Management Of Chronic Pain Research Articles

Chronic Pain Management by Analgesic Effects of Shoolprashman Mahakashaya Herbal Drugs: A Conceptual Review

Chronic pain can lead to physical limitations, emotional suffering, and social isolation, all of which can seriously impair a person's quality of life. In addition, poor chronic pain diagnosis and management can worsen opioid use disorders and increase the risk of morbidity and mortality among people who suffer from it. Consequently, healthcare professionals must understand chronic pain and implement appropriate treatment strategies. Due to the discovery of analgesic nephropathy and other systemic illnesses brought on by excessive and prolonged use of analgesics, Shoolprashman Mahakashya, an alternate method of managing chronic pain of unknown cause, is referenced in Ayurveda. This article focuses on Shoolprashman Mahakashaya's herbal drug phytoconstituent, which acts as an analgesic, and its mode of action on the pain and inflammatory markers.

Characteristics of the practice of New Zealand osteopaths who manage patients with chronic pain.

Chronic pain management is challenging. Those with chronic pain present to health professionals, including osteopaths. Secondary analysis of a cross-sectional survey of the Osteopathy Research Connect - New Zealand (ORC-NZ), a practice-based research network (PBRN). Demographic, practice, and treatment characteristics of osteopaths who 'often' and 'not often' treat chronic pain patients were collected. Two hundred and seventy-seven (277) NZ osteopaths responded and just over half (50.7% N = 138) reported 'often' treating chronic pain patients. This group, who have a similar male-to-female ratio, often use a diagnostic screening questionnaire (aOR 3.78), and often treat patients with non-musculoskeletal complaints (aOR 3.12) and tendinopathies (aOR 3.41). This study highlights practice and clinical management characteristics of NZ osteopaths who manage chronic pain patients.

The Melatonin Type 2 Receptor Agonist IIK7 Attenuates and Reverses Morphine Tolerance in Neuropathic Pain Rats Through the Suppression of Neuroinflammation in the Spinal Cord

Background: Morphine analgesic tolerance (MAT) limits the clinical application of morphine in the management of chronic pain. IIK7 is a melatonin type 2 (MT2) receptor agonist known to have antioxidant properties. Oxidative stress is recognized as a critical factor in MAT. This study sought to assess the impact of IIK7 on the progression of MAT and its potential to reverse pre-existing MAT. Methods: Wistar rats underwent partial sciatic nerve transection (PSNT) surgery to induce neuropathic pain (NP). Seven days post nerve transection, we implanted an intrathecal (i.t.) catheter and linked it to an osmotic pump. Rats were randomly divided into the following groups: sham-operated/vehicle, PSNT/vehicle, PSNT/IIK7 50 ng/h, PSNT/MOR 15 g/h, and PSNT/MOR 15 g + IIK7 50 ng/h. We implanted two i.t. catheters for drug administration and the evaluation of the efficacy of IIK7 in reversing pre-established MAT. We linked one to an osmotic pump for MOR or saline continuous i.t. infusion. On the 7th day, the osmotic pump was disconnected, and 50 μg of IIK7 or the vehicle was administered through the second catheter. After 3 h, 15 μg of MOR or saline was administered, and the animal behavior tests were performed. We measured the levels of mRNA for Nrf2 and HO-1, pro-inflammatory cytokines (PICs), and the microglial and astrocyte activation in the spinal cord. Results: The co-administration of IIK7 with MOR delayed MAT development in PSNT rats by restoring Nrf2 and HO-1 while also inhibiting the microglial-cell and astrocyte activation, alongside the suppression of PICs. Additionally, a single injection of high-dose 50 μg IIK7 was efficient in restoring MOR’s antinociception in MOR-tolerant rats. Conclusions: Our results indicate that the co-infusion of ultra-low-dose IIK7 can delay MAT development and a high dose can reverse pre-existing MAT.

