Manifestations Of Pain Research Articles

Features of pain manifestations in women with premenstrual syndrome

Features of pain manifestations in women with premenstrual syndrome

Association of Uterine Tissue Innervation and Peripheral Nerve Density with Adenomyosis Related Pain. A Systematic Review.

Adenomyosis is associated with dysmenorrhea and chronic pelvic pain; however, the triggering mechanisms of painful stimuli and the role of uterine nerve fibers in the manifestation of pain remain poorly understood. The objective of this study was to systematically review the role of uterine nerve fibers' presence and density in the occurrence of pain in patients with adenomyosis. An electronic search was performed using the Embase, PubMed/Medline, and Cochrane databases. We included all studies from inception to November 2023. A total of ten studies that compared uterine biopsies samples of women with and without adenomyosis were included. The biomarker antiprotein gene product 9.5 was decreased or absent in the endometrium of most included women with adenomyosis. None of the included studies observed a difference in neurofilament (NF) staining between the adenomyosis and non-adenomyosis groups. Studies that assessed nerve growth factor (NGF) staining were heterogeneous in design. One study reported no difference in immunohistochemistry staining in any endometrial layer between the adenomyosis and non-adenomyosis groups, while another reported increased staining in the adenomyosis functional endometrial layer, and a third study reported overexpression of NGF, synaptophysin (SYN), and microtubule-associated protein 2 mRNA in focal adenomyosis alone. Preliminary data from poor-quality studies suggest an increase in the uterine density of nerve fibers in patients with adenomyosis. Well-designed studies are essential to assess the cause-and-effect relationship between uterine nerve fibers and pain in patients with adenomyosis.

Multidisciplinary Management Strategies for Long COVID: A Narrative Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused millions of infections to date and has led to a worldwide pandemic. Most patients had a complete recovery from the acute infection, however, a large number of the affected individuals experienced symptoms that persisted more than 3 months after diagnosis. These symptoms most commonly include fatigue, memory difficulties, brain fog, dyspnea, cough, and other less common ones such as headache, chest pain, paresthesias, mood changes, muscle pain, and weakness,skin rashes, and cardiac, endocrine, renal and hepatic manifestations. The treatment of this syndrome remains challenging. A multidisciplinary approach to address combinations of symptoms affecting multiple organ systems has been widely adopted. This narrative review aims to bridge the gap surrounding the broad treatment approaches by providing an overview of multidisciplinary management strategiesfor the most common long COVID conditions.

The Detection of Thoracolumbar Spine Injuries in Horses with Chronic Laminitis Using a Novel Clinical-Assessment Protocol and Ultrasonographic Examination.

Postural adaptation is a prominent feature in horses affected by laminitis. Laminitis induces intense pain, especially in the forelimbs, prompting affected horses to assume a caudally displaced trunk posture, resulting in the hyperflexion of the thoracolumbar spine. This study assessed the nature and prevalence of thoracolumbar injuries in horses with chronic laminitis compared to horses without it. Sixty horses were used (thirty laminitic and thirty non-laminitic) of different athletic purposes and ages (2-20 years). The experimental protocol entailed a single assessment of horses' thoracolumbar spines, utilizing physical examination by MACCTORE, a scoring system developed specifically for this study. Additional evaluations included the Grimace Equine Pain Scale (HGS) and ultrasound exams. Statistical tests were used to compare values (Mann-Whitney or t-test) and lesions prevalences (Fisher) between groups (p < 0.05). The results showed a higher pain manifestation (HGS and heart rate, p < 0.0001) and thoracolumbar-spine-injury levels in chronic laminitis horses, both in MACCTORE clinical examinations (11.7 ± 4.8 vs. 4.2 ± 3.3, p < 0.0001) and general ultrasonographic indices (39.6 ± 12.0 vs. 20.7 ± 7.1, p < 0.0001), including specific examination approaches for various spinal elements. Horses with laminitis presented with a 14-fold higher prevalence of ultrasound-relevant lesions in the thoracolumbar spine (CI: 4.4 to 50.6, p < 0.0001) compared to controls. These findings constitute new evidence of an association between chronic laminitis and the presence of thoracolumbar spine injuries in horses, which may be confirmed by more sophisticated study designs.

