Higher Pain Threshold Research Articles

Transdermal iontophoresis versus high power pain threshold ultrasound in Mechanical Neck Pain: a randomized controlled trial

BackgroundThe investigation aimed to assess the impacts of magnesium sulphate (MgSO4) iontophoresis and high-power pain-threshold ultrasound (HPPT-US) on pain, range of motion (ROM), and functional activity in physical therapy students suffering from mechanical cervical pain.MethodsTypically, 75 males aged 19 to 30 years suffering from mechanical neck pain were enrolled in this investigation. Participants were divided at random into three groups. Group A received iontophoresis plus conventional physical therapy program, Group B received HPPTUS along with conventional therapy, and Group C received conventional therapy only. The outcomes were pain evaluated by visual analog scale (VAS) and Digital Electronic Pressure Algometer, cervical range of motion measured by Myrin gravity reference goniometer, and Arabic Neck disability index (ANDI) evaluate neck function.ResultsThe differences within and between groups were detected utilizing a mixed-design multivariate analysis of variance (MANOVA). The within- and between-group analysis of all outcome measures revealed that there were statistically significant differences at post-intervention between high-power ultrasound and conventional group at all variables and also between iontophoresis and conventional group, but there was no statistically significant variation between high-power ultrasound and iontophoresis.ConclusionMgSO4 iontophoresis and HPPT-US are effective in decreasing pain, improving neck function, and improving neck ROM in subjects with mechanical neck pain who have active myofascial trigger points (MTrPs) on the upper fibers of the trapezius with no superiority of one over the other.Trail registrationThe study was registered in the Clinical Trials Registry (registration no: NCT05474898) 26/7/2022.

Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection

ObjectiveThis study aims to evaluate the real-world effectiveness of applying different levels of Enhanced Recovery After Surgery (ERAS) guidelines to video-assisted thoracic day surgery (VATS). The goal is to determine the optimal degree of ERAS protocols and management requirements to improve postoperative recovery outcomes.MethodsIt was designed as a single-centre, prospective pragmatic randomized controlled trial (PRCT), including patients who underwent VATS at the Day Surgery Center of West China Hospital, between January 2021 and November 2022. Patients were divided into Group A and Group B through convenience sampling to implement different levels of ERAS management protocols. Data collection included the baseline characteristics (gender, age, marital status, education level, BMI, PONV risk score, ASA classification), surgery-related indicators (type of surgery, pathological results, hospitalization costs, duration of surgery, intraoperative blood loss, intraoperative rehydration volume), postoperative recovery indicators (postoperative chest tube duration time, time to first postoperative ambulation and urination, postoperative complications, follow-up condition), pain-related indicators (pain threshold score, pain score at 6 h postoperatively, bedtime, and predischarge), psychological state indicators (anxiety level), Athens Insomnia Scale (AIS) scores, and social support scores. Propensity score matching (PSM) was utilized and statistical analyses were conducted using R version 4.4.1. Comparisons of categorical variables were performed using the χ² test, while comparisons of continuous variables were conducted using ANOVA or the Kruskal-Wallis rank-sum test. A significance level of α = 0.05 was set for statistical tests.ResultA total of 340 patients were included, with 187 in Group A and 153 in Group B. After propensity score matching (PSM), there were 142 patients in Group A and 105 in Group B, with no significant baseline differences. Group A had a significantly higher proportion of chest tube removals within 24 h postoperatively (P < 0.001) and earlier mobilization (P < 0.001). Despite a higher pain threshold in Group A (P = 0.016), their postoperative pain scores were not higher than those in Group B. Additionally, Group A had a lower incidence of postoperative complications.ConclusionThe more comprehensive ERAS protocol significantly improved postoperative recovery, confirming its value in day-case VATS and supporting its clinical adoption. However, the study has limitations; future research should focus on standardizing ERAS protocols and expanding their application to a broader patient population to validate these findings further.Trail RegistrationThis study underwent review by the Ethics Committee of West China Hospital of Sichuan University under No. 2020 (1001). It has been officially registered with the China Clinical Trial Registry, TRN: ChiCTR2100051372 and registration date is Sept. 22, 2021.