New-Occurrence of Postoperative Modic Changes and Its Influence on the Surgical Prognosis After Percutaneous Endoscopic Lumbar Disc Discectomy.

Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence. This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area. One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence. The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.

A Decades-Long Journey of Palmitoylethanolamide (PEA) for Chronic Neuropathic Pain Management: A Comprehensive Narrative Review.

Palmitoylethanolamide (PEA) has been prescribed in neuropathic pain management for over 20years. This study aims to summarize what has been published on the topic in the last 15years and determine the appropriateness of the prescribing. It describes the pharmacological aspect of PEA, especially focusing on its pharmacodynamics and pharmacokinetics. Then, it deeply explores why PEA may be useful in the pharmacological management of both neuropathic and mixed pain. Finally, it examines some innovative patent, which aims to address obstacles encountered with conventional PEA formulations, for its pharmacodynamic characteristics. One of them (Equisetum-PEA) seems promising. It partially ameliorates the bioavailability and the targeted distribution. It seems to introduce novel advancements that can potentially enhance the therapeutic effectiveness of PEA in terms of its anti-inflammatory, antioxidant, and analgesic properties. The deep literature analysis aims to examine the potential advantages of PEA, in the context of several pathological conditions that may benefit from this molecule. It focuses on various published data regarding the clinical efficacy of PEA in managing neuropathic and mixed pain. Also, it tries to understand if it can modernize the field of therapy based on PEA, thus offering a better treatment option for individuals with chronic long-term inflammation, oxidative stress, and neuropathic or mixed pain with a neuropathic component. The study examines the possible impact of PEA on personalized medicine strategies and its potential for translation into clinical practice. It analyses the possibilities that PEA has in enhancing patient outcomes in a range of central nervous system and inflammatory conditions. A complete analysis of the therapeutic potentialities of this product was missing. This extensive narrative review makes a valuable contribution to the ongoing comprehension of PEA therapy. It establishes a foundation for further exploration in research and potential uses in clinical settings.

Genicular Nerve Blocks for the Management of Chronic Knee Pain Related to Osteoarthritis - A Case Series.

Chronic knee pain from osteoarthritis (OA) is a leading cause of disability, with limited treatment options for patients who fail conservative management and intra-articular (IA) injections. Genicular nerve blocks (GNBs) have emerged as a promising treatment for chronic knee pain, especially in patients who are not candidates for total knee replacement (TKR). This case series discusses six patients with chronic knee pain from OA who failed conventional treatments, including IA injections, and found significant relief with GNBs.

Assessing Blood-Brain Barrier Function in the Context of Pain Management.

One essential component of the neurovascular system is known as the blood-brain barrier (BBB). This highly effective biological barrier plays a pivotal role in regulating the brain's internal microenvironment and carefully controlling the passage of various chemicals into and out of the brain. Notably, it serves as a safeguard for the brain, particularly when it comes to the selective transportation of drugs like opioids and non-steroidal anti-inflammatory medications (NSAIDs), which are commonly used in the management of chronic pain. It's important to note that during the development of chronic pain, the activation of microglia and astrocytes can potentially disrupt or damage the integrity of the BBB. In this comprehensive review, we aim to delve into the intricate interplay between the blood-brain barrier and the transportation of pain-relieving drugs, shedding light on the challenges and mechanisms involved in this process.

“My Back Exercise App”—mHealth for Low Back Pain: Development and Usability Testing