Patient-reported experience with Fabry disease and its management in the real-world setting: results from a double-blind, cross-sectional survey of 280 respondents

BackgroundFabry disease (FD) is a rare X-linked lysosomal storage disorder with a heterogeneous clinical presentation. Patients with FD may exhibit early signs/symptoms including neuropathic pain, gastrointestinal complaints, and dermatologic manifestations. FD may ultimately progress to renal, neurologic, and cardiac dysfunction. Current treatments for FD have significantly improved the management and outcomes for patients with FD, but important clinical and convenience limitations still exist.MethodsTo illuminate the impact of FD on daily life from the patient’s perspective, we asked adult patients (≥ 18 years old) with FD in the United States and Canada to complete a 33-question online survey to assess patient-reported disease severity, management, and treatment outcomes.ResultsA total of 280 respondents with FD completed the survey; they had a mean age of 47 years, and 68% (191/280) were women. Most were currently receiving FD treatment (84%, 234/280) with enzyme replacement therapy (ERT) (89%, 208/234) or chaperone therapy (11%, 26/234). Common symptoms included low energy/fatigue (72%, 201/280), tingling (62%, 174/280) or pain in the hands/feet (60%, 168/280), ringing in ears/hearing loss (54%, 151/280), general body pains/pain crises (51%, 143/280), and abdominal/stomach pain (50%, 140/280). More than half (51%, 144/280) of respondents reported their symptoms as bothersome (38%, 106/280) or difficult to control (14%, 38/280). Temporary symptom worsening between infusions was reported by about half of respondents: 51% (108/211) currently receiving ERT and 48% (14/29) previously receiving ERT. Only 48% (59/122) of respondents reported their symptom worsening to their physician. Of those who reported it, 41% (24/59) said that their physician prescribed medication to manage their symptoms or changed their treatment regimen.ConclusionsOur analysis highlights the gap between current standard-of-care in disease monitoring and patient perception of disease progression among patients with FD. This information may be helpful for healthcare providers and drug developers seeking to improve the care of patients with FD by addressing unmet needs of high relevance.

Advances in stem cell therapy for articular cartilage lesions: clinical evidence and future directions: a systematic review

The significance of articular cartilage, an essential connective tissue, cannot be overstated in relation to joint health and functionality. Nevertheless, the human body might have adverse effects due to traumatic incidents, degenerative conditions, or repetitive stress, resulting in the manifestation of pain, inflammation, and impaired functionality. The primary objective of this study is to assess the effectiveness of stem cell therapy in the treatment of articular cartilage damage such as lesions. The systematic review was conducted adhering to the PRISMA principles. Boolean logic is employed in the search technique to integrate phrases pertaining to stem cell therapy, articular cartilage diseases, and biological processes. The research employs a range of databases and medical subject headings (MeSH) in order to facilitate a thorough examination. The stem cell therapy in the treatment of articular cartilage lesions has great potential. It enhances management and treatment outcomes for individuals afflicted with cartilage abnormalities. It is beneficial particularly those diagnosed with osteoarthritis (OA). Encouraging outcomes, such as alleviation of pain and improvement in functionality have been reported. Additional investigation is required to enhance therapy regimens, encompassing cell dosage, delivery techniques, and supplementary medicines. The use of stem cell therapies necessitates the imperative collaboration among researchers, doctors and regulatory agencies.

Parabrachial Calca neurons drive nociplasticity

Pain that persists beyond the time required for tissue healing and pain that arises in the absence of tissue injury, collectively referred to as nociplastic pain, are poorly understood phenomena mediated by plasticity within the central nervous system. The parabrachial nucleus (PBN) is a hub that relays aversive sensory information and appears to play a role in nociplasticity. Here, by preventing PBN Calca neurons from releasing neurotransmitters, we demonstrate that activation of Calca neurons is necessary for the manifestation and maintenance of chronic pain. Additionally, by directly stimulating Calca neurons, we demonstrate that Calca neuron activity is sufficient to drive nociplasticity. Aversive stimuli of multiple sensory modalities, such as exposure to nitroglycerin, cisplatin, or lithium chloride, can drive nociplasticity in a Calca-neuron-dependent manner. Aversive events drive nociplasticity in Calca neurons in the form of increased activity and excitability; however, neuroplasticity also appears to occur in downstream circuitry.

