Manifestations Of Pain Research Articles

Sex differences in pain-related behaviors and clinical progression of disease in mouse models of colonic pain.

Previous studies have reported sex differences in patients with irritable bowel syndrome and inflammatory bowel disease, including differences in visceral pain perception. Despite this, sex differences in behavioral manifestations of visceral pain and underlying pathology of the gastrointestinal tract have been largely understudied in preclinical research. In this study, we evaluated potential sex differences in spontaneous nociceptive responses, referred abdominal hypersensitivity, disease progression, and bowel pathology in mouse models of acute and persistent colon inflammation. Our experiments show that females exhibit more nociceptive responses and referred abdominal hypersensitivity than males in the context of acute but not persistent colon inflammation. We further demonstrate that, after acute and persistent colon inflammation, pain-related behavioral responses in females and males are distinct, with increases in licking of the abdomen only observed in females and increases in abdominal contractions only seen in males. During persistent colon inflammation, males exhibit worse disease progression than females, which is manifested as worse physical appearance and higher weight loss. However, no measurable sex differences were observed in persistent inflammation-induced bowel pathology, stool consistency, or fecal blood. Overall, our findings demonstrate sex differences in pain-related behaviors and disease progression in the context of acute and persistent colon inflammation, highlighting the importance of considering sex as a biological variable in future mechanistic studies of visceral pain as well as in the development of diagnostics and therapeutic options for chronic gastrointestinal diseases.

Acute urticaria in patients with COVID-19

Information about the epidemiology, clinical features, prevention and treatment of a new coronavirus infection caused by the SARS-CoV-2 virus is continuously updated and updated. The most common clinical manifestations of COVID-19 are hyperthermia, symptoms of intoxication, cough, shortness of breath, decreased sense of smell and taste, less often abdominal pain, vomiting, diarrhea and other extrapulmonary manifestations. The main target of SARS-CoV-2 is type II alveolar cells, which defines lung damage as the main clinical manifestation of COVID-19. Damage to the neurons of the brain and glia leads to neurological symptoms (fever with headaches, loss of sense of smell, taste, ataxia and seizures). Immunological complications leading to cytokine storm syndrome and acute respiratory distress syndrome play a special role in the pathogenesis of COVID-19 coronavirus infection.
 Recently, clinical observations have been increasingly appearing describing dermatological skin lesions as a variant of the manifestation of COVID-19 coronavirus infection, including at the onset of the disease, i.e. before the appearance of any signs of the disease. The specificity of skin symptoms in COVID-19 has not yet been proven, and some authors use the term unexplained skin manifestations of COVID-19.
 The article presents a description of clinical cases of acute idiopathic urticaria at the onset of COVID-19, that does not respond to treatment with antihistamines. On the skin of the chest, abdomen, back, buttocks, arms and legs of patients, multiple, edematous, merging, bright pink, various sizes of urticaria were observed, appearing simultaneously with weakness, partial loss of taste, smell, muscle pain, temperature rise to 3839С. Taking a single dose of the glucocorticoid combined drug betamethasone improved the patients condition within a day; in a man on the 7th day and in a woman on the 3rd day of antiviral therapy with favipiravir, all rashes disappeared. In the general blood test after 2 weeks of treatment, a slight negative dynamics was noted: in a man ― absolute leukopenia (3.6109/l), relative lymphocytosis (51%), an increase in ESR up to 28 mm/h, in a woman ― absolute leukopenia (3.4109/l), relative lymphocytosis (57%). The patients were discharged after a month of treatment with antiviral drugs in satisfactory condition with two negative PCR results for COVID-19.
 The data obtained suggest that acute urticaria that cannot be treated with antihistamines in COVID-19 can be considered one of the variants of the course of a new coronavirus infection (SARS-CoV-2), and require further in-depth study.