Abstract Effective management of chronic low back pain (LBP) often relies on maintaining a healthy lifestyle. Mobile health (mHealth) applications provide a unique opportunity to support LBP sufferers by integrating evidence-based health education into daily routines. However, many existing mHealth apps lack scientific rigour in their development, limiting their impact. This study reports on developing and usability testing My Back Exercise, an mHealth app designed to support individuals managing chronic LBP through a user-centred, theory-based approach. The development followed the Double Diamond framework and Software Development Life Cycle (SDLC) model, focusing on behaviour change theory to promote healthy lifestyle habits. Usability testing involved ten users and employed the System Usability Scale (SUS) and Mobile App Rating Scale (MARS) to assess engagement, functionality, aesthetics, and information quality. Additionally, a think-aloud approach captured real-time feedback and guided iterative improvements. Results showed that the app was well-received, achieving a SUS mean score of 79 (total score of 100) and a MARS mean score of 3.7 (out of 5.0). Key intervention components included exercises, sleep management, diet, and pain education, contributing to a holistic self-management tool. This study provides a transparent roadmap for the development of evidence-based digital health tools. The My Back Exercise app offers an innovative, holistic approach to help people self-manage chronic LBP using evidence-based methods.

The Association Between Employment in Coal Mining and History of Injury, Current Pain, and Prescription Opioid Use.

Coal mining involves heavy physical demand, which is associated with increased risk of injury and long-term musculoskeletal health disorders and chronic pain. Management of chronic or recurrent pain is in turn associated with prescription opioid use and risk of opioid use disorder (OUD). We analyzed clinical data from 5463 coal miners evaluated between 2004 and 2015. Using an iterative text mining procedure, we analyzed structured clinical notes to extract information on occupational histories and clinical data. We evaluated associations along the causal chain using a series of multivariable logistic regression models to determine the relationship between (1) specific mining occupations and history of traumatic injury, (2) history of traumatic injury and current pain, and (3) current pain and current prescription opioid use. Among these mostly-former coal miners (mean age 62.4 years), the average coal mining tenure was 27.3 years; 88.4% reported being previously injured, 92.3% reported suffering from current pain and 39.2% reported current prescription opioid use. Occupations involving the most strenuous mining work were associated with a history of traumatic injury. A history of traumatic injury to body regions of the head/neck/back/spine was associated with current pain involving the head/neck/back/spine (adjusted OR = 5.04; CI 95%: 4.46, 5.70; p < 0.001). In a separate model, reported current pain of the head/neck/back/spine was associated with current prescription opioid use (aOR = 2.66; CI 95%: 2.35, 3.01; p < 0.001). These miners had a high prevalence of self-reported current pain, and certain specific mining occupations were more strongly associated with a history of injury, pain, and prescription opioid use.

A discrete choice experiment: Understanding patient preferences for managing chronic non-cancer pain.

The management of chronic non-cancer pain (CNCP) is complex. Concerns about adverse effects associated with opioid pain medications and a lack of funding for holistic programs present challenges for decision-making among clinicians and patients. Discrete choice experiments (DCE) are one way of assessing and valuing patient treatment preferences. DCE attributes and levels were generated through qualitative research and included number of medicines, side effects from medicines, pain interference, care management, risk of addiction, activity goals, preferred source of information on pain management and willingness to pay. The survey was administered to participants with CNCP recruited through an existing cohort study (n = 442) and a sample of people living with CNCP recruited through Australia's leading pain advocacy body (Painaustralia) (n = 256). The median age of participants was 58 years (SD 12.0), the majority were female. The analysis revealed two latent demographic classes: a younger group with higher levels of private health insurance and an older group with lower levels of private health insurance coverage. There were notable differences in preference. The younger cohort exhibited a greater willingness-to-pay to reduce pain interference, whereas the older group prioritized GP management, preferred more medicines and expressed fewer addiction concerns. Patients' treatment preferences diverged based on age and insurance status, underscoring the importance of understanding patient perspectives in treatment communication and care coordination. These findings provide insight into patient decision-making, which is important for promoting access to quality healthcare and engagement with evidence-based treatment of CNCP. A discrete choice experiment identified two groups: younger, with more private insurance, and older, with less private health insurance, each with unique pain management preferences. Clinicians should be aware that age and private health insurance may have an impact on a patient's preferences for CNCP management.