Management of post COVID arthralgia by Amalaki Rasayana: A case report

Background: COVID-19 is an infectious disease caused by the newly discovered coronavirus. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2). Post-COVID syndrome for people who still have symptoms for more than 12 weeks after the start of acute symptoms. This may last up to one year. The most common symptoms reported are fatigue, anorexia, joint pain, dyspnoea, headache, anxiety, and critical manifestations like diabetes, hypertension, pulmonary fibrosis, renal failure, Rheumatoid Arthritis (RA), etc. Agnimandya (~diminution of Agni) is a residual symptom of COVID-19 which leads to Dhatukshya (~diminution of Dhatu). Methods: We describe a case of a 50-year-old male who developed arthralgia after the remission of acute COVID-19 infection and post-COVID symptoms. The patient was treated with Haritakyadi yoga for koshtha shuddhi followed by Rasayana chikitsa by Amalaki Rasayana for the next 30 days for post-COVID ailments. The prime aim of treatment was to recover the function of Agni and koshtha shuddhi by administering Haritakyadi yoga followed by rejuvenation treatment by Amalaki Rasayana. The patient was assessed using the WHO well-being index scale, signs- and symptoms of post-COVID, six-minute walk test on the 0th, 15th, and 30th day follow-up. Results: Haritakyadi yoga followed by Amalaki Rasayana reduced symptoms of post-COVID arthralgia, improved energy levels of post-COVID symptoms, and enhanced WHO- well-being score. Conclusions: It is suggested by the mentioned case that Amalaki Rasayana may be used for managing post-COVID arthralgia and for improving general well-being in long COVID.

Addiction to budda blues : About 2 clinical cases

IntroductionBuddha Blue, or PTC for “Pète Ton Crâne”, is a synthetic drug particularly popular with young people. It is sold as a liquid to be inhaled in electronic cigarettes.ObjectivesTo discuss the clinical manifestations and psychopathology associated with PTC.MethodsWe shed light on PTC addiction through clinical vignettes of patients who were hospitalized in pediatrics at the Gonesse hospital.ResultsWe received two male patients with manifestations of PTC intoxication or withdrawal. One of the patients presented with an acute delirious flush requiring long-term treatment, while the second presented with somatic manifestations of pain and vomiting, as well as psychiatric manifestations such as hallucinations, without meeting the criteria for a psychiatric disorder. Both cases required addictological follow-up and child psychiatric therapy.ConclusionsPTC addiction can lead to life-threatening complications, hence the importance of prevention and screening in order to institute early and effective treatment.Disclosure of InterestNone Declared

Lipoxin A4 ameliorates knee osteoarthritis progression in rats by antagonizing ferroptosis through activation of the ESR2/LPAR3/Nrf2 axis in synovial fibroblast-like synoviocytes

BackgroundOur previous studies have shown that lipoxin A4 (LXA4) can serve as a potential biomarker for assessing the efficacy of exercise therapy in knee osteoarthritis (KOA), and fibroblast-like synoviocytes (FLSs) may play a crucial role in KOA pain as well as in the progression of the pathology. ObjectiveBy analyzing the GSE29746 dataset and collecting synovial samples from patients with different Kellgren–Lawrence (KL) grades for validation, we focused on exploring the potential effect of LXA4 on ferroptosis in FLSs through the ESR2/LPAR3/Nrf2 axis to alleviate pain and pathological advancement in KOA. MethodsThe association between FLSs ferroptosis and chondrocyte matrix degradation was explored by cell co-culture. We overexpressed and knocked down LPAR3 in vitro to explore its potential mechanism in FLSs. A rat model of monosodium iodoacetate (MIA)-induced KOA was constructed and intervened with moderate-intensity treadmill exercise and intraperitoneal injection of PHTPP to investigate the effects of the LXA4 intracellular receptor ESR2 on exercise therapy. ResultsESR2, LPAR3, and GPX4 levels in the synovium decreased with increasing KL grade. After LXA4 intervention in the co-culture system, GPX4, LPAR3, and ESR2 were upregulated in FLSs, collagen II was upregulated in chondrocytes, and MMP3 and ADAM9 were downregulated. LPAR3 overexpression upregulated the expression of GPX4, Nrf2, and SOD1 in FLSs, while downregulating the expression of MMP13 and MMP3; LPAR3 knockdown reversed these changes. Moderate-intensity platform training improved the behavioral manifestations of pain in KOA rats, whereas PHTPP treatment partially reversed the improvement in synovial and cartilage pathologies induced by platform training. ConclusionLXA4 inhibited FLSs ferroptosis by activating the ESR2/LPAR3/Nrf2 axis, thereby alleviating the pain and pathological progression of KOA. This study brings a new target for the treatment of KOA and also leads to a deeper understanding of the potential mechanisms of exercise therapy for KOA.