The Effects of Combined Contrast Heat Cold Pressure Therapy on Post-Exercise Muscle Recovery in MMA Fighters: A Randomized Controlled Trial

The purpose of this study was to evaluate the effects of contrast heat and cold pressure therapy (CHCP) on muscle tone, elasticity, stiffness, perfusion unit, and muscle fatigue indices after plyometric training consisting of five sets of jumping on a 50-cm high box until exhaustion. A prospective, randomized, controlled single-blind study design was used. Twenty professional MMA fighters were included in the study. The experimental group (n = 10) was subjected to the CHCP protocol (eGR), while the control group (cGR) (n = 10) was subjected to sham therapy. Both protocols consisted of three CHCP sessions performed immediately after plyometric exercise, 24 and 48 h afterwards. Measurements were taken at the following time points: 1) at rest; 2) 1 min post-exercise; 3) 1 min post-CHCP therapy; 4) 24 h post-CHCP therapy; 5) 48 h post-CHCP therapy. The results of the eGR compared to the cGR showed significantly higher perfusion at time point 5 (p &lt; 0.001), higher muscle tone at time points 1, and 3–5 (p &lt; 0.001 for all), higher stiffness at time points 1, 3–5 (p &lt; 0.001 for all) and a higher pain threshold at time points 1 and 5 (p &lt; 0.001 for all). This study suggests a positive effect of CHCP therapy on muscle biomechanics, the pain threshold, and tissue perfusion, which may contribute to increasing the effectiveness of post-exercise muscle recovery in MMA athletes.

A - 61 Lifelong Intellectual Developmental Disorder and Autism Spectrum Disorder Diagnosed in Early Adulthood: Implications for a Patient Residing in Frontier America

Abstract Objective Individuals residing in frontier America often lack access to specialized medical care. Obstacles to receiving accurate diagnosis and intervention of neuropsychological conditions in childhood is common and individuals and families may have difficulty in adapting to the implications of such diagnoses later in life. Methods This 18-year-old Caucasian male from frontier Kansas first presented for neurological or neuropsychological workup in adulthood. History was noteworthy for premature birth, late attainment of milestones, respiratory conditions resulting in multiple instances of cardiac arrest, and facial dysmorphism. Education was attended remotely due to risk of respiratory infection. Parents reported several atypical traits, including hyperfixation on automobiles, high pain threshold, and low frustration tolerance resulting in outbursts. Patient was considered socially and academically delayed, which parents attributed to remote school attendance. No support services were in place. Results Neuropsychological evaluation showed FSIQ = 71 and pronounced executive dysfunction. Parental questionnaire evidenced deficits in adaptive functioning, most pronounced in self-direction and social skills. Patient and parents denied significant concerns on behavioral health questionnaire. Paraeducator endorsed concerns in atypicality, attention/learning problems, and functional communication. Conclusions This young man’s presentation and estimated cognitive and functional abilities are consistent with mild intellectual developmental disorder and autism spectrum disorder. On feedback, this information was distressing to parents; capabilities in some complex tasks may have masked his deficits. Although parents were resistant to findings, it is believed these labels will assist in explaining abnormal behaviors, attaining services, and facilitating genetic testing and related medical care.

Natural history in Malan syndrome: survey of 28 adults and literature review

BackgroundMalan syndrome (MALNS), previously referred to as “Sotos syndrome 2” due to its resemblance to Sotos syndrome (SS), is an ultra-rare neurodevelopmental disorder characterized by overgrowth, typical craniofacial features, intellectual disability (ID), and a range of psychobehavioral, musculoskeletal, vision and neurological signs. As MALNS and SS partly overlap, it is essential to more accurately profile their clinical presentations and highlight their differences in order to improve syndrome specific management. An increasing number of individuals with MALNS reach adult-age though the natural history of the disorder is poorly characterized due to the small number of adult individuals described so far. As a consequence, current guidelines are limited to the pediatric population. Further delineation of MALNS is essential to optimize care in adulthood.ResultsA mixed approach based on cross-sectional data collection with a survey disseminated to caregivers of adults with molecularly confirmed MALNS and literature review was conducted. Twenty-eight caregivers completed the survey. Clinical presentation in adulthood is multisystemic and defined by psychobehavioral comorbidities (96%), musculoskeletal involvement (96%), vision impairment (96%) and neurological complications (86%). The most common signs were anxiety (79%), hypotonia (75%), movement difficulty (75%), scoliosis (64%), problems with coordination (61%), strabismus (57%), constipation (54%), breastbone abnormalities (54%) and advanced bone age during childhood (54%). Impaired vision was complicated by vision decline (36%) and optic atrophy (32%). We report some previously unidentified features, including high pain threshold (46%), incontinence (25%), tremors (21%), muscle hypoplasia (18%) and tics (18%).ConclusionsThis survey in the adult population has allowed a more complete description of the natural history of MALNS. Our findings will contribute to the development and improvement of standards of care for adults with MALNS to assure optimal health monitoring and treatment of evolutive complications. We propose additional recommendations to the previous dataset of clinical evaluations specifically applied to adults. The comparison of MALNS and SS adult presentation highlights significant differences in terms of prevalence and severity of ID, behavioral issues, and vision problems, confirming that a proper differential diagnosis between the two conditions is indispensable to guide physicians and mental health professionals to syndrome specific management.