Opioid prescriptions following behavioral health training among primary care providers

BackgroundOverdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians.MethodsWe retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider’s TNT “treatment” if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification.ResultsPost-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p < 0.001) as well as after clustering patient observations by provider.ConclusionIn a large Southern California healthcare system, the TNT training program preceded a reduction in primary care providers’ prescription rates of opioids. If replicated in larger samples, a low-cost provider training program has the potential to promote more judicious use of opioids for pain management. We encourage more studies to understand the program’s long-term impact on physician behavior and, potentially, on patient outcomes.

Concomitant suppression of COX-1 and COX-2 is insufficient to induce enteropathy associated with chronic NSAID use.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used medications for the management of chronic pain; however, they are associated with gastrointestinal (GI) adverse events. Although many mechanisms have been suggested, NSAID-induced enteropathy has been thought to be primarily due to inhibition of both cyclooxygenases (COX) -1 and -2, which results in suppression of prostaglandin synthesis. Here we report that concomitant postnatal deletion of Cox-1 and -2 over 10 months failed to cause intestinal injury in mice unless they were treated with naproxen or its structural analog, phenylpropionic acid, which is not a COX inhibitor. Cox double knockout mice exhibit a distinct gut microbiome composition, and cohousing them with controls rescues their dysbiosis and delays the onset of NSAID-induced GI bleeding. Suppression of bile acid synthesis is also protective. In both the UK Biobank and All of Us human cohorts, coadministration of antibiotics with NSAIDs is associated with an increased frequency of GI bleeding. These results show that prostaglandin suppression plays a trivial role in NSAID-induced enteropathy. However, Cox deletion causes dysbiosis of the gut microbiome that amplifies the enteropathic response to NSAIDs.

Effectiveness of Non-Pharmacological Interventions in the Management of Pediatric Chronic Pain: A Systematic Review

(1) Background: Chronic pain in children remains an under-researched area, especially compared to acute pain. This systematic review aims to evaluate the effectiveness of non-pharmacological interventions in the management of pediatric chronic pain and their impact on the well-being of both children and their families. Given the growing interest in integrative treatments to reduce reliance on pharmacological solutions, this review addresses the need for alternative therapeutic approaches. (2) Methods: A systematic review was conducted following the PRISMA guidelines, covering studies published between 2019 and 2024 from PubMed, Cochrane Library, Web of Science, and Scopus. Eligible studies included children aged 2 to 18 years with chronic pain who received non-pharmacological interventions. Data were extracted on intervention types, participant characteristics, and outcomes. The risk of bias was assessed using RoB2 for randomized trials and ROBINS-I for non-randomized studies. (3) Results: A total of 11 studies involving 1739 children were included, assessing interventions such as cognitive behavioral therapy, personalized psychosocial follow-up programs, hypnotherapy, music therapy, and digital tools. The results demonstrated significant reductions in pain severity, improvements in emotional and physical well-being, and high patient satisfaction. However, the generalizability of findings was limited by the small sample sizes and variability in study designs. (4) Conclusions: Non-pharmacological interventions appear effective in managing pediatric chronic pain, offering improvements in pain reduction and quality of life. Further research is needed to optimize these approaches and confirm their long-term benefits across diverse populations. These interventions represent promising alternatives or complements to pharmacological treatments in pediatric pain management.

Volunteer Peer Support for Chronic Pain Self-Management: A Qualitative Study of Benefits and Barriers.