EXPERIENCE OF RESORPTION OF LUMBAR SPINE HERNIAS

Background. In most cases, the reduction in pain and clinical manifestations is associated with a decrease in the size of the hernia or its resorption, which is the natural process of reduction or complete disappearance of the hernia without the need for surgical intervention. Currently, there are several intensive physical therapy methods that influence the process of hernia resorption, making conservative treatment preferable. Materials and methods. At the «Expert Neuro» clinic, as part of a prospective observational study from 2023 to 2024, 30 patients with a confirmed diagnosis of “herniated intervertebral discs of the lumbar spine” were analyzed based on the results of magnetic resonance imaging. The main group of patients received conservative treatment using modern high-intensity physiotherapy methods, the control group received classical methods of conservative treatment. Results. According to magnetic resonance of the spine, 3 patients developed resorption of a herniated intervertebral disc. In all patients, radiculopathy symptoms improved after 1 month and lower back pain symptoms improved after 2 to 3 months. Conclusion. According to our clinical experience and relevant literature, sequestered disc herniations have a high rate of resorption. Pathophysiological processes of inflammation and regeneration are the main mechanisms of this phenomenon. Conservative management of such patients in the absence of definitive surgical indications should not be underestimated.

EFFECT OF USING A RELAXATION SPLINT ON REDUCING CHRONIC NECK PAIN

Background: Approximately 80% of patients seeking dental care exhibit parafunctional manifestations of the temporomandibular joint (TMJ), while approximately 70% of patients with TMJ dysfunction experience pain in the cervical spine. It is noteworthy that neck pain is a socially significant phenomenon, as this condition can lead to a substantial decline in the patient's quality of life and disability.&#x0D; Aim: To determine the effect of using a relaxation mouthguard in patients with TMJ dysfunction on reducing chronic neck pain.&#x0D; Materials and methods: The study involved 16 individuals with manifestations of TMJ dysfunction, who were divided into 2 groups. The diagnosis was based on a questionnaire following the research diagnostic criteria for TMD, VAS, and the Oswestry cervical scale. Questionnaires and other examinations were conducted on all patients four times (before treatment, on days 8, 15, and 23 after treatment). Cervical spine mobility was assessed in all patients, and mandibular axiography was performed. Patients in the experimental group, comprising 8 individuals, were fitted with individual relaxation splints and prescribed manual massage of the masticatory and cervical muscles. Patients in the control group, also consisting of 8 patients, were instructed to perform manual massage of the masticatory and cervical muscles.&#x0D; Results: Patients in both study groups demonstrated a reduction in clinical symptoms. According to the study data, the reduction of pain in the experimental group from the beginning to the end of treatment was 62.86% (p &lt; 0.001) of the initial value, whereas in the control group, it was 13.75% (p &lt; 0.001). There was an increase in mobility of the cervical spine in both study groups (p &lt; 0.001). The index of cervical spine disability in the experimental group improved by 225% compared to the control group.&#x0D; Conclusions: The use of a relaxation mouthguard in patients with TMJ dysfunction and existing neck pain symptoms can alleviate chronic pain manifestations in the cervical spine.

Pain: A Necessary Evil? (Anesthetic Management of Congenital Pain Insensitivity Syndrome)

Abstract Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal disorder. It is characterized by systemic insensitivity to pain, unexplained fever, and psychiatric manifestations. Anesthetic management of these cases is a challenge to the anesthetist due to the various implications associated with it. In this case report, we describe the anesthetic management of a 3-year-old child with CIPA and report the implications and challenges faced

Percutaneous Continuous Radiofrequency Versus Pulsed Radiofrequency Thermorhizotomy for the Treatment of Neuralgia of the Trigeminal Nerve: A Retrospective Observational Study.

