Regional Pain Research Articles

Underlying synovial sarcoma undiagnosed for more than 20years in a patient with regional pain: a case report.

Synovial sarcoma (SS) is a malignant tumor comprising 5-10% of all soft tissue sarcomas. SS has distinct characteristics, such as a predilection for young adults and relatively slow growth compared to other soft tissue sarcomas. Some patients with SS experience long-standing pain at the tumor site before the development of a palpable mass. Herein, we report the case of a 39-year-old woman with SS in the upper arm who presented with pain for > 20years. The tumor detected on magnetic resonance imaging at 17years was an SS. To the best of our knowledge, no English-language reports on imaging study-based identification of SS, which was undiagnosed for > 20years, are known in the literature. This report discusses the imaging features of this latent lesion and the volume-doubling time of this unusual tumor.

Noninvasive treatment of cutaneous neurofibromas (cNFs): Results of a randomized prospective, direct comparison of four methods

BackgroundPeople with Neurofibromatosis Type 1 (NF1) suffer disfigurement and pain when hundreds to thousands of cutaneous neurofibromas (cNFs) appear and grow throughout life. Surgical removal of cNFs under anesthesia is the only standard therapy, leaving surgical scars. ObjectiveEffective, minimally-invasive, safe, rapid, tolerable treatment(s) of small cNFs that may prevent tumor progression. MethodsSafety, tolerability, and efficacy of four different treatments were compared in 309, 2-4mm cNFs across 19 adults with Fitzpatrick skin types (FST) I-IV: radiofrequency (RF) needle coagulation, 755nm alexandrite laser with suction, 980nm diode laser, and intratumoral injection of 10mg/mL deoxycholate. Regional pain, clinical responses, tumor height and volume (by 3D photography) were assessed before, 3 and 6 months post-treatment. Biopsies were obtained electively at 3 months. ResultsThere was no scarring or adverse events >grade 2. Each modality significantly (p<0.05) reduced or cleared cNFs, with large variation between tumors and participants. Alexandrite laser and deoxycholate were fast and least painful; 980nm laser was most painful. Growth of cNFs was not stimulated by treatment(s) based on height and volume values at 3 and 6 months compared to baseline. LimitationsIntervention was a single treatment session; dosimetry has not been optimized. ConclusionsSmall cNFs can be rapidly and safely treated without surgery.

Adenoid cystic carcinoma of head and neck: Summary and review of imaging findings

PurposeCurrent reports of adenoid cystic carcinoma of the head and neck (ACC) are all case reports, and there is no basilar summary of its imaging findings. This study aims to summarise ACC's computed tomography (CT) and magnetic resonance imaging (MRI) findings to improve radiologists' knowledge of this disease. MethodsWe collected clinical and imaging data of patients with ACC during the last decade, and two radiologists retrospectively analysed the imaging characteristics. ResultsOf the 16 patients included, six were able to self-perceive bulkiness, and 11 had regional pain. Tumour morphology was regular in six cases, with clear borders in 11 cases, invasion of the surrounding bony mass in 12 cases, and invasion of peripheral nerves in 15 cases. CT mostly shows an irregular soft-tissue density mass with mild-to-moderate enhancement after contrast medium administration. On MRI, the ACC showed isointense or hypointense signals on T1-weighted images (T1WI) and hyperintense or slightly hyperintense signals on T2-weighted images (T2WI). All signals were markedly enhanced after gadolinium enhancement. ConclusionsACC often has an irregular morphology, sometimes with a cystic component, enhancement on enhancement scans, easy destruction of adjacent bone, and invasion of peripheral nerves. The diagnosis should be considered when these features are encountered in clinical practice.

Can Myofascial Trigger Points Involve Nociplastic Pain? A Scoping Review on Animal Models.

Nociplastic pain is a non-specific, regional pain lasting more than three months, characterised by the onset of hypersensitivity, despite no clear evidence of tissue damage. It is a relatively new classified type of pain. As a result, there has not yet been much work describing its precise modelling. The mechanism of its formation needs to be clearly explained. Authors point out that the occurrence of myofascial trigger points (MTrPs) can lead to this type of pain as one possibility. This paper summarises the available literature on modelling nociplastic pain and MTrPs. It complies with studies describing animal model creation and presents the results of performed experiments. The literature search was conducted in December 2022 and included the following databases: PubMed, Scopus, and Web of Science. In this scoping review, six studies were included. Two described the creation of animal models of nociplastic pain, one adapted old models to nociplastic pain, and three described the modelling of MTrPs. This is the first paper pointing in the possible direction of detecting and studying the correlation between MTrPs and nociplastic pain in animal models. However, there is currently insufficient evidence to describe MTrPs as nociplastic, as few studies with animal models exist.