Pain self-management is a key ingredient in chronic pain management. Peer support has been shown to be effective in helping patients self-manage other chronic conditions and may be a promising approach to implementing pain self-management programs more broadly without placing additional demands on clinicians. The Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) trial tested peer-supported chronic pain self-management. Although peers may be paid staff or volunteers, the ECLIPSE intervention was delivered by volunteer peer coaches, to test a low-resource model that could be easily implemented if effective. Trial results showed no statistically significant differences between intervention and control participants on key outcomes, and intervention adherence was low. To understand participants' experiences with peer coaching to help explain trial results. Semi-structured qualitative interviews with participants and peer coaches. Veterans with chronic musculoskeletal pain. Benefits to intervention participation included connecting with fellow veterans, receiving encouragement and hope, and improving pain self-management. Peer coaches described benefits unique to their role: facilitating their own pain self-management, having a "positive distraction," and a sense of "giving back." Barriers included difficulties reaching participants; resistance to focusing on the curriculum, including prioritizing socializing and being unwilling to set pain management goals; and phone delivery, which impeded communication and rapport-building. Participants described benefitting from the ECLIPSE intervention. Challenges, mostly related to engagement, were also described and may help explain trial results. The low-resource nature of the intervention may have exacerbated these difficulties. Volunteer coaches typically receive less training than paid peers and may have been less prepared to handle challenges; moreover, as volunteers, peer coaches likely had competing demands that left less time for coaching. Future research should seek to identify whom to target for peer-led versus other types of interventions to maximize benefit and use of resources.

Cannabis combined with oxycodone for pain relief in fibromyalgia pain: a randomized clinical self-titration trial with focus on adverse events.

We determined whether adding cannabis to oxycodone for chronic non-cancer pain management could reduce treatment-related adverse effects (AEs) while maintaining effective analgesia. In this open-label study, fibromyalgia patients aged ≥18 years were randomized to receive 5 mg oxycodone tablets (max. four times/day), 150 mg of inhaled cannabis containing 6.3% Δ9-tetrahydrocannabinol and 8% cannabidiol (max. times inhalation sessions/day), or a combination of both for 6 weeks. The primary endpoint was treatment-related adverse events, assessed using a 10-point composite adverse event (cAE) score; additionally, we recorded daily reported pain relief and daily tablet and cannabis consumption. In total, 23 patients were treated with oxycodone, 29 with cannabis, and 29 with the oxycodone/cannabis combination. Three patients from the oxycodone group (13%) and 18 patients from the cannabis groups (31%, 9 in each group) withdrew from the trial within 2-3 weeks because of the severity of AEs. There were no differences in treatment-related cAE scores among the three groups that completed the study (p = 0.70). The analgesic responder rate showed a ≥1- point reduction in pain in 50% and a ≥2-point reduction in 20% of patients, while 50% of patients experienced no treatment benefit. The combination treatment reduced oxycodone tablet consumption by 35% (p = 0.02), but it did not affect the number of cannabis inhalation sessions. Cannabis combined with oxycodone offered no advantage over either treatment alone, except for a reduction in opioid tablet intake; however, the overall drug load was the highest in the combination group. Moreover, cannabis was poorly tolerated and led to treatment discontinuation in one-third of participants treated with cannabis. The trial was registered at the WHO International Clinical Trials Registry Platform (trialsearch.who.int) on July 26, 2019, identifier NL7902.

How Veterans with Chronic Pain Approach Using Cannabis for Symptom Management: Results from a Qualitative Interpretive Description Study.

Introduction: Veterans use cannabis as a chronic pain treatment due to a combination of the easing of restrictions and dissatisfaction with care standards. The segregation of medical cannabis from conventional health systems may translate to opportunities and disadvantages that are not well defined. Our study aimed to characterize how Veterans with chronic pain approach using cannabis for symptom management, including product access, developing a treatment plan, and its integration into daily life. Materials and Methods: We used an interpretive description design and conducted semi-structured interviews with U.S. Veterans in Michigan who had chronic pain; were aged 21 years or older; and (a) used cannabis, (b) were planning to use cannabis, or (c) interested in learning about how cannabis could help with pain. We analyzed deidentified interview transcripts to develop themes that focused on how Veterans approached new and continued use of cannabis for chronic pain management. Results: Participants were Veterans with chronic pain, median age = 50 years (n = 32). Participants described how factors at the individual, relationship, community, and societal levels influenced their interest in and use of cannabis for chronic pain. We identified five main themes: (1) cannabis supports holistic wellness, but there are also undesired effects; (2) medical cannabis requires a personalized treatment approach; (3) Veterans seek expanded access to medical cannabis and more assurance regarding product safety and efficacy; (4) sociopolitical attitudes and advocacy shape medical cannabis acceptability; and (5) the interest in research to inform treatment approaches and facilitate access. Discussion: This article illustrates how Veterans approached using cannabis for chronic pain management. Findings illuminate the potential value of cannabis for Veterans with chronic pain while also highlighting numerous obstacles and limitations related to its use. There are opportunities for health care providers to support Veterans who are interested in cannabis while research regarding efficacy and safety continues. Future efforts should engage Veterans to collectively work toward a better understanding of cannabis as a pain treatment option.

