Medications For Treatment Of Pain Research Articles

Algologies: an artistic exploration of the entangled relationship between seaweed, women and science through a BioArt methodology

ABSTRACT This paper describes the “Algologies” project, an art project about seaweed exploring the entangled relationships between seaweed, women and science. The project was created in 2021, during the COVID-19 Pandemic, through the Living Coast Art Residency awarded by Fabrica Gallery and The Living Coast UNESCO World Biosphere and the coastline to the East of Brighton. The project plays with the Victorian word algology which used to mean the study of seaweed and its contemporary meaning as the study and medical treatment of pain and highlights the calming nature of the coastal environment during a time of collective global trauma. The “Algologies” project drew links between Victorian seaweed collectors, the use of seaweed-based agar jelly in contemporary biology, and seaweed growth as a barometer of climate change and the environment as well as a strategy for carbon capture. The transdisciplinary project fused fine art, performance and BioArt techniques with biohacking and DIY science, as well as digital technologies and resulted in a series of outputs including a public sculpture. Central to “Algologies” was the examination of the historical role of women in seaweed collection and scientific observation. In Victorian Britain, where patriarchal norms prevailed, women were often relegated to domestic roles but found opportunities for scientific engagement through activities like seaweed collecting. Figures such as Mary Philadelphia Merrifield and Anna Atkins emerged as pioneers in the study of seaweed, making significant contributions to botanical research and early photographic techniques. Notably, the project highlighted the pivotal role of Angelina (Lina) Fannie Hesse in suggesting the use of seaweed-derived agar in microbiology, a contribution that continues to impact scientific practices today. Beyond historical perspectives, “Algologies” addresses contemporary issues such as climate change and invasive species of seaweed and how the public can be engaged in these topics through art. The paper concludes by discussing the potential of seaweed for carbon capture and its role as a barometer of environmental health, as well as its use biotechnology

Association of cannabis use with patient-reported pain measures among adults with chronic pain in US states with medical cannabis programs

IntroductionMost Americans live in a state that has legalized cannabis as a medical treatment for pain, but it is unclear how chronic pain intensity relates to cannabis use. Our objective...

Demographic Characteristics and Pain Treatments of Patients Applying to the Algology Polyclinic of Firat University Medical Faculty

Aim: The aim of this study is to retrospectively evaluate the patients who were admitted to the Algology polyclinic with pain, focusing on their sociodemographic characteristics, types of pain, and pain management. Materials and Methods: In this study, the pain assessment forms of patients who presented to our Algology polyclinic with pain complaints between January 2022 and December 2022 were examined. The sociodemographic characteristics of the patients, pain properties, and treatments administered were retrospectively evaluated. Results: Within one-year period, a total of 2001 patients have been admitted to our clinic. 75.5% of the patients were between the ages of 15 and 64. The average age of men was found to be significantly lower than the average age of women. 71.7% of the patients were overweight or obese, with obesity being more prevalent in women. Additionally, 69.8% of the patients had at least one comorbidity, with cardiovascular disease (CVD) and diabetes mellitus (DM) being the most common. The most common causes of pain were low back pain, neck pain, myofascial pain, and knee pain. The Visual Analog Scale (VAS) score was found to be 6.64. Interventional pain treatment was applied to 53.3% of the patients, with the most common methods were caudal epidural injection, cervical epidural injection, and ozone trigger point injection. Conclusion: Close examination of patients' responses to treatment and knowledge of sociodemographic characteristics are important. In addition to well-planned medical treatment for pain, we believe that interventional pain treatment can alleviate patients' pain, improve their quality of life, and potentially prevent work loss due to chronic pain.

Association Between Pain Severity, Pain Beliefs, Pain Coping and Attitudes Towards Complementary and Alternative Treatments among Physical Therapy Patients