Pain of Threatened Self: Explicit and Implicit Self-Esteem, Cortisol Responses to a Social Threat and Pain Perception.

Background: Rejection, injustice, and exclusion from meaningful interpersonal relationships are often extremely painful and stress-generating experiences. This study aimed to define the role of explicit and implicit self-esteem in pain perception as a component of the physiological-psychological system that regulates the body's response to stress associated with the threat of social rejection. Methods: In total, 360 individuals participated in this study. The measurement of cortisol in saliva, the assessment of pain thresholds using thermal stimuli, the IAT to assess implicit self-esteem, and a questionnaire on global self-esteem and social pain were used. The study included three measurements: baseline and 15 and 45 min after the application of a laboratory socially threatening stimulus (the Trier Social Stress Test). Results: People experiencing chronic social pain (CSP) are more likely to have fragile self-esteem, higher pain thresholds, and tend to experience reduced pain tolerance in situations of acute social threat than people without CSP experience. In people with CSP and fragile self-esteem, after the introduction of a social threat, an increase in pain tolerance was observed along with a longer-lasting increase in cortisol levels. Conclusions: Fragile self-esteem, along with feelings of chronic exclusion, injustice, and rejection, may prolong stress reactions and produce a hypoalgesic effect.

893 Psychophysical Pain Encoding in the Cingulate Cortex Predicts Responsiveness of Electrical Stimulation

INTRODUCTION: The anterior cingulate cortex (ACC) plays an important role in pain's cognitive and emotional processing. Prior studies have used deep brain stimulation (DBS) to treat chronic pain, but results have been inconsistent. This may be due to network adaptation over time and variable causes of chronic pain. Identifying patient-specific pain network features may be necessary to determine patients' candidacy for DBS. METHODS: Four patients who underwent intracranial monitoring for epilepsy (stereo-electroencephalography) participated in a pain task. Subjects placed their hand on a device capable of eliciting thermal pain for five seconds and rated their pain. Current-controlled biphasic trains of electrical stimulation were applied to a random subset of trials for each subject. Thermal pain thresholds with and without electrical stimulation were determined. To evaluate whether patients had neural activity susceptible to modulation, generalized linear mixed-effects models assessed the relationship between broadband high-frequency local field potential amplitude within the cingulate cortex (HFA; 70-150 Hz) and the resulting psychophysical pain evaluations. RESULTS: The pain threshold for each patient was determined from the psychometric probability density function. Two patients had a higher pain threshold with stimulation than without, while the others had no difference. We also evaluated the relationship between neural activity and pain responses. We found that patients who responded to stimulation had specific time windows where high-frequency activity was associated with increased pain ratings. CONCLUSIONS: Stimulation of cingulate regions with increased pain-related neural activity was more effective at modulating pain perception than stimulating non-encoding regions. Personalized evaluation of neural activity biomarkers could help identify the best target for stimulation and predict its effectiveness in future studies evaluating DBS.

Tryptophan metabolism and small fibre neuropathy: a correlation study.

