical procedures in dental medicine. It is still routinely performed by general practitioners and dental undergraduates. The Benex extraction system allows for the extraction of teeth in a vertical direction, which avoids most trauma against surrounding alveolar bone and soft tissues. The study included 56 patients who were recruited from the Department of Oral Surgery, Medical University-Plovdiv. The patients were split into two groups of 28 patients-Group I (control group) and Group II (study group). For each group, the success of the extraction, buccal cortical plate preservation, pain experience and early wound healing were assessed. There was no statistical significance between the success of the extractions in both groups. The Benex extractions preserved the buccal cortical plate in 95% of the cases, whereas the forceps extractions preserved it in only 71.8%, which is statistically significant. On the seventh day, patients in Group II reported less pain, without a significant difference. There was a significantly bigger number of completely healed extraction wounds on the 10th day. Atraumatic extractions allow for more hard and soft tissues to be preserved in the extraction site. This is essential for a successful outcome and the aesthetically pleasing results of the following dental restoration.

Neural circuit basis of placebo pain relief.

Placebo effects are notable demonstrations of mind-body interactions1,2. During pain perception, in the absence of any treatment, an expectation of pain relief can reduce the experience of pain-a phenomenon known as placebo analgesia3-6. However, despite the strength of placebo effects and their impact on everyday human experience and the failure of clinical trials for new therapeutics7, the neural circuit basis of placebo effects has remained unclear. Here we show that analgesia from the expectation of pain relief is mediated by rostral anterior cingulate cortex (rACC) neurons that project to the pontine nucleus (rACC→Pn)-a precerebellar nucleus with no established function in pain. We created a behavioural assay that generates placebo-like anticipatory pain relief in mice. In vivo calcium imaging of neural activity and electrophysiological recordings in brain slices showed that expectations of pain relief boost the activity of rACC→Pn neurons and potentiate neurotransmission in this pathway. Transcriptomic studies of Pn neurons revealed an abundance of opioid receptors, further suggesting a role in pain modulation. Inhibition of the rACC→Pn pathway disrupted placebo analgesia and decreased pain thresholds, whereas activation elicited analgesia in the absence of placebo conditioning. Finally, Purkinje cells exhibited activity patterns resembling those of rACC→Pn neurons during pain-relief expectation, providing cellular-level evidence for a role of the cerebellum in cognitive pain modulation. These findings open the possibility of targeting this prefrontal cortico-ponto-cerebellar pathway with drugs or neurostimulation to treat pain.