Objective: The study aimed to determine the correlation between pain severity, pain beliefs, pain coping, and attitudes toward complementary and alternative treatments among physical therapy patients.
 Methods: This cross-sectional and analytical was conducted in a physical therapy and rehabilitation hospital in north-eastern Turkey. The sample consisted of 150 physical therapy patients. Data were collected using Demographic Information Form, Pain Beliefs Questionnaire, Pain Coping Questionnaire, and Attitudes towards Complementary and Alternative Medicine Questionnaire. Spearman’s Correlation Analysis and Multiple Linear Regression Analysis were used in data analysis.
 Results: The study revealed that the patients had negative attitudes towards complementary (13.64 ± 4.00) and alternative medicine use (13.18 ± 4.14). The scores were moderate for the patients' psychological (18.62 ± 3.69) and organic belief (33.68 ± 5.17). A significant correlation was determined between patients’ attitudes towards complementary medical treatment and conventional medical treatment for pain (p=0.020). The patients had moderate pain intensity (5.70±2.44), and there was a significant correlation between pain intensity and attitudes towards alternative medicine (p=0.012).
 Conclusion: Physical therapy patients’ attitudes towards complementary and alternative medicine are associated with pain coping and severity. The patients should be educated to cope with pain and manage it by health professionals.

Pain Catastrophizing Influences Preoperative and Postoperative Patient-Reported Outcomes in Adolescent Idiopathic Scoliosis.

Patients with adolescent idiopathic scoliosis (AIS) often report chronic back pain; however, there is inadequate research on psychological factors associated with pain in this patient population. Pain catastrophizing, a psychological factor that describes a pattern of negative thoughts and feelings about pain, has been associated with poorer responses to medical treatment for pain. The purpose of this study was to report the prevalence of pain catastrophizing in the AIS population and assess its relationship with preoperative and postoperative self-reported outcomes. In this prospective cohort study of consecutive patients undergoing posterior spinal fusion (PSF) for AIS, patients experiencing clinically relevant pain catastrophizing, defined as a Pain Catastrophizing Scale for Children (PCS) score in the 75th percentile or higher, were compared with patients with normal PCS scores. Preoperative and 2-year postoperative Scoliosis Research Society Society Questionnaire-30 (SRS-30) scores were correlated with the preoperative PCS score. One hundred and eighty-nine patients underwent PSF for AIS, and 20 (10.6%) were considered to be experiencing pain catastrophizing. Despite comparable demographic and radiographic variables, pain catastrophizing was associated with significantly lower preoperative scores than were found in the normal-PCS group in all SRS-30 domains, including pain (2.98 versus 3.95; p < 0.001), appearance (2.98 versus 3.48; p < 0.001), activity (3.51 versus 4.06; p < 0.001), mental health (3.12 versus 4.01; p < 0.001), and total score (3.18 versus 3.84; p < 0.001), except satisfaction (3.72 versus 3.69; p > 0.999). At 2 years, the pain catastrophizing group experienced significant improvement from their preoperative scores in most SRS-30 domains, including a large clinically relevant improvement in pain (from 2.98 preoperatively to 3.84 postoperatively; p < 0.001) and the total score (from 3.18 to 3.85; p < 0.001), but continued to have lower scores than the normal-PCS group for pain (3.84 versus 4.22; p = 0.028) and the total score (3.85 versus 4.15; p = 0.038). Receiver operating characteristic (ROC) curve analysis indicated that an SRS-30 pain score of <3.5 has good sensitivity for predicting pain catastrophizing (PCS ≥75th percentile). In this cohort, patients with AIS who exhibited pain catastrophizing experienced significant improvement in self-reported health 2 years after PSF. However, they did not have the same levels of self-reported health as the normal-PCS group. Pain catastrophizing may be identifiable by lower preoperative SRS-30 pain scores. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Chronic Pain and Prescription Opioid Use Among Socially Marginalized Nigerian Women: Exploring Supply Channels and Pathways to Misuse

This study explores pathways to prescription opioid misuse and supply channels based on in-depth interviews with 16 socially marginalized Nigerian women suffering chronic pain. The pathways identified were medical pain treatment, prior substance use and opioid use for recreation and coping with psychological distress. Facing barriers to prescription opioids due to prescribing restrictions and provider stigma, many resorted to unlicensed chemist stores and street drug dealers for opioid analgesics, including fake and potentially harmful products. Patterns of prescription opioid misuse were woven into multiple and overlapping dynamics of marginalization shaping the lives of these women, including homelessness, sex work, substance use and intimate partner violence. Findings show a need to improve access to prescription opioids and other evidence-based approaches, framed within a trauma-informed approach to pain management. Further, integrating substance abuse treatment and pain management could make services responsive to the inter-related problems of chronic pain and prescription opioid misuse.