Small nerve fibres located in the epidermis sense pain. Dysfunction of these fibres decreases the pain threshold known as small fibre neuropathy. Diabetes mellitus is accompanied by metabolic changes other than glucose, synergistically eliciting small fibre neuropathy. These findings suggest that various metabolic changes may be involved in small fibre neuropathy. Herein, we explored the correlation between pain sensation and changes in plasma metabolites in healthy Japanese subjects. The pain threshold evaluated from the intraepidermal electrical stimulation was used to quantify pain sensation in a total of 1021 individuals in the 2017 Iwaki Health Promotion Project. Participants with a pain threshold evaluated from the intraepidermal electrical stimulation index <0.20 mA were categorized into the pain threshold evaluated from the intraepidermal electrical stimulation index-low group (n = 751); otherwise, they were categorized into the pain threshold evaluated from the intraepidermal electrical stimulation index-high group (n = 270). Metabolome analysis of plasma was conducted using capillary electrophoresis time-of-flight mass spectrometry. The metabolite set enrichment analysis revealed that the metabolism of tryptophan was significantly correlated with the pain threshold evaluated from the intraepidermal electrical stimulation index in all participants (P < 0.05). The normalized level of tryptophan was significantly decreased in participants with a high pain threshold evaluated from the intraepidermal electrical stimulation index. In addition to univariate linear regression analyses, the correlation between tryptophan concentration and the pain threshold evaluated from the intraepidermal electrical stimulation index remained significant after adjustment for multiple factors (β = -0.07615, P < 0.05). These findings indicate that specific metabolic changes are involved in the deterioration of pain thresholds. Here, we show that abnormal tryptophan metabolism is significantly correlated with an elevated pain threshold evaluated from the intraepidermal electrical stimulation index in the Japanese population. This correlation provides insight into the pathology and clinical application of small fibre neuropathy.

Esophageal Cancer with Early Onset in a Patient with Cri du Chat Syndrome.

In Cri du Chat (CdC), cancer as comorbidity is extremely rare. In databases from Denmark, Spain, Australia, New Zealand, and Japan, no cancer was reported; in Italy and Germany, four cancers were identified out of 321 CdCs. In a 29-year-old CdC patient, clinical investigations following hematemesis led to the diagnosis of esophageal adenocarcinoma (EAC). A high pain threshold was also observed. Conventional and molecular cytogenetic defined the size of the deletion, and exome analysis on the trio completed the molecular work. Cytogenetic analysis showed a de novo chromosomal alteration: 46,XY,ishdel(5)(p14.3)(D5S28-) and arr[GRCh37] 5p15.33p14.3(1498180_19955760)x1. A quantitative sensory test demonstrated a high heat threshold. A 18f-fluorodeoxyglucose PET/TC scan of the brain failed to detect reduction of metabolism in the somatosensory area or insular cortex. Exome analysis in the trio (patient and parents) failed to identify variants to be interpreted as a likely risk factor for EAC. We conclude that the presence of well-known risk factors (maleness, obesity, gastroesophageal reflux, and Barrett's metaplasia) in a patient with very limited capability of expressing discomfort or referring clinical symptoms have been the main risk factors for developing EAC. At present, based on the available data, there is no evidence of any increased risk of developing cancer in CdC patients.

LKB1 and CRMP1 cooperatively promote the repair of the sciatic nerve injury.

After peripheral nervous system injury, Schwann cells (SCs) can repair axons by providing a growth-promoting microenvironment. The aim of this study is to explore the effects and mechanisms of LKB1 and CRMP1 on the repair of sciatic nerve injury (SNI). The expressions of LKB1 and CRMP1 were changed in rats with SNI from 12h to 4 weeks by hematoxylin-eosin staining, RT-PCR assay, immunohistochemical staining, and western blotting. Immunofluorescence results show that LKB1 and CRMP1 are co-localized in the regenerated axons of the sciatic nerve tissue of SNI rats. Co-immunoprecipitation indicates that LKB1 interacts with CRMP1. LKB1 interference suppresses the phosphorylation level of CRMP1. Overexpression of LKB1 and CRMP1 promotes the invasion and migration of SCs, and nerve cell protuberance extends. The structure of the myelin sheath in the sciatic nerve of the model group was found to be loose and disordered. Rats in the model group had higher pain thresholds and heat sensitivity response times than those in the control group. Nerve conduction velocity, the latency of action potential, and the peak value of compound muscle action potential in the SNI group were significantly lower than those in the control group, and the muscle atrophy was severe. Overexpression of LKB1 may significantly improve the above conditions. However, the function of LKB1 to improve SNI is abolished by the interference of CRMP1. In summary, the interaction between LKB1 and CRMP promotes the migration and differentiation of SCs and the extension of neurons, thereby improving the repair of nerve injury.