Low-Field Magnetic Resonance Imaging Findings of the Fetlock Region of Nonracehorses

Low-field, magnetic resonance imaging (MRI) is an advanced imaging modality widely used to diagnose distal limb pathology in horses, but there are limited data regarding lesion distribution within the metacarpo/metatarsophalangeal joint (MCP/MTPJ) region in lame nonracehorses. The aim of this study was to describe the low-field MRI findings and lesion distribution in nonracehorses with MCP/MTPJ region pain. Clinical records from horses undergoing MRI of the MCP/MTPJ region between July 2016 and March 2023 were reviewed. Horses were included if pain causing lameness was localized to this region and conventional imaging failed to provide a definitive diagnosis. Eighty-four horses met the inclusion criteria. Soft tissues were affected in 76 (90.5%) horses, with suspensory ligament branch injuries being the most frequent (60.7%) soft tissue pathology identified. Osseous pathology was diagnosed in 51 horses. The subchondral bone (SCB) of the distal third metacarpal/metatarsal bone (MC3/MT3) was the osseous structure most frequently affected (40.5%), with 79.4% of these horses having lesions on the dorsal aspect of the bone. Osteoarthritis was present in 48 (57.1%) horses. The main limitations of the study were the lack of a standardized diagnostic analgesia pattern due to varying veterinary surgeon involvement, and the absence of bilateral magnetic resonance (MR) sequences in all limbs. MRI is a useful diagnostic tool to assess soft tissue structures in the MCP/MTP region, especially in horses with thick skin, which may make ultrasonographic imaging unreliable.

Large retroperitoneal extraskeletal Ewing’s sarcoma with renal pedicle invasion: a case report

BackgroundExtraskeletal Ewing’s sarcoma (EES) is a rare malignant tumor primarily found in children and young adults. Localized disease can present with nonspecific symptoms such as local mass, regional pain, and increased skin temperature. More severe cases may present with systemic symptoms such as malaise, weakness, fever, anemia, and weight loss. Among these lesions, retroperitoneal sarcomas are relatively uncommon and difficult to diagnose. Since they are usually asymptomatic until large enough to compress or invade the surrounding tissues, most are already advanced at first detection. Traditionally, the treatment of choice is complete surgical resection, sometimes combined with postoperative radiotherapy and chemotherapy. We report a case of EES with left renal artery invasion in the left retroperitoneal cavity successfully treated with transarterial embolization and surgery.Case presentationA 57-year-old woman with a negative family history of cancer presented at our Urology Department with a large left retroperitoneal tumor found by magnetic resonance imaging during the health exam. Physical examination showed a soft abdomen and no palpable mass or tenderness. Imaging studies showed that the tumor covered the entire left renal pedicle, but the left kidney, left adrenal gland, and pancreas appeared tumor free. Since the tumor tightly covered the entire renal pedicle, tumor excision with radical nephrectomy was advised. The patient underwent transarterial embolization of the left renal artery with 10 mg of Gelfoam pieces daily before surgical excision. Tumor excision and left radical nephrectomy were uneventful the day after embolization. Post-operatively, the patient recovered well and was discharged on day 10. The final histopathological analysis showed a round blue cell tumor consistent with an Ewing sarcoma, and the surgical margins were tumor free.ConclusionsRetroperitoneal malignancies are rare but usually severe conditions. Our case report showed that retroperitoneal EES with renal artery invasion could be treated safely with transarterial embolization and surgery.

The Effect of Different Lying Positions on Regional Pain and Comfort Levels in Intramuscular Drug Administration

The Effect of Different Lying Positions on Regional Pain and Comfort Levels in Intramuscular Drug Administration

Musculoskeletal pain and its impact on prognosis following acute coronary syndrome or stroke: A linked electronic health record cohort study.

Musculoskeletal painful conditions are a risk factor for cardiovascular disease(CVD), but less is known about whether musculoskeletal pain also worsens prognosis from CVD. The objective was to determine whether patients with musculoskeletal pain have poorer prognosis following acute coronary syndrome (ACS) or stroke. The study utilised UK electronic primary care records (CPRD Aurum) with linkage to hospital and mortality records. Patients aged ≥45years admitted to hospital with incident ACS/stroke were categorised by healthcare use for musculoskeletal pain (inflammatory conditions, osteoarthritis [OA], and regional pain) based on primary care consultations in the prior 24months. Outcomes included mortality, length of stay, readmission and management of index condition (ACS/stroke). There were 171,670 patients with incident ACS and 138,512 with stroke; 30% consulted for musculoskeletal pain prior to ACS/stroke and these patients had more comorbidity than those without musculoskeletal pain. Rates of mortality and readmission, and length of stay were higher in those with musculoskeletal pain, particularly OA and inflammatory conditions, in ACS. Readmission was also higher for patients with musculoskeletal pain in stroke. However, increased risks associated with musculoskeletal pain did not remain after adjustment for age and polypharmacy. Inflammatory conditions were associated with increased likelihood of prescriptions for dual anti-platelets (ACS only) and anti-coagulants. Patients with musculoskeletal pain have higher rates of poor outcome from ACS which relates to being older but also increased polypharmacy. The high rates of comorbidity including polypharmacy highlight the complexity of patients with musculoskeletal pain who have new onset ACS/stroke.