Performance evaluation study of a commercially available smart patient-controlled analgesia pump with the microbalance method and an infusion analyzer.

BackgroundPatient-controlled analgesia (PCA) has been widely used as an effective medical treatment for pain and for postoperative analgesia. However, improper dose errors in intravenous (IV) administration of narcotic analgesics from a PCA infusion pump can cause patient harm. Furthermore, opioid overdose is considered one of the highest risk factors for patients receiving pain medications. Therefore, accurate delivery of opioid analgesics is a critical function of PCA infusion pumps.MethodsWe designed a microbalance method that consisted of a closed acrylic chamber containing a layer and an oil layer with an electronic balance. A commercially available infusion analyzer (IDA-5, Fluke Co., Everett, WA, USA) was used to measure the accuracy of the infusion flow rate from a commercially available smart PCA infusion pump (PS-1000, UNIMEDICS, Co., Ltd., Seoul, Korea) and compared with the results of the microbalance method. We evaluated the uncertainty of the flow rate measurement using the ISO guide (GUM:1995 part3). The battery life, delay time of the occlusion alarm, and bolus function of the PCA pump were also tested.ResultsThe microbalance method was good in the short-term 2 h measurement, and IDA-5 was good in the long-term 24 h measurement. The two measurement systems can complement each other in the case of the measurement time. Regarding battery performance, PS-1000 lasted approximately 5 days in a 1 ml/hr flow rate condition without recharging the battery. The occlusion pressure alarm delays of PS-1000 satisfied the conventional alarm threshold of occlusion pressure (300-800 mmHg). Average accuracy bolus volume was measured as 63%, 95%, and 98.5% with 0.1 ml, 1 ml, and 2 ml bolus volume presets, respectively. A 1 ml/hr flow rate measurement was evaluated as 2.08% of expanded uncertainty, with a 95% confidence level.ConclusionPS-1000 showed a flow accuracy to be within the infusion pump standard, which is ± 5% of flow accuracy. Occlusion alarm of PS-1000 was quickly transmitted, resulting in better safety for patients receiving IV infusion of opioids. PS-1000 is sufficient for a portable smart PCA infusion pump.

Der Römer und der Schmerz

In ancient Rome, the ability to endure pain was a source of social respect. A celebrated example of masculine endurance was the operation for varicose veins on the general and politician Marius. The article uses this procedure as a starting point to examine the importance of the ability to bear pain and the way(s) endurance was taught as part of the socialization process. It also explores the role it played in how masculinity was constructed, and how the social value placed on endurance impacted the medical treatment of pain.

Effectiveness of Oxycodone Hydrochloride (Strong Opioid) vs Combination Acetaminophen and Codeine (Mild Opioid) for Subacute Pain After Fractures Managed Surgically

Patients with a surgically managed fracture are commonly discharged from the hospital with a strong opioid prescription, but limited evidence exists to support this practice. To test the hypothesis that strong opioids provide greater analgesia than mild opioids over the first week postdischarge from hospital after fracture surgical treatment. This double-blind, superiority, randomized clinical trial was conducted at a single-center, major trauma hospital in Sydney, Australia. Participants were inpatients who had sustained an acute nonpathological facture of a long bone or the pelvis, patella, calcaneus, or talus who were treated with surgical fixation and enrolled from July 27, 2016, to August 22, 2017. Data were analyzed from June through October 2018. Initiation at discharge of oxycodone hydrochloride 5 mg of 10 mg (ie, 1 or 2 tablets) or combination acetaminophen and codeine 500 mg and 8 mg or 1000 mg and 16 mg (ie, 1 or 2 tablets) 4 times daily for a maximum duration of 3 weeks. The primary outcome was the mean of daily pain scores collected during week 1 of treatment measured using the Numerical Pain Rating Scale (NRS). Participants were asked to rate their mean pain over the previous 24 hours daily using an NRS score from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable. The key secondary outcomes were EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) responses, worst pain, medication adverse events, global perceived effect, and return to work. A total of 120 patients with 1 or more acute orthopedic fractures requiring surgical fixation were randomized, including 59 patients in the strong-opioid group (43 [72.9%] men; mean [SD] age, 36.0 [14.1] years; mean oral morphine equivalent for days 1-7 of 32.9 mg) and 61 patients in the mild opioid group (47 [77.1%] men; mean [SD] age, 38.2 [13.5] years; mean oral morphine equivalent for days 1-7 of 5.5 mg). From days 1 to 7 postdischarge, the mean daily NRS mean pain score was 4.04 (95% Cl, 3.67 to 4.41) in the strong opioid group and 4.54 (95% Cl, 4.17 to 4.90) in the mild opioid group. The between-group difference of the primary outcome was not statistically significant (-0.50 [95% Cl, -1.11 to 0.12]; P = .11) despite a 6-fold increased dose of opioids being delivered in the strong opioid group. This study found that treatment with strong opioid medication subacutely was not superior to treatment with milder medication for treatment of pain among patients with surgically managed orthopedic fractures. These findings suggest that ongoing first-line strong opioid use after discharge from the hospital should not be supported. Australia New Zealand Clinical Trial Registry No.: ACTRN12616000941460.