Results of an open multicenter non-interventional study of clinical efficacy and tolerability of etoricoxib in osteoarthritis and nonspecific back pain with additional evaluation of the effect of the drug on the «central» manifestations of pain

The formation of chronic musculoskeletal pain (MSP) is a multifactorial process, in its pathogenesis mechanism of central sensitization (CS) plays an important role.Objective: to evaluate the effectiveness of etoricoxib at a dose of 60 mg per day in diseases accompanied by moderate/severe chronic MPS, with an additional analysis of the effect of this drug on the manifestations of CS.Patients and methods. An open observational study, 790 patients (71.6% women, mean age 54.5±13.0 years) with osteoarthritis and chronic nonspecific back pain received etoricoxib 60 mg/day for 2 weeks. The dynamics of pain, dysfunction, fatigue, sleep disturbances, general health assessment (GHA) on a numerical rating scale (NRS 0–10), as well as signs of CS according to part A of the CSI questionnaire were assessed.Results and discussion. After 2 weeks, the intensity of pain during movement, at rest and at night decreased on average by 58.8±24.1, 69.7±32.6 and 70.1±32.8% respectively; functional insufficiency by 58.2±22.5%, fatigue by 52.2±25.8%, GHA by 50.0±22.6%, sleep improvement by 54.3±25.8% was observed (p<0.001 for all parameters). There was a decrease in the CSI value by an average of 33.1±14.5% (p<0.001), as well as a decrease in the number of patients with highly probable CS (CSI ≥40) from 35.3 to 10.3% (p<0.001). No serious drug-related complications were recorded. The overall frequency of adverse reactions was 5.9%, with dyspepsia and hypertension being the most common.Conclusion. Etoricoxib is an effective and relatively safe treatment for chronic MSP. It reduces the severity of CS, one of the central mechanisms of the pathogenesis of chronic MSP.

The Effects of Ozone Therapy on the Expression of IL-8, IL-10, CXCL9 and CXCL11 in Joint Fluid in Patients with Knee Osteoarthritis

Knee joint is one of the common sites of osteoarthritis (OA) with manifestation of localized joint swelling, pain and deformity, often seriously affecting daily work and life. It was found that the activation of Janus kinase / signal transducer and activator of transcription 3 (JAK / STAT3) signal pathway can lead to osteoarthritis. JAK-STAT signal transduction pathway is closely related to painful diabetic peripheral neuropathy and participates in neuropathic pain. Ozone therapy is often used for alleviating pain in neck, shoulder, waist and leg due to its oxidative, anti-inflammatory and analgesic effects. In recent years, ozone therapy is promising in treating knee osteoarthritis, which can significantly reduce the pain and swelling of the joints. The mechanism of ozone for knee osteoarthritis remains unclear and might associated with inhibition of inflammatory factors and matrix metalloproteinase activity, and intervention of free radical metabolism. In this study, the efficacy of ozone in the treatment of OA and its effect on inflammatory factors were evaluated by knee joint cavity ozone injection and detecting the expression of inflammatory factors IL-8, IL-10, CXCL9 and CXCL11 in joint fluid.

Fascia in Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is described as the muscle, sensory, motor, and autonomic nervous system symptoms caused by stimulation of myofascial trigger points (MTP), but the participation of fascia in this syndrome has often been neglected. This presentation will explore the important contribution of structural and functional alterations of the deep fascia to the pathophysiology and clinical manifestation of MPS. The interaction of the three dimensional fascial system, with the dynamic nature of sensitization, will be presented in the context of the pathophysiology of MTP and the expression of quantitative, reproducible physical findings in the clinical manifestation of chronic myofascial pain. Emphasis will be given to recent developments in the biology of fascia, and in particular, its hyaluronan (HA)‐rich matrix content that provide a viscoelastic property possible cause of MPS. The presentation will translate these findings to highlight novel clinical directions in the diagnosis and non‐pharmaceutical management of MPS.

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review.

Spontaneous spinal subdural hematoma (SSDH) is a rare and dangerous intraspinal hematoma that usually occurs in the thoracic vertebra. The influence of early cardiovascular changes secondary to spinal cord injury is an important emergent issue.Herein, we report a case of a middle-aged woman with clinical manifestations of back pain and motion and sensory disturbances below the level of spinal cord compression. During the disease course, she also developed changes indicative of myocardial injury, such as tachycardia, markedly increased concentrations of brain natriuretic peptide and cardiac troponin I, and a decreased left ventricular ejection fraction, which were consistent with the diagnosis of Takotsubo cardiomyopathy (TTC). After the administration of supportive therapies, the symptoms of myocardial injury rapidly resolved. With the absorption of SSDH, the symptoms and clinical signs were alleviated. We also reviewed the literature on cases of concomitant SSDH and TTC.This rare case broadens the symptom spectrum of SSDH and highlights the need for clinicians to be aware of concomitant SSDH and TTC. Initial conservative treatment is a viable option for SSDH with concomitant TTC. However, urgent surgery may be a better option if the SSDH progressively enlarges and causes spinal cord compression.