Neighborhood disadvantage and pain-related experiences in a pain psychology clinic: The mediating roles of pain catastrophizing and pain-related fear

This study investigated the relationship between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and pain-related variables in a pain psychology clinic. We also examined the sequential mediating roles of pain catastrophizing and pain-related fear on these relationships. Participants (N = 509) completed questionnaires assessing usual pain intensity, fatigue, emotional distress, and interference with daily activities. The mean ADI score was 32.57 (SD = 22.65), with scores ranging from 1 to 100. Linear regression analysis, adjusting for age and gender, revealed that higher ADI (i.e., less advantage) was significantly associated with higher scores on pain-related variables (pain intensity: B = 0.026, p < .001; fatigue: B = 0.018, p < .001; emotional distress: B = 0.020, p < .001; interference with daily activities: B = 0.014, p = .006). Sequential mediation analysis revealed pain catastrophizing and pain-related fear mediated these relationships, with significant indirect effects for fatigue (B = 0.001, 95% CI [0.000, 0.002]) and interference with daily activities (B = 0.001, 95% CI [0.001, 0.003]) — but not pain intensity or emotional distress. Pain catastrophizing alone mediated neighborhood disadvantage-pain relationship for all variables. The results suggest that neighborhood disadvantage is associated with higher scores on pain-related experiences and that consistent with the fear avoidance model, pain catastrophizing and pain-related fear may play a role in these relationships for fatigue and interference with daily activities. These findings underscore that neighborhood disadvantage is associated with worse pain-related experiences and highlight the importance of considering neighborhood factors in chronic pain management. PerspectiveThis study identifies potential pathways linking neighborhood disadvantage to chronic pain variables, highlighting the roles of pain catastrophizing and pain-related fear. The findings underscore the need for a holistic approach to pain management that recognizes both individual cognitive-emotional factors and the broader social context in which pain occurs.

Pharmacological Targeting of Sodium and Calcium Channels as a Therapeutic Approach for Chronic Pain Relief

Background: It is determined that chronic pain is a common, worsening health issue that reduces patient’s quality of life and is a huge strain on health systems. Sodium and calcium channels are key for the process of transferring pain signals. Pharmacological targeting of these ion channels has been identified as a potential and efficient long-term therapy of chronic pain in the absence of non-specific side effects of traditional analgesics.Objectives: In a clinical trial, to determine the effectiveness of the drugs, selective sodium and calcium channel blockers in the management of chronic pain symptoms by comparing patients’ pain scores and the number of effectively treated patients over time.Study design: A Double-blind, randomized, controlled trialPlace and duration of the Study: Department of Biochemistry, Saidu Medical College, Saidu Sharif Swat KP – Pakistan from March 2022 to March 2023.Methodology: The effect of sodium and calcium channel blockers was examined in a double-blind, randomized comparison study of 150 patients in a chronic pain clinic. Subjects rated their pain using an anchored pain intensity scale at baseline, two weeks, and four weeks. In analyzing the results, the use of mean, standard deviation and P-value were used whereby the P value used to test hypotheses in an experiment is the probability of obtaining the observed results. Hypothesis derived parameters included; the primary end point being pain score reduction, and the secondary end points including functional changes and side effects respectively.Results: In 150 patients these three groups recognized 23 percent achieving reasonable pain heading for sodium and calcium channel blockers who achieved extra pain cut off the placebo mean pain heading of 7.3 ±1.5 SD reducing to mean pain heading of 3.8 ±1.2 SD in the same patients. Actual placebo group demonstrate a slight improvement (mean change from 7.4 to 6.8). Analysis of the data by the G * Power software showed that the effect size was highly statistically significant, with a p-value = &lt; 0.001. Hundred percent increase in the functional scores for the treatment group, but the adverse effects were reported to be less and were comparable with that of the placebo group. These results suggest that selective sodium and calcium channel blockade can attenuate neuropathic pain.Conclusion: This class of drugs has a substantial potential and does not trigger such severe side effects as constant use of traditional analgesics does for relieving chronic pain. The present work provides evidence that ion channel modulation can be used for chronic pain management, which should be further investigated and considered for implementation into therapeutic pain paradigms.Conclusion: Results indicate that G6PD deficiency is a leading cause of neonatal jaundice, particularly in populations at higher risk due to genetic factors. Early diagnosis and treatment significantly improve outcomes, though complications such as kernicterus remain a risk in severe cases.