5-O-methylcneorumchromone K Exerts Antinociceptive Effects in Mice via Interaction with GABAA Receptors.

The proper pharmacological control of pain is a continuous challenge for patients and health care providers. Even the most widely used medications for pain treatment are still ineffective or unsafe for some patients, especially for those who suffer from chronic pain. Substances containing the chromone scaffold have shown a variety of biological activities, including analgesic effects. This work presents for the first time the centrally mediated antinociceptive activity of 5-O-methylcneorumchromone K (5-CK). Cold plate and tail flick tests in mice showed that the 5-CK-induced antinociception was dose-dependent, longer-lasting, and more efficacious than that induced by morphine. The 5-CK-induced antinociception was not reversed by the opioid antagonist naloxone. Topological descriptors (fingerprints) were employed to narrow the antagonist selection to further investigate 5-CK’s mechanism of action. Next, based on the results of fingerprints analysis, functional antagonist assays were conducted on nociceptive tests. The effect of 5-CK was completely reversed in both cold plate and tail-flick tests by GABAA receptor antagonist bicuculline, but not by atropine or glibenclamide. Molecular docking studies suggest that 5-CK binds to the orthosteric binding site, with a similar binding profile to that observed for bicuculline and GABA. These results evidence that 5-CK has a centrally mediated antinociceptive effect, probably involving the activation of GABAergic pathways.

Harmaline potentiates morphine-induced antinociception via affecting the ventral hippocampal GABA-A receptors in mice

Morphine is one of the most effective medications for treatment of pain, but its side effects limit its use. Therefore, identification of new strategies that can enhance morphine-induced antinociception and/or reduce its side effects will help to develop therapeutic approaches for pain relief. Considering antinociceptive efficacy of harmaline and also highlighted the important role of GABA-A receptors in the pain perception, this research aimed to determine whether the ventral hippocampal (vHip) GABA-A receptors are involved in the possible harmaline-induced enhancement of morphine antinociception. To achieve this, vHip regions of adult male mice were bilaterally cannulated and pain sensitivity was measured in a tail-flick apparatus. Intraperitoneally administration of morphine (0, 2, 4 and 6 mg/kg) or harmaline (0, 1.25, 5 and 10 mg/kg) increased the percentage of maximal possible effect (%MPE) and induced antinociception. Interestingly, co-administration of sub-effective doses of harmaline (5 mg/kg) and morphine (2 mg/kg) induced antinociception. Intra-vHip microinjection of muscimol (0, 200 and 300 ng/mice), a GABA-A receptor agonist, enhanced the anti-nociceptive effects of harmaline (2.5 mg/kg)+morphine (2 mg/kg) combination. Microinjection of the same doses of muscimol into the vHip by itself did not alter tail-flick latency. Intra-vHip microinjection of bicuculline (100 ng/mouse), a GABA-A receptor antagonist, did not cause a significant change in MPE%. Bicuculline (60 and 100 ng/mouse, intra-vHip) was administered with the harmaline (5 mg/kg)+morphine (2 mg/kg), and inhibited the potentiating effect of harmaline on morphine response. These findings favor the notion that GABAergic mechanisms in the vHip facilitate harmaline-induced potentiation of morphine response in the tail-flick test in part through GABA-A receptors. These findings shall provide insights and strategies into the development of pain suppressing drugs.

Is There a Gender Self-Advocacy Gap? An Empiric Investigation Into the Gender Pain Gap.