Differentiated approach to the treatment of external genital endometriosis as prevention of recurrence

The objective: to evaluate the effectiveness of a differentiated approach in the postoperative management of patients with external genital endometriosis (EGE) to determine the regression of clinical symptoms and reduce the number of recurrences. Materials and methods. 207 patients with different forms of EGE after surgical treatment of the endometriosis foci removal were examined. After the determination of the prevalence of the pathological process (intraoperatively), the subjects were divided into three groups. A1 group (n=67) included women with severe disease who had an optimized approach for postoperative management. A2 group (n=75) included patients with moderate severity of EGE and the traditional treatment approach. B group was a comparison group (n=65) and was formed from patients with severe disease who were traditionally treated.Clinical-anamnestic, laboratory, morphological, immunohistochemical methods, gynecological examination data, ultrasound examination of the pelvic organs were used during the examination of women with EGE; magnetic resonance imaging (MRI) – if necessary. The standard approach included surgical treatment (laparoscopic method), removal of visible endometrioid heterotopias and the medical treatment from the 1st day of the next menstrual cycle after surgery (progestins (dienogest 2 mg) for 6 months or gonadotropin-releasing agonists in the presence of comorbidity of hyperplastic processes for 3-6 months in combination with add-back therapy). In the absence of reproductive plans combined oral contraceptives or intrauterine levonorgestrel-releasing system were used. Patients were observed for 1 month, 1 year after surgery, and then once a year. The optimized approach included surgery (laparoscopy or laparotomy) with the removal of endometrioid heterotopias, use of nonsteroid anti-inflammatory drugs in the postoperative period for 5 days, then dienogest 2 mg for 3-6 months was used by the cases of algomenorrhea and other manifestations of pain. The pathogenetic therapy was started on the 2nd or 3rd day of the postoperative period. Patients were observed for 2 months after surgery, then every 3 months for 1 year. The severity of pain was assessed on the Biberoglu and Behrman (B’n’B) and Numerical Rating Scale (NRS) scales. Recurrence of the disease was diagnosed in the presence of endometrioid heterotopia according to ultrasound examination and/or MRI, as well as the appearance of clinical complaints (pain) in 6 months after their absence.Results. In one year after the first surgery, recurrence of the disease was found in 13.43 % of women in A1 group, 12 % – A2 group and 24.61 % – B group. The average value of pain on the NRS scale in 12 months after treatment was 3.26 points in A1 group, 2.47 – A2 group and 1.59 – B group, on the B’n’B scale - 1.94, 1.61, and 1.40 points, respectively. Conclusions. The applying an optimized approach in the management of patients with severe and moderate external genital endometriosis (more radical surgery, the prescription at once in the postoperative period the hormonal therapy and nonsteroid anti-inflammatory drugs, more frequent observation after surgery) compared with traditional treatment lead to decrease the pain severity on 3.26 points on the Biberoglu and Behrman scale and 1.94 points – the Numerical Rating Scale, and reduce the recurrence rate by 45.4%.

The Imaging Diagnosis of Patients with Shoulder Pain Caused by Sports Injury.