Trigeminal neuralgia (TN) represents one of the most powerful manifestations of neuropathic pain. The diagnostic criteria, as well as its therapeutic modalities, stand firmly established. The percutaneous radiofrequency thermorhizotomy of the gasserian ganglion and posterior root of the trigeminal nerve stands as a widely employed procedure in this context. In this retrospective observational investigation, we undertake a comparative analysis of patients subjected to treatment employing continuous radiofrequency (C-rF) versus pulsed radiofrequency (P-rF). A cohort of 128 patients afflicted with essential neuralgia of the trigeminal nerve, all under the care of the distinguished author (JCA), underwent percutaneous radiofrequency thermorhizotomy between the years 2005 and 2022. They were stratified into two cohorts: Group 1 encompassed 76 patients treated with C-rF, while Group 2 comprised 52 patients subjected to P-rF intervention.All participants met the stringent inclusion and exclusion criteria for TN, with a notable concentration in the V2 and V3 territoriesaccounting for 60% and 45%, respectively. The post-procedural follow-up period exhibited uniformity, spanning from six months to 16 years. Preceding the intervention, all patients uniformly reported a visual analog scale (VAS) score surpassing 6/10. Additionally, everyone had been undergoing pharmacological management, involving a combination of antineuropathic agents and low-potency opioids. The evaluation of clinical improvement was conducted across three temporal domains: the immediate short-term (less than 30 days), the intermediate-term (less than one year), and the prolonged-term (exceeding one year). In the short term, a noteworthy alleviation of pain, surpassing the 50% threshold, was evident in most patients (94%), a similarity observed in both cohorts (98% in Group 1 and 90% in Group 2). The VASrevealed an average rating of 3/10 for Group 1 and 2/10 for Group 2. Moving to the intermediate term, more than 50% improvement in pain was registered in 89% of patients (92% in Group 1 and 86% in Group 2). The mean VAS score stood at 3.5/10, marginally higher in Group 2 at 4/10 compared to 3/10 in Group 1. In the final assessment, a 50% or greater reduction in pain was reported by 75% of patients, with no discernible disparity between the two cohorts. Among the cohort, 18 individuals necessitated a subsequent percutaneous intervention (10 in Group 1 and eight in Group 2), while microvascular decompression was performed on six patients (equitably distributed between the two groups), and radiosurgery was administered to three patients in Group 1. Percutaneous radiofrequency thermorhizotomy emerges as an efficacious modality for addressing essential TN. The employment of continuous radiofrequency yields superior long-term outcomes, albeit accompanied by sensitive manifestations that may prove discomforting. Pulsed radiofrequency demonstrates commendable clinical efficacy with a diminished incidence of complications, rendering it a viable option even for other manifestations of facial pain.

Psychiatric disorders and mortality due to external causes following diagnosis of endometriosis at a young age: a longitudinal register-based cohort study in Finland

BackgroundEndometriosis diagnosed in adults is associated with increased risk of various psychiatric disorders. However, little is known concerning psychiatric comorbidity and mortality due to external causes associated with endometriosis diagnosed at a young age. Objective(s)In this longitudinal cohort study, we investigated the link between surgical diagnosis of endometriosis at a young age, and subsequent psychiatric disorders and mortality due to external causes. Additionally, we compared the occurrence of the most common psychiatric disorders between different sites of surgically confirmed endometriosis (ovarian versus other) due to possible different pain manifestations. Study DesignWe conducted a retrospective register-based cohort study. Altogether 4532 women with surgically confirmed diagnosis of endometriosis before the age of 25 in 1987–2012 were identified from the Finnish Hospital Discharge Register and matched with women without surgically diagnosed endometriosis for age and municipality on the index day (n=9014). Women were followed from the index day until the end of 2019 for the outcomes of interest, which included nine groups of psychiatric disorders (inpatient episodes since 1987, outpatient episodes since 1998) and death due to external causes, including deaths due to accidents, suicides, and violence (Finnish Register of Causes of Death). Cox proportional hazard models were applied to assess the crude and parity-adjusted hazard ratios and 95% confidence intervals. ResultsThe cohort’s median age was 22.9 years (interquartile range: 21.3–24.1) at the beginning and 42.5 years (36.7–48.3) after a median follow-up time of 20.0 years (14.5–25.7). We observed a higher hazard of depressive, anxiety, and bipolar disorders in women with endometriosis compared to the reference cohort. These differences appeared early and remained the same during the entire follow-up, irrespective of whether assessed from the data on inpatient episodes only, or using data on both in- and outpatient episodes. The corresponding adjusted hazard ratios were 2.57 (95% confidence interval 2.11–3.14) and 1.87 (1.65–2.12) for depressive disorders, 2.40 (1.81–3.17) and 2.09 (1.84–2.37) for anxiety disorders, 1.71 (1.30–2.26) and 1.66 (1.28–2.15) for bipolar disorders, respectively. A higher hazard was seen for nonorganic sleeping disorders for the first ten years only (3.83, 2.01–7.30) when assessed using the data on both in- and outpatient episodes. When based on inpatient records, a higher hazard for alcohol/drug dependence after 15 years of follow-up (2.07, 1.21–3.54) was observed. The difference in hazard for personality disorders tended to increase during follow-up (<10 years 2.12, 1.28–3.52; 10 years or more 3.08, 1.44–6.57). Depressive and anxiety disorders occurred more frequently in women with other than ovarian endometriosis. No difference in deaths due to external causes was observed between the endometriosis and reference cohorts. Conclusion(s)Surgical diagnosis of endometriosis at young age associated with increased incidence for several psychiatric disorders. Moreover, within the endometriosis population, psychiatric comorbidity was more common in women with other than ovarian endometriosis. We speculate that chronic pain is essential in the development of these psychiatric disorders, and that early and effective pain management is important in reducing the risk of psychiatric morbidity in young women. More research concerning the associations and management of endometriosis and associated psychiatric disorders is warranted.