There are documented differences in the efficacy of medical treatment for pain for men and women. Women are less likely to have their pain controlled and receive less treatment than men. We are investigating one possible explanation for this gender pain gap: that there is a difference in how women and men report their pain to physicians, and so there is a difference in how physicians understand their pain. This paper describes an exploratory study into gendered attitudes towards reporting uncontrolled pain to a physician. This exploratory study provided subjects with a vignette describing a situation in which their pain is not being treated adequately and asked them questions about their attitudes towards self-advocacy and the strategies they would likely use to express themselves. We found that women scored higher than men on measures of patient likelihood to self-advocate. Women also reported intending to use more varied self-advocacy strategies than men. This suggests it is unlikely that patient's communication styles are to blame for the gender pain gap.

Pain is associated with reduced quality of life and functional status in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Background and aims Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is challenging to live with, often accompanied by pervasive fatigue and pain, accompanied by decreased quality of life (QoL) as well as anxiety and/or depression. Associations between higher pain, lower QoL and higher anxiety and depression have been shown in patients with various chronic pain disorders. Few studies have however examined such associations in a sample of patients with ME/CFS. The aims of the current study were to examine the impact of pain levels and compare levels of pain, health related QoL, anxiety and depression between patients with ME/CFS and healthy controls. In addition, the study aimed and to examine these relationships within the patient group only. Methods This is a cross-sectional questionnaire based study comparing 87 well-diagnosed patients with ME/CFS with 94 healthy controls. The De Paul Symptom Questionnaire (DSQ), the Medical Outcomes Study Short-Form Surveys (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were used to examine and compare pain, physical function, QoL, anxiety and depression in patients and healthy controls. Further the pain variables were divided into pain total, pain intensity and a pain frequency score for analyses of the above mentioned variables within the patient group only. Results Significantly higher levels of pain, anxiety and depression, and lower levels of QoL were found in the patient group compared with healthy controls. For the patient group alone, pain was significantly associated with lower QoL in terms of physical functioning, bodily pain, general health functioning, vitality and social functioning capacity. In this patient sample, only frequency of joint pain showed significant difference in psychological variables such as depression and anxiety - depression combined. Conclusions ME/CFS patients differ significantly from healthy controls in pain, health related QoL, anxiety and depression. Pain is significantly associated with reduced QoL and overall a lower level of functioning. The relation between pain and anxiety and depression appears less clear. Implications Pain is for many ME/CFS patients associated with reduced physical functioning and reduced QoL. A thorough pain assessment can therefore be essential for clinicians, and subsequent medical pain treatment combined with good pain coping skills may increase functioning level and QoL for these patients. The link between joint pain and psychological factors should also be focused in clinical practice in terms of mapping and counseling. Pain should be further examined to understand the importance it may have for functioning level as reduced function is a main criteria when diagnosing the patients.

Ibuprofen Is Deleterious for the Development of First-Trimester Human Fetal Ovary Ex Vivo

(Abstracted from Hum Reprod 2018;33(3):482–493) Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used over-the-counter medications for treatment of pain, inflammation, and fever. In 2013, up to 28.3% of pregnant women reported the use of ibuprofen at some stage during their pregnancy.

NECK AND UPPER LIMB PAIN AMONG GYNECOLOGISTS WORKING AT MENOUFIA GOVERNORATE IN EGYPT

Introduction: Little attention was paid to explore the prevalence of neck and upper limb pain among gynecologists particularly those who perform laparoscopic procedures.Aim of work: To assess the frequency of pain in the neck and upper limbs among gynecologists working at Menoufia governorate in Egypt and to explore common risk factors. Materials and methods: A pre-designed questionnaire was sent to 642 gynecologists who worked at Menoufia governorate in Egypt; 583 were returned (90.8%). Descriptive and analytical statistical analyses were performed to assess the frequency of pain in neck and upper limb and to detect their risk factors. Results: Among 583 gynecologists, 293 (50.3%) were male and 290 (49.7%) were females; age ranged from 27 to 60 years old, out of them 315 (54.03%) experienced neck and/or upper limb pain. Most of the affected participants experience pain 1-2 times/week (80.6%), received medical treatment for pain (92.7%), applied for sick leave 1-2 times/month (77.1%) and taught that attaining certain posture while operating is the main cause of their pain (73.3%). Age above 45 years (odd’s ratio 1.45), clinical practice over 15 years, laparoscopic procedures (odd’s ratio 1.88), more than ten operations per week (odd’s ratio 2.78) and operations took more than one hour (odd’s ratio 2.10) increase the risk for developing neck and/or upper limb pain. Conclusion: This study revealed that neck and/or upper limb pain is common among gynecologic laparoscopists. Adoption of ergonomic posture and decreasing working hours when performing laparoscopic procedures may help to minimize the risk of a work-related pain. Future research should explore the implementation of ergonomic guidelines and correlation with subsequent improvement of outcome.