The shoulder joint is the most complex and movable joint of the human body. A variety of diseases can affect the shoulder joint and cause shoulder pain. Sports injuries are an important and common cause of shoulder pain. In the clinical diagnosis of shoulder joint injury, the most commonly used diagnostic methods are X-ray photography and CT imaging, but X-ray photography has poor ability to distinguish shoulder joints and other tiny tissue structures and has a sense of inspiration for shoulder joint injuries. In addition, CT arthrography has a certain risk to the lesion and is easy to form trauma, and it cannot clearly show the shoulder joint structures such as the rotator cuff and the labrum. Therefore, this article conducts MR imaging diagnostic research on patients with shoulder pain caused by sports injuries and plays an important role in imaging. This article deeply studied the clinical manifestations of shoulder joint pain and image processing technology, designed a research experiment on imaging diagnosis results of patients with shoulder joint pain caused by sports injuries, selected 87 patients with shoulder joint pain in a hospital, and analyzed X-ray photography, CT imaging, and MR imaging diagnosis, three methods to compare the diagnostic accuracy and inspection results and conduct an in-depth analysis of the causes of shoulder joint injury. The experimental results showed that there were 87 patients with shoulder joint pain, 65 patients with rotator cuff tear were diagnosed using arthroscopy, and 63 patients with rotator cuff tear were diagnosed by MR imaging. The accuracy rate was as high as 95.6%. Among them, the proportion caused by sports injuries is the highest, reaching 56%.

Динаміка експресії генів факторів транскрипції Т-клітин та інтерлейкінів на тлі пробіотичної терапії хронічних гастродуоденітів у дітей

Chronic gastroduodenitis (HGD) in children is one of the most common diseases of the digestive tract in children, the treatment of which needs to be improved. Purpose - to study the effectiveness of Lactobacillus rhamnosus GG ATCC 53103 (LGG) in the treatment of children with chronic gastroduodenitis and the effect of treatment on the expression of pro- and anti-inflammatory cytokines and T-lymphocyte transcription factors in the buccal mucosa. Materials and methods. We examined 39 children with chronic gastroduodenitis aged 10-14 years, of which 2 comparison groups were formed. The main group (n=21) included patients for whose treatment, in addition to traditional therapy, a probiotic drug was containing 5×109 lyophilized viable bacteria LGG. The control group (n=18) was represented by patients receiving only traditional therapy. The duration of treatment with probiotic LGG was 14 days. To prove the effectiveness of LGG in therapy, the level of mRNA expression of transcription factors (Tbet, RORyt, FOXP3) of T cells and interleukins (IL-1β, IL-17α, IL-10) was determined by polymerase chain reaction with reverse transcription. Results. The period of CGD exacerbation was characterized by an increase in the expression level of mRNA of the RORyt transcription factor of Th17-cells and mRNA of IL-1β, IL-17α in the buccal mucosa. After standard therapy in children with CHD, there was a significant increase in the activity of mRNA expression of the transcription factor Tbet of Th1-cells and a decrease in the activity of mRNA expression of the RORyt of transcription factor Th17-cells. After treatment with combination therapy using a probiotic preparation containing LGG, there was also a decrease in the activity of mRNA expression of the RORyt transcription factor of Th17-cells, but in contrast to children who received standard therapy, there was a low level of mRNA of the transcription factor Tbet of Th1-cells and mRNA IL-17α; in combination with an increased level of mRNA of the FOXP3 transcription factor of Treg-cells. Conclusions. The appointment of a combination therapy using a probiotic preparation containing Lactobacillus rhamnosus GG in children with chronic gastroduodenitis contributes to the rapid regression of the clinical manifestations of pain, dyspeptic syndromes. The administration of LGG leads to a more rapid decrease in the level of expression of the IL-17 genes due to an increase in the activity of mRNA expression of the FOXP3 of Treg-cells. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: chronic gastroduodenitis, children, transcription factors, interleukins, probiotic therapy, Lactobacillus rhamnosus GG.