SCN8A epileptic encephalopathy: literature review and own observation

A genetic disease caused by pathogenetic nucleotide variants in the SCN8A gene (Sodium channel protein type 8 subunit alpha, also known as Nav1.6), encoding the α-subunit of the Na channel type 8, is included in the group of early epileptic encephalopathies. In most cases, this pathology is characterized by the development of polymorphic pharmacoresistant epileptic seizures over the first year of a child’s life, a lag in psychomotor development or regression, loss of skills. In some patients, seizures may appear during the first days of life, while in others they appear later (at the age of 2 to 7 months), against the background of a pronounced or slight developmental delay. Types of seizures may include generalized, tonic-clonic seizures, infantile spasms, absences and focal seizures. Other signs and symptoms of encephalopathy caused by mutations of the SCN8A gene may include low muscle tone (hypotension), high pain threshold, motor disorders (such as dystonia and ataxia), mild to severe mental retardation, sleep problems and autistic traits. In some people with SCN8A encephalopathy, various other pathological changes in the body have been reported, including hearing or vision impairment, scoliosis, and thermoregulation difficulties. The disease is inherited by an autosomal dominant type.&#x0D; To date, the disease in the OMIM system is referred to as «Developmental encephalopathy and epileptic encephalopathy type 13». Previously, the disease was called «Early infantile (infantile) epileptic encephalopathy, type 13». The serial number «13» indicates this form of early epileptic encephalopathy to be caused by a heterozygous mutation in the gene on the long arm of chromosome 12 in chromosome region 12q13.13.&#x0D; This report also presents a clinical description of a patient suffering from early infantile epileptic encephalopathy, type 13.

Pain experience in eating disorders: The mediating role of depression, alexithymia and interoceptive awareness.

Evidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self-report and real-time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED). 145 participants (90 ED, 55 healthy controls (HC)) underwent a real-time evoked examination of pain and completed self-report questionnaires for pain (Pain Detect Questionnaire (PD-Q), PD-Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI-II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS-20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS-20 as mediators, were tested. Participants with ED and HC exhibited similar pain type and intensity (self-report and real-time). Eating disorders diagnosis was associated with lower self-report pain intensity and non-neuropathic like pain experience (model 1-2). Depressive symptoms partially (model 1-2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology. ED diagnosis is associated with non-neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.

PAIN THRESHOLD PARADOX IN SCHIZOPHRENIA: A NARRATIVE REVIEW BASED ON THE LASTEST NEUROSCIENCE.

Pain is one of the basic defense responses of living organisms. Although the threshold for pain perception varies from person to person, there is no doubt that pain reduces a person's quality of life. Assessing the subjective experience of pain is especially important in the treatment of patients with schizophrenia. In light of recent advances in neuroscience, we discuss pain thresholds in patients with schizophrenia. A narrative review of pain thresholds in patients with schizophrenia was conducted. We electronically searched the PubMed and Google Scholar databases for articles in English with "pain," "schizophrenia," "neural circuits," and "neurotransmitters" in the title or abstract, for the period January 2000 through June 2022. A seemingly contradictory phenomenon has been noted with regard to pain thresholds in patients with schizophrenia. One phenomenon is a high pain threshold for nociceptive stimuli, and the other is a low pain threshold in chronic pain. As a result, a pain threshold paradox has been observed. Many schizophrenia patients appear to have an excess of dopamine in the mesolimbic system, which stimulates both the descending pain inhibitory pathway and the salience network. As a result, a pain threshold paradox has been observed, in which the threshold for acute nociceptive pain is high and the threshold for chronic pain is low.

Global posture reeducation compared with segmental muscle stretching exercises in the treatment of fibromyalgia: a randomized controlled trial