22.2 NEUROPHYSIOLOGY AND PSYCHOPHARMACOLOGY OF CHRONIC PAIN

The goal of this session is to introduce evidence for using psychotropic medications in treatment of pain and discuss the role of psychopharmacology in somatization.

Evolução do uso abusivo de derivados de ópio

Opium is a substance extracted from a plant that belongs to the Papaveraceae family, known popularly as poppy. The name has Greek origin and its nomenclature varies according to provenance, being opiates for natural and some semi-synthetic substances and opioids for synthetic. They act as agonists of specific presynaptic or postsynaptic opioid receptors, located generally in the central nervous system and peripheral system. It is estimated that there are between 12 and 21 million opioid users worldwide and recently some European countries and the United States reached epidemiological levels of consumption. Usually opium derivatives are used as a drug of recreation or as medication for treatment of pain and may cause irreparable damage when used in excess. Thus, the administration, the dose and its frequency should be watched carefully, avoiding undesirable side effects. The aim of this paper is to present the complications arising from the use of these substances, as well as providing information and establish consumption parameters in Brazil and other countries. As it is a topic of concern for public health, it is necessary to encourage further clinical and epidemiological research.

Patients with chronic pain: One-year follow-up of a multimodal rehabilitation programme at a pain clinic

Background and aimsMultimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment, there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year. MethodsA prospective, observational study with a one-year follow-up was performed. SubjectsA total of 42 individuals (38 females, age 44.0±12.3 years and 4 men age 40±8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records. ResultsThe PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1±0.282, and EQ VAS of 32.67±20.1), moderate insomnia (ISI 18.95±6.7), doubtful cases of depression and anxiety (HADS-depression 9.35±4.1 and HADS-anxiety 9.78±3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8±9.8), as well as moderate current pain (VAS 61.31±20.4). The sense of coherence was weak (SOC of 51.37±14). At one-year follow-up, significant (p≤0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified. ConclusionsMMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics. ImplicationsSince access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.

"Unclassical" Combination of Smell Dysfunction, Altered Abdominal Nociception and Human Hypertension Associated "Classical" Adrenal-Augmentation.

We report a 33-year-old female patient, who arrived to the emergency ward with an abdominal pain that suddenly started 10 days before admission. Simultaneously, the patient developed sudden arterial hypertension and smell disturbances. Conventional medical treatment for pain and arterial hypertension was effortless. Laboratory tests ruled out pancreatitis. Metanephrines in her urine were also normal. A dual-phase intravenous contrast computed tomography of the abdomen showed a large mass within left adrenal gland. Adrenocortical adenoma was diagnosed. The mass was not hypervascularized but positive for synaptophysin and chromogranin A. Importantly, these proteins are heavily involved with acetylcholine metabolism. The triad of olfactory disorders, pain and arterial hypertension normalized after surgically extracting the adrenal mass. To our knowledge, this medical case is the first reported patient exhibiting immediate recovery of such unclassical triad of local and remote findings. The function and dysfunction of key nanocholinergic pathways involved with smell, blood pressure and nociception would explain the pathophysiology of this unique medical case.

Oral ketamine for phantom limb pain: An option for challenging cases

Phantom limb pain (PLP) is a referred neuropathic pain perceived to arise from an amputated part of the body. It occurs in up to 80% of limb amputees and affects the patient's quality of life and rehabilitation.[1,2] The mechanisms of PLP remain unknown but involve both peripheral and central neural factors including activation of N-methyl-D-aspartate (NMDA) receptors.[2] Although ketamine, an NMDA receptor blocker, has been successfully used in many neuropathic pain conditions, its role in treating PLP is unclear.[3,4] We describe a challenging case of PLP where treatment with oral ketamine provided adequate relief.