773 BARRIERS TO RECOGNISING PAIN IN PATIENTS WITH DEMENTIA AND DELIRIUM ON A HEALTHCARE OF THE ELDERLY INPATIENT WARD

Abstract Introduction Pain is often poorly recognised and remains under-treated in older patients, especially those who are unable to articulate their discomfort. In those with severe cognitive impairment or communication difficulties, recognition of the non-verbal manifestations of pain is needed to ensure patient comfort. Understanding how likely these patients are to have pain, how we improve recognition of the signs of discomfort, and encouraging doctors to think about prescribing analgesics will allow these patients to retain their dignity, and reduce their physical and psychological distress during their inpatient stays. Method Over two periods in 2019–2020, pre and post introduction of Abbey Pain Scale. Inpatients on a HCE ward >65 years old Diagnosis of dementia and/or delirium Review of pain scores on the observation charts, analgesia and documentation of sources of pain. Results 75 patients were reviewed, 39% with delirium, 45% with dementia Pain was often not considered during medical assessments, even if patients had presented with a fall 56% had a potential source of pain identified either in their medical or nursing notes, however there was disparity between these The majority of sources of pain were chronic joint issues or injuries sustained from falls Patients had their observations checked 2–4 times/day. A pain score was entered 56% of the time and less frequently in: diabetics (due to chart layout), long-stayers and those who refused their observations Use of the Abbey Pain Scale made no significant difference. Conclusion (s). Disparity between notes highlighted a gap in communication. There is a risk of complacency with long-staying patients. Ketone readings are recorded over the pain score area on the observation charts, this needs to change. Refusing observations may be a sign of pain and staff should be more vigilant in these cases. A more integrative tool to monitor pain is required.

NMDA receptor antagonist amantadine in treatment of neuropathic orofacial pain

Neuropathic orofacial pain caused by trauma to the distal branches of the trigeminal nerve is most often an iatrogenic complication in the practice of dentists, maxillofacial surgeons, ENT surgeons, cosmetologists and plastic surgeons. The pain is often high-intensity, persistent, and difficult to treat with pain medications. Early signs of spontaneous pain aggravate the course of the disease. There is evidence of the use of N-methyl-d-aspartate (NMDA) receptor antagonists in the treatment of neuropathic pain in the practice of oncologists and diabetologists. The present study was designed to test the efficacy of administration of the NMDA receptor antagonist amantadine (PK-Merz) in the treatment of neuropathic orofacial pain in patients with posttraumatic trigeminal neuropathy (PTN). Our task was to study the effect of amantadine (PK-Merz) on spontaneous burning and evoked types of pain.Objective.To present a treatment protocol using amantadine (PK-Merz) and evaluate the effect of a three-time infusion of the drug on the clinical manifestations of pain in patients with post-traumatic trigeminal neuropathy.Materials and methods.30 patients were examined (22 women, 8 men). The average age is 42.6 years. Patients are experiencing amantadine (PK-Merz, Merz + Co., Germany) – 200 mg (500 ml) intravenously, drip, for 2 hours with a frequency of 1 time per week. A total of three infusions were performed. Spontaneous and evoked pain was measured within 48 hours before treatment, during treatment (after 1 hour), immediately after infusion (after 2 hours), as well as after 7, 14 and 21 days from the start of therapy. The effectiveness of therapy was studied according to the highest criteria: VAS, questionnaires for neuropathic pain DN 4 and Pain DETECT. Spontaneous and induced pain were considered separately. To assess the immediate effects of treatment, spontaneous pain was measured using a visual analog scale (VAS) before, after 1 hour, and at the end of each treatment (after 2 hours), as well as at visits on days 7th, 14th, and 21st. A series of mechanical and thermal stimuli was applied to each patient before, after 1 hour, and at the end of each treatment session to study the pain evoked. Pain caused by these stimuli was also measured using VAS.Results.The patients were divided into two groups, which were formed according to the duration of the disease. Group 1 (n = 12) included patients in the acute period – the time after nerve injury ranged from 5 to 30 days. In group 2, patients were in subacute and chronic periods (time after injury ranged from 30 days to 1.5 years). The mean score of spontaneous pain according to VAS in patients of group 2 was significantly higher than in patients of group 1 (6.1 ± 2.1 vs 4.2 ± 1.6; p = 0.0001). A mean pain reduction of 71 % was reported at the end of amantadine infusion (after 2 hours) in patients in the acute period (Group 1) compared with 29 % in patients in Group 2. The difference in pain reduction between the two patient groups was statistically significant (p = 0.009). Further dynamics of pain also showed the best analgesic result in patients of group 1 – after the completion of treatment with amantadine (PK-Merz), in patients of group 1, a significant decrease in the average score of spontaneous burning pain according to VAS was demonstrated from 4.2 ± 1.6 points to 1.2 ± 1.1 points (p = 0.006; 71 ± 10 % reduction). After treatment of patients in group 2, only a slight and insignificant decrease in VAS was found from 6.1 ± 2.1 to 5.0 ± 1.7 (p = 0.400; 18.0 ± 8.5 %). Symptoms of induced pain were determined mainly among patients of the 2nd group – allodynia (n = 12), hyperalgesia to a needle prick (n = 10), thermal (cold) hyperalgesia (n = 10), "inflated" pain in response to repeated injections (n = 10). A mean decrease in allodynia of 52 % ± 8 % was found at the end of the course of treatment (3.8 ± 1.1 points at the beginning and 1.9 ± 1.1 points at the end; p = 0.006). Indicators of cold hyperalgesia (4.4 ± 1.4 points at the beginning, 2.7 ± 1.4 points at the end; p = 0.004) and ‘inflated’ pain (2.9 ± 1.1 points at the beginning, 1.5 ± 1.2 at the end; p = 0.004) before treatment and at the end of therapy (after 21 days) also differed significantly.Conclusions.We concluded that amantadine (PK-Merz) infusion is a safe and effective treatment for neuropathic pain in the acute period of KITN, and also has a positive effect on the manifestations of induced pain in patients with chronic orofacial pain. Further trials of long-term oral or parenteral treatment with amantadine should be conducted.