Effectiveness of multimodal active physiotherapy for chronic knee pain: a 12-month randomized controlled trial follow-up study.

Active physiotherapy (APT) embraces a patient-centered approach, prioritizing self-management within the biopsychosocial model and involving active patient movements. Beyond structured exercise, APT incorporates pain neuroscience education, Mulligan Mobilization (MWM), and active myofascial release techniques to integrate sensory-motor information for functional recovery and pain relief. This study aims to rigorously compare the effectiveness of APT versus conventional physical therapy (CPT) on pain and functional outcomes in patients with chronic knee pain. Eighty-seven patients with symptomatic and radiographically confirmed knee pain were included in this 12-month follow-up of a randomized controlled trial, conducted at a national institute and a rehabilitation clinic. Patients were randomized to either APT (n = 44) or CPT (n = 43). The APT protocol integrated pain neuroscience education, MWM, active myofascial release techniques, and structured exercises focusing on flexibility, stability, neuromuscular control, and coordination. The CPT protocol included health education, laser therapy, ultrasound therapy, and exercise. Both interventions were performed for 60 min twice a week for 3 months. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). Secondary outcomes included pain intensity (VAS), KOOS-pain, activities of daily living (ADL), function in sport and recreation (Sports/Rec), knee-related quality of life, global rating of change (GROC), quality of life (SF-36), Tampa Scale for Kinesiophobia (TSK), and functional performances measured at different intervals. Intention-to-treat analyses were performed. Of the 87 patients, 70 (80.5%) completed the 12-month follow-up. KOOS4 improved more in the APT group (16.13; 95% CI, 10.39-21.88) than in the CPT group (11.23; 95% CI, 5.42-17.04). APT showed additional improvement in KOOS4 compared to CPT (2.94; 95% CI: 0.04 to 5.85, p = 0.047). The VAS difference was -3.41 mm (95% CI: -6.40 to -0.43, p = 0.025), favoring APT. APT also showed more improvements in KOOS-pain, KOOS-ADL, KOOS-Sports/Rec, and TSK (p < 0.05). No differences between groups were observed in GROC and SF-36. APT significantly improved most functional performance variables compared to CPT (p < 0.05). Active Physiotherapy outshines conventional physical therapy by delivering more substantial reductions in pain intensity and marked enhancements in function among patients with knee pain. This distinctive efficacy underscores the invaluable role of APT in the management of chronic knee pain. By actively involving patients in their recovery journey, APT not only fosters superior results but also emphasizes the critical need to integrate these advanced therapeutic strategies into everyday clinical practices.

A Practice Facilitation-Based QI Approach to Improve the Management of Non-Cancer Chronic Pain in Older Adults

A Practice Facilitation-Based QI Approach to Improve the Management of Non-Cancer Chronic Pain in Older Adults