A172 A CLASSIC CASE OF WHIPPLE'S DISEASE

Abstract Background Whipple’s disease is a systemic disorder caused by the Gram-positive bacillus Tropheryma whippelii. It is classically defined by the four cardinal clinical manifestations of arthralgias, weight loss, diarrhea and abdominal pain. Classic Whipple’s disease is considered extremely rare, with an estimated global incidence of 30 cases per year, though this may be an underestimate. Aims To present a case of classic Whipple’s disease, so as to raise awareness and clinical suspicion for this rare condition. Methods We performed a retrospective chart review of a case of classic Whipple’s disease diagnosed in Saint John, NB, in 2020. Results A 55-year-old female presented to hospital with intractable weakness and diarrhea. Her history was notable for several years of right leg weakness, myalgias and low-grade fevers. More acutely, she presented to hospital due to worsening secretory diarrhea resulting in 15kg weight loss. Initial investigations were remarkable for an elevated C-reactive protein. The patient was admitted for coordinated evaluation for possible rheumatologic and infectious causes. As part of that workup, colonoscopy was performed. Colonoscopy revealed an abnormal ileum, with villi described as edematous with a mosaic pattern alternating between erythematous and “white tipped”. On histologic assessment, ileal biopsies showed macrophages with PAS-positive diastase resistant granules suspicious for Whipple’s disease. A follow-up esophagogastroduodenoscopy with duodenal biopsies was thus performed to gain further tissue for confirmatory testing. The duodenal mucosa was also noted to have a mosaic pattern with hypertrophic villi alternating between pale and erythematous in appearance. Duodenal biopsies were taken and sent for PCR testing. This testing was positive for T. whippelii, confirming the diagnosis of Whipple’s disease. The patient was initiated on long-term antibiotic therapy with ceftriaxone transitioning to trimethoprim-sulfamethoxazole prior to discharge. She unfortunately re-presented one month post-discharge with recurrent fevers, malaise and arthralgias. Given suspicion that her disease may be resistant to trimethoprim-sulfamethoxazole, she was transitioned to doxycycline and hydroxychloroquine as second-line therapy. She clinically improved on this regimen, and was able to be de-escalated to long-term doxycycline monotherapy after one year. At a recent follow-up, nearly three years from her initial diagnosis, she was doing well with essentially no ongoing symptoms of her Whipple’s disease. Conclusions Whipple’s disease is a rare infection presenting with intractable diarrhea and abdominal discomfort. Our case highlights the excellent clinical response that can be achieved with successful diagnosis and management of this otherwise debilitating disease. Funding Agencies None

Multifaceted aspects of chronic disease: do diffuse idiopathic skeletal hyperostosis affect the quality of life?

Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition that affects the spine and peripheral joints, characterized by the progressive ossification of ligaments and tendons. It is a non-inflammatory degenerative disease that affects predominantly the elderly population. It has been associated with reduced mobility and chronic pain, which can have a significant impact on patients’ quality of life (QOL). Although DISH has always been considered a benign condition, patients with DISH report higher levels of pain, stiffness, and disability compared to the general population. It can affect their ability to perform daily activities and participate in social and recreational activities. In addition, extra-spinal manifestations such as enthesopathy and involvement of peripheral joints, but still dysphagia and airway obstruction have been described in DISH. These, although not as common, when present result in signs and symptoms significantly impacting the patient’s QOL. The objective of this review is to assess the QOL in individual with DISH. This involves an examination of various facets of the condition, including pain, spinal and extraspinal manifestations, fractures, and metabolic syndrome.

Clinical effects and biological mechanisms of exercise on lumbar disc herniation.

Lumbar Disc Herniation (LDH) is a syndrome in which lumbar disc degeneration, rupture of the annulus fibrosus, and herniation of the nucleus pulposus irritate and compress the nerve roots and cauda equina, resulting in the main manifestations of lumbar pain and/or lower extremity pain. There is evidence in various clinical areas that exercise is effective in treating LDH, and exercise intervention for more than 2weeks reduces disease activity in LDH. However, the mechanism of exercise's action in reducing disease activity in LDH is unclear. In this article, we first summarize and highlight the effectiveness of exercise in treating LDH and provide guideline recommendations regarding exercise type, intensity, frequency, and duration. Then, we integrate the existing evidence and propose biological mechanisms for the potential effects of exercise on neuromechanical compression, inflammatory chemical stimuli, and autoimmune responses from the perspective of LDH pathogenesis as an entry point. However, a large body of evidence was obtained from non-LDH populations. Future research needs to investigate further the proposed biological mechanisms of exercise in reducing disease activity in LDH populations. This knowledge will contribute to the basic science and strengthen the scientific basis for prescribing exercise therapy for the routine clinical treatment of LDH.

Research progress of plant medicine and Chinese herbal compounds in the treatment of rheumatoid arthritis combined with osteoporosis.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The clinical manifestations of various joint pain and bone destruction are common. RA has a high disability rate and is closely related to local and systemic osteoporosis (OP). RA can occur at any age, however, its incidence increases with age. Most patients are 40 to 50 years old with an incidence among women approximately 3 to 5 times more than among men. Osteoporosis is a kind of metabolic bone disease characterized by bone mass and bone microstructure damage and is one of the common complications of RA. Currently, in the clinic, more patients develop RA with OP symptoms. Therefore, both OP and RA-related factors should be considered in the OP treatment of RA. Currently, there is more and more research on RA combined with OP drugs, including basic drugs, bone resorption inhibitors, bone formation promoters, and anti-rheumatic drugs to improve the condition. The high cost or limited efficacy of certain Western drugs, coupled with their potential for adverse reactions during treatment highlight the pressing need for novel pharmaceuticals in clinical practice. In recent years, traditional Chinese medicine (TCM) can improve the bone formation and bone resorption indexes of patients with RA, regulate the balance of osteoclasts and osteoblasts, and regulate the immune inflammatory response, so as to treat RA combined with OP. This article discusses the advancements in single Chinese medicine and Chinese medicine combination treatments for RA complicated with OP, focusing on the mechanism of action and syndrome differentiation and classification, to offer new ideas for future clinical prevention and treatment.

What Lies Beyond Their Hurting: Representations of Female Pain and Personhood in Animation

The representation of women in art is a fraught one. This article analyzes the relationship American society has to female pain, using four cartoon series as case studies to argue that cultural perceptions around women's suffering are shifting towards viewing women as more than the sum total of their pain. The methodology of this analysis relies on Simone de Beauvoir's Second Sex and Leslie Jamison's "Grand Unified Theory of Female Pain" as a theoretical framework that illuminates cultural manifestations of female pain and the stereotypes that perpetuate these models, specifically applying them to female characters in Avatar: The Legend of Korra, Rapunzel's Tangled Adventure, She-Ra and the Princesses of Power, and Steven Universe. Animation analysis demonstrates how portrayals of women in media have evolved, yet continue to rely on female pain as a plot device for character development and plot progression. This analysis throws into relief the concept of the "post-wounded woman," a modern opposition to the "wounded woman" trope that asserts societal notions of female pain have rendered women's relationship to their emotions full of disadvantage as they must yield control over how they are perceived. Emotions such as rage and anger are deemed impermissible by society because they challenge essentialist notions of the female condition. However, new female archetypes are appearing in animation alongside classical depictions, placing the medium ahead of traditional sexist societal views in this respect.