Laporan Kasus Karsinoma Sel Skuamosa yang Berkembang dari Papiloma Tipe Inverted Sinonasal pada Pekerja Pabrik Cermin

Background. Sinonasal inverted (PI) papilloma is a benign tumor of the mucosal epithelium of the nasal cavity and paranasal sinuses with an endophytic growth pattern. PI is more common in men in the fifth and sixth decades of life. These tumors have local aggressive behavior, high recurrence rates, and can undergo malignant transformation. Squamous cell carcinoma (SCC) is the most common malignancy developed from sinonasal PI. SSC developed from PI (KSS/PI) is related to exposure in the work environment.
 Methods. We report a sinonasal SCC/PI case by describing the clinical manifestations, radiological features, and histopathological features of a young male patient who was a non"‘smoker mirror"‘making factory worker.
 Results. Clinical manifestations of pain, epistaxis, and proptosis in patients suggest malignancy. Computed Tomography (CT) results showed lesions of the nasal cavity and paranasal sinuses with bone destruction and expansion of the mass to the intracranial point of the aggressive behavior of the tumor. Microscopic histopathological examination revealed endophytic squamous epithelial growth characteristic of an inverted papilloma accompanied by cell atypia, invasive components, connective tissue desmoplasia, and keratin pearls, suggesting a well"‘differentiated keratinized squamous cell carcinoma that developed from the sinonasal inverted papilloma. Exposure to dust in the work environment is related to malignancy in this patient.
 Conclusion. Support of clinical and radiological data, adequate sampling, and identification of malignancy morphology routinely on histopathological examination is critical to avoid misdiagnosis of sinonasal SCC/PI. A complete history directed at extracting risk factors can add value in establishing a diagnosis.

Clinical and Joint Pain Manifestations of Zoonotic Tropical Diseases Endemic to Kenya

Clinical and Joint Pain Manifestations of Zoonotic Tropical Diseases Endemic to Kenya

Women and Photography in Africa: Creative Practices and Feminist Challenges

Women and Photography in Africa: Creative Practices and Feminist Challenges

Exploring the intersection of adverse childhood experiences, pediatric chronic pain, and rheumatic disease