BackgroundMuscle stretching exercises preserve corporal flexibility and decrease the retraction and shortening of myofascial and articular structures. These exercises are recommended for the treatment of fibromyalgia (FM). The purpose of the study was to verify and compare the effect of muscle stretching exercises on FM patients based on the global posture reeducation method against segmental muscle stretching exercises, both used in concert with an educational approach rooted in cognitive behavioral therapy.MethodsForty adults with FM were randomly allocated into two groups: global and segmental. The two kinds of therapies were performed in 10 individual sessions once a week. Two assessments were made: one at baseline and one at the end of therapy. The primary outcome variable was pain intensity (Visual Analog Scale). The secondary outcome variables were multidimensional pain (McGill Pain Questionnaire), the pain threshold at tender points (dolorimetry), attitudes toward chronic pain (Survey of Pain Attitudes-Brief Version), body posture (Postural Assessment Software Protocol), postural control (Modified Clinical Test of Sensory Interaction on Balance), flexibility (sit-and-reach test), the impact of FM on quality of life (Fibromyalgia Impact Questionnaire, FIQ), and self-reported perceptions and body self-care.ResultsAt the end of treatment, there were no statistically significant differences between the groups in the outcome variables. Furthermore, the groups presented lower pain intensity (baseline vs. final; global group: 6 ± 1.8 vs. 2.2 ± 1.6 cm, p<0.01; segmental group: 6.3 ± 2.1 vs. 2.5 ± 1.7 cm, p<0.01), higher pain threshold (p ≤ 0.01), lower total FIQ score (p < 0.01), and greater postural control (p < 0.01) after treatment.ConclusionsMuscle stretching exercises based on global posture reeducation and segmental muscle stretching exercises, both used in concert with an educational approach rooted in cognitive behavioral therapy, reduced the pain intensity and impact of FM on quality of life. These exercises also improved FM patients’ pain threshold at tender points, attitudes toward chronic pain, and postural control. There were no differences between global posture reeducation and segmental muscle stretching exercises.Trial registrationClinicalTrials.gov NCT02384603. Registered on 10 March 2015.

Myocardial Infarction Signs and Symptoms: Females vs. Males.

Cardiovascular disease is the number one killer of females in the United States today, and myocardial infarction (MI) plays a role in many of these deaths. Females also present with more "atypical" symptoms than males and appear to have differences in pathophysiology underlying their MIs. Despite both differences in symptomology and pathophysiology being present in females versus males, a possible link between the two has not been studied extensively. In this systematic review, we analyzed studies examining differences in symptoms and pathophysiology of MI in females and males and evaluated possible links between the two. A search was performed for sex differences in MI in the databases PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Complete, Biomedical Reference Collection: Comprehensive, Jisc Library Hub Discover, and Web of Science. Seventy-four articles were ultimately included in this systematic review. Typical symptoms for both ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) such as chest, arm, or jaw pain were more common in both sexes, but females presented on average with more atypical symptoms such as nausea, vomiting, and shortness of breath. Females with MI also presented with more prodromal symptoms such as fatigue in days leading up to MI, had longer delays in presentation to the hospital after symptom onset, and were older with more comorbidities than males. Males on the other hand were more likely to have a silent or unrecognized MI, which concurs with their overall higher rate of MI. As they age, females have a decrease in antioxidative metabolites and worsened cardiac autonomic function than male. In addition, at all ages, females have less atherosclerotic burden than mles, have higher rates of MI not related to plaque rupture or erosion, and have increased microvasculature resistance when they have an MI. It has been proposed that this physiological difference is etiologic for the male-female difference in symptoms, but this has not been studied directly and is a promising area of future research. It is also possible that differences in pain tolerance between males and females may play a role in differing symptom recognition, but this has only been studied one time where females with higher pain thresholds were more likely to have unrecognized MI. Again, this is a promising area for future study for the early detection of MI. Finally, differences in symptoms for patients with different atherosclerotic burden and for patients with MI due to a cause other than plaque rupture or erosion has not been studied and are both promising avenues to improve detection and patient care in the future.

What endocrinologists can do to prevent cardiovascular complications in adults with Prader-Willi syndrome: Lessons from a case series.

Prader-Willi syndrome (PWS) is a complex rare genetic syndrome. Mortality in patients with PWS is 3% per year. In nearly half of the patients, the cause of death is of cardiopulmonary origin. Prevention, diagnosis and treatment of cardiovascular (CV) disease in PWS adults is complicated by the behavioral phenotype, reduced ability to express physical complaints, high pain threshold and obesity. To describe the challenges in prevention, diagnosis and treatment of CV disease in PWS adults, in order to increase awareness and improve medical care. Retrospective study of medical records of adults visiting the Dutch PWS reference center. We describe the challenges encountered during diagnosis and treatment of four PWS adults with heart failure. All had pre-existent peripheral edema. CV risk factors in these patients were obesity (n=4), type 2 diabetes mellitus (n=2), hypertension (n=2), hypogonadism (n=3) and sleep apnea (n=2). Remarkably, all patients were younger than 40 years during their first cardiac decompensation. All patients presented with progressive shortness of breath and/or orthopnea and progressive pitting edema. In 117 controls with PWS without CV problems, 31% had leg edema. Diagnosing CV problems in PWS adults is challenging. Peripheral edema is common in PWS adults without CV morbidity, which makes edema in general a poor marker for heart failure. However, when edema is of the pitting kind and progressive, this is a strong predictor of cardiac decompensation. We provide practical recommendations for diagnosing and treating CV problems in this vulnerable patient population.