BackgroundWhile the general relationship between ACEs and the development of chronic pain has become increasingly clear, how ACEs may shape a child’s clinical presentation with regards to chronic pain has yet to be fully expounded. We aimed to determine the association between ACEs and clinical manifestations of pediatric chronic pain and explore the interaction of ACEs and pediatric rheumatic disease among youth with chronic pain on health-related outcomes.MethodsWe conducted a cross-sectional cohort study of patients aged ≤18 years with chronic pain seen in a pediatric rheumatology amplified pain clinic between August 2018 and July 2020. We stratified subjects into three groups: no ACEs, one ACE, and ≥ 2 ACEs. We assessed clinical signs and symptoms associated with the presence of ACEs using Chi-square or Wilcoxon-rank test. The association between ACEs as well as other variables of interest with functional impairment was tested using simple and multivariable linear regression.ResultsOf the 412 patients included, more than 75% of patients reported at least one ACE. Most frequent included history of mental illness in a first degree relative (56%) and parental divorce or separation (20%). Those with ≥2 ACEs had more somatic symptoms, worse functional disability, and a higher proportion of mental health conditions. There appeared to be a dose dependent interaction between ACEs and functional disability from co-morbid rheumatologic disease. In multivariable regression, higher verbal pain score, symptom severity score (SSS), and presence of autonomic changes were associated with estimated average increase in FDI score (β = 1.05, 1.95 and 4.76 respectively; all p < 0.01).ConclusionChildren with chronic pain and/or rheumatologic diseases who are exposed to ACEs are at increased risk of greater symptomatology, functional disability, and somatization of symptoms. Our findings indicate an ongoing need for systemic evaluation of ACEs in children with chronic pain and/or rheumatic disease and incorporation of trauma-based care.

Rasagiline Withdrawal Syndrome in Parkinson's Disease.

Parkinson’s disease (PD) patients using dopamine agonists can develop withdrawal symptoms, referred to as dopamine agonist withdrawal syndrome (DAWS), under dose tapering or discontinuation of these drugs. DAWS includes a severe stereotypical cluster of psychiatric and psychological symptoms encompassing severe mood and anxiety disturbances, autonomic symptoms, as well as generalized pain and drug cravings. However, symptoms of withdrawal of dopamine replacement therapies (DRT) are not simply limited to dopamine agonists tapering, as observed in PD patients on deep brain stimulation after dopaminergic drugs withdrawal related to surgery. To date, no DRT-related withdrawal syndrome has been described in PD patients who discontinue rasagiline, an irreversible inhibitor of monoamine oxidase-B (MAO-B). Here we report three PD patients who developed a severe withdrawal syndrome after rasagiline suspension. The syndrome was mainly characterized by prominent psychiatric disorders (depression, anxiety with panic attacks, dysphoria, and agitation) associated with fatigue, generalized pain, and autonomic manifestations (closely resembling symptoms of DAWS). In our opinion, this report suggests the importance of closely monitoring PD patients undergoing rasagiline suspension for withdrawal symptoms and provides interesting points of reflection on the role of rasagiline and other MAO-B inhibitors in mood disorders.

Normal range of motion at the hip show different pressure behavior in the lateral and acetabular compartments: a cadaveric investigation

PurposeThe techniques used previously to assess intracapsular pressures did not allow the assessment of pressure variations in both compartments throughout the entire range of motion without puncturing the capsular tissue. Our hypothesis was that the intra-capsular pressure would be different in the lateral and acetabular compartment depending on the movement assessed.MethodsEight hip joints from four cadaveric specimens (78.5 ± 7.9 years) were assessed using intra-osseous tunnels reaching the lateral and acetabular compartments. Using injector adaptors, 2.7 ml of liquid were inserted in both compartments to simulate synovial liquid. Optic pressure transducers were used to measure pressure variations. We manually performed hip adduction, abduction, extension, flexion and internal rotation at 90° of flexion.ResultsHip extension and internal rotation show the highest intra-capsular pressures in the lateral compartment with increases of 20.56 ± 19.29 and 19.27 ± 18.96 mmHg, respectively. Hip abduction and hip internal rotation showed depressurisations of − 16.86 ± 18.01 and − 31.88 ± 30.71 mmHg in the acetabular compartment, respectively. The pressures measured in the lateral compartment and in the acetabular compartment were significantly (P < 0.05) different for the hip abduction, 90° of flexion and internal rotation. Pressure variations showed that maximum intracapsular fluid pressures in the lateral compartment occur at maximum range of motion for all movements.ConclusionAs an increase in pressure may produce hip pain, clinician should assess pain at maximum range of motion in the lateral compartment. The pressure measured in the acetabular compartment vary depending on the hip position. The movements assessed are used in clinical practice to evaluate hip integrity and might bring pain. The pressure variations throughout the entire range of motion are a relevant information during hip clinical assessment and might help clinicians to better understand the manifestations of pain.

Approaching phantom complex after limb amputation in cats

The aims of this study were to describe the presence, clinical manifestations, risk factors, quality of life and measurement of mechanical nociceptive threshold of phantom limb complex in a feline population that underwent amputation of a limb. A questionnaire was developed containing 3 sections with a total of 71 closed-end questions. Clinical cases were retrospectively reviewed. The evaluation of mechanical nociceptive threshold was conducted applying an algometer at the level of the stump of the amputated limb and exerting a gradually increasing pressure. Descriptive statistics and frequency distribution analyses were performed on the collected data. Chi-squared test or Fisher's exact test were used for assessment of the associations between categorical variables. A total of 27 amputee cats were included in the study. All owners answered the questionnaire, and the mechanical nociceptive threshold assessment was conducted in 44% (N = 12/27) patients. The most frequent reason for amputation was related to trauma. The presence of pain after limb amputation has been commonly described by owners. The time between diagnosis and amputation was found to be significantly associated with the presence of pain after amputation. The majority of owners described different manifestations of pain or discomfort both before and after amputation, with environmental and physical stress described as related to the onset of pain in some cases. Furthermore, a significant reduction of the nociceptive threshold in the amputated region was noted. This pilot study introduces previously unreported signs that may be interpreted as expressions of pain in amputee cats.

Do difficulties in emotional processing predict procedure pain and shape the patient’s colonoscopy experience?

ObjectivesPain and fear of colonoscopy are inter-related; they make the colonoscopy experience unpleasant and impede adherence to colorectal cancer screening and prevention campaigns. According to previous research, fear and pain...

Vitamin D Effect on the Severity of Chronic Pelvic Pain in Patients with Ovarian Endometriosis Combined with Pelvic Inflammatory Diseases

Numerous publications in recent years indicate the impact of vitamin D deficiency on the course and severity of a number of gynecological diseases, including endometrial disease. As this transmitter is associated with immune disorders, its involvement in local immunosuppression in the progression of the systemic inflammatory response in the case of endometrial disease is not excluded. Considering the pathogenetic links between vitamin D metabolism and the severity of pelvic pain, it became appropriate to study the relationship between this parameter and the intensity of pelvic pain in patients with ovarian endometriomas associated with chronic pelvic inflammatory diseases, which was the objective of this research. Materials and methods of research. The study included 90 patients with ovarian endometriosis aged 20 to 41 years. The main group consisted of 44 patients with endometrioma combined with pelvic inflammatory diseases; the comparison group consisted of 46 patients with isolated ovarian endometrioma. The control group included 30 relatively healthy women without gynecological and somatic pathology. At the initial stage, the level of 25-hydroxyvitamin-D3 (25 (OH) D) was determined in patients of the three groups by mass spectrometry using standard methods. Analysis and discussion of research results. Patients with ovarian endometrial cysts on the background of pelvic inflammatory disease were statistically significantly older compared with the group of isolated endometriomas; more than half of the observations were patients aged 36-40 years (p&lt;0.05). Laparoscopic diagnostic and therapeutic techniques allowed to present objective signs of combination of ovarian endometrioma with manifestations of external genital endometriosis: severe manifestations of external genital endometriosis were diagnosed in 31.8% vs. 15.21% in the comparison group. Depending on the severity of the pain syndrome according to VAS, patients of the main group were stratified as follows: 22.7% noted pelvic pain of low intensity, 40.9% – moderate pain, 25.0% – severe pain; in the comparison group there were no manifestations of severe pelvic pain. The combination of pelvic inflammatory disease with ovarian endometriosis was accompanied by an increase in the share of vitamin D deficiency – in 38.64% and the share of severe pain – in 25.0%.&#x0D; Conclusion. A significantly moderate inverse correlation was found between the verification of the manifestations of external genital endometriosis and the level of vitamin D in the blood serum. The obtained data dictated the need to assess the therapeutic potential of vitamin D in combination with nonsteroidal anti-inflammatory drugs to enhance the analgesic effect and reduce the drug load.