SCN9A rs6746030 Polymorphism and Pain Perception in Combat Athletes and Non-Athletes

One of the genes associated with pain perception is SCN9A, which encodes an α-subunit of the voltage gated sodium channel, NaV1.7, a crucial player in peripheral pain sensation. It has been suggested that a common missense polymorphism within SCN9A (rs6746030; G>A; R1150W) may affect nociception in the general population, but its effects of pain perception in athletes remain unknown. Therefore, the aim of the study was to investigate the association between a polymorphism within SCN9A (rs6746030) and pain perception (pain threshold and pain tolerance) in the group of combat athletes (n = 214) and students (n = 92) who did not participate in sports at a professional level. Genotyping was carried out using TaqMan Real-Time PCR method. No significant differences were found between the SCN9A genotype distributions with respect to the pain threshold. However, the probability of having a high pain threshold was higher in the combat sports group than in the control group. The probability of having a decreased pain tolerance was higher in the carriers of the GA and AA genotype than in the homozygotes of the GG genotype. Moreover, the possibility of having a high pain threshold was higher in the combat athlete group than in the control group. The results of our study suggest that the SCN9A rs6746030 polymorphism may affect pain perception. However, the additional effect of the experimental group may suggest that pain tolerance is significantly modulated by other factors, such as the systematic exposure of the athletes' bodies to short-term high-intensity stimuli during training sessions.

Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis

Objectives This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG). Methods A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists' evaluation(DE), the patients' overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH). Results Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2. Conclusion FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present. Registration PROSPERO CRD42021242160 (available from https://www.crd.york.ac.uk/prospero).

The Importance of Personality Traits, Optimism and Quality of Life for Pain Threshold and Pain Tolerance in the Elderly

With increasing age, the frequency of chronic pain increases compared to acute pain. This is due to structural and functional changes caused by ageing of the nervous system. The aim of this study was to investigate relationships between personality traits, optimism, quality of life, and subjective assessment of pain measured experimentally with an algometer and clinically with the Visual Analoque Scale (VAS). In the group of 133 seniors (61-86 years; 78% women), we used an algometer to measure pain threshold and tolerance, the VAS scale to assess subjective intensity, and standardized questionnaires (EPQ-R(s), LOTR, SWLS) to measure psychological variables. Extraversion was found to promote both higher pain threshold and higher pain tolerance, whereas pain tolerance was negatively correlated with neuroticism. Higher severity of the psychotic trait was associated with more intense subjective pain experience. Optimism and overall quality of life were not associated with any pain measures. A better understanding of the personality correlates of pain perception could support a more accurate tailoring of pain management in elderly patients.

Comparison of High Power Pain Threshold Ultrasound and Ischemic Compression Techniques for the Treatment of Latent Myofascial Trigger Points: A Randomized Controlled Study

Abstract Objective Myofascial trigger points (MTrPs) have been defined as discrete and hyperirritable areas located within a taut band of skeletal muscle or fascia, which when compressed produce pain, tenderness, dysfunction and autonomic phenomena. The treatment techniques aimed to return the fiber groups to their optimum length and end plates to their optimum function. Ischemic Compression (IC) and of High Power Pain Threshold Ultrasound (HPPT-US) are among the treatment techniques used for MTrPs. The aim of the current study is to compare the efficacy of IC and HTTP-US which was applied in different ways on MTrPs treatment. Patients and Methods This is a randomized prospective study conducted with 153 participants have at least three latent trigger points. Participants received HPPT-US technique in which the intensity is kept constant at the pain level, HPPT-US technique in which the intensity is kept constant at half the pain level or IC. Outcome measures were the Visual Analog Scale, Beck Depression Inventory, Neck Pain and Disability Scale, number of deactivated MTrPs and Pain Pressure Threshold (PPT). Results Pain, psychological status and disability improved in each group; there was no significant difference between the groups (p&gt;0.05). PPT increased in each group; a significant difference was found between the groups (p&lt;0.05). IC was slightly more effective than HPPT-US. Conclusion Our results have shown that HPPT-US which was applied in different ways and IC were effective therapies for latent trigger points.