Comparison of cytokine production in mice inoculated with messenger RNA vaccines BNT162b2 and mRNA-1273.

Two messenger RNA (mRNA) vaccines of BNT162b2 and mRNA-1273 were licensed. The most common adverse event is regional pain at the injection site in 80%. As systemic reactions, fatigue and headache were noted in 40%-60% and febrile illness in 10%-40% of the recipients. To investigate the mechanism of adverse events, cytokine profiles were investigated in mice. Muscle tissue and serum samples were obtained on days 0, 1, 3, 5, and 7, and at 2 and 4 weeks after the first dose. The second dose was given 4 weeks after the first dose and samples were obtained. After inoculation with 0.1 mL of mRNA-1273, IFN-γ and IL-2 were detected in muscle tissues and serum samples on day 1 of the second doses, and similar profiles were observed for IL-4, IL-5, and IL-12 production. mRNA-1273 induced higher levels of Th1 and Th2 cytokines. TNF-α was induced in muscle tissues on day 1 of the first dose and enhanced on day 1 of the second dose after inoculation with BNT162b2 and mRNA-1273. IL-6 was also detected in muscle tissue on day 1 of the first dose, but it decreased after day 3, and enhanced production was demonstrated on day 1 of the second dose. Granulocyte colony-stimulating factor in muscle tissues showed a similar profile. The induction of inflammatory cytokines in the mouse model is related to the cause of adverse events in humans, with a higher incidence of adverse events after the second dose.

The Highlighting of the Relationships between Biomechanical Parameters of Musculoskeletal System of the Spine Measured with Backfix Technology and its Statokinetic Functional State

The aim of this paper is to highlight the close relationship between mechanical work (J) values and functional status of the spine expressed by clinical signs such as regional pain and mobility. The group of participants is heterogeneous, consisting of 11 people who perform office work for 8 hours a day as employees of a software company. All are clinically healthy but experience temporary pain or discomfort during or at the end of the work schedule and during daily activities that involve low intensity physical exertion. They benefited from the 10 sessions of the program designed to measure, assess and enhance the statokinetic function of the spine for prevention purposes using BackFix technology. The research findings reveal an important connection between the evolution of test results and clinical manifestations.

Are lower urinary tract conditions more common in children with sleep bruxism?

Sleep bruxism is a parasomnia caused by rhythmic and non-rhythmic activity of the masticatory muscles during sleep. Prevalence of sleep bruxism is reported up to 40.6% in the literature. Sleep bruxism is a multifactorial issue and associated with multiple dental complications, sleep-related disorders, and psychosocial problems. We aimed to investigate if children with sleep bruxism suffer more from lower urinary tract conditions. Prospectively 128 children were included in this study. Sixty-four children constituted in the bruxism group and 64 children constituted in the control group. Children who admitted to the pediatric dentistry clinic with bruxism symptoms were recruited in the bruxism group. Control group constituted of consecutive 64 children who admitted to the pediatric dentistry clinic for routine dental examination. Parents were asked to fill out a questionnaire including Dysfunctional Voiding and Incontinence Scoring System (DVISS) form. Children's demographic data, presence of urinary frequency, presence of urgency, behaviour of voiding postponement, presence of daytime urinary incontinence, presence of enuresis nocturna, presence of fecal incontinence, presence of constipation, status of circumcision, and presence of bruxism related symptoms were recorded. Children with a DVISS score above 8 were considered to have functional voiding disorder. All children underwent a dental examination. The mean age of children was 73.3±26.9 months. For all children (n=128), the girl to boy ratio was 40:88. Mean DVISS score was 2.5±3.8 and the mean QOL score was 0.1±0.4 for all children. Eight (6.3%) children were found to have functional voiding disorder based on the DVISS score. There was no statistically significant difference for any lower urinary tract condition between the bruxism group and the control group (Table). Children with bruxism significantly had more tooth wear and masseter muscle hypertrophy (<0.001 and<0.05). Sleep bruxism has been linked to a number of health issues including dental, systemic and psychosocial problems. Tooth wears, fatigue/pain in chewing muscles, gum recession, facial pain, masseter muscle hypertrophy and temporomandibular joint damage are the main complications of bruxism. Moreover, bruxism has been associated with systemic diseases and sypmtoms like asthma, respiratory illnesses, enuresis nocturna, anxiety, and stress. Children with sleep bruxism suffer more from tooth wear, masseter muscle hypertrophy, and regional pain over the jaw. Additionally morning fatigue, relationship issues, and respiratory illnesses are more common in bruxist children. Lower urinary tract conditions are not more frequent in children with sleep bruxism.

Increased Production of Inflammatory Cytokines after Inoculation with Recombinant Zoster Vaccine in Mice.

Increasing numbers of patients with zoster were reported recently, and recombinant zoster vaccine (Shingrix®) was licensed using the AS01B adjuvant system. Although it induces highly effective protection, a high incidence of local adverse events (regional pain, erythema, and swelling) has been reported with systemic reactions of fever, fatigue, and headache. To investigate the mechanism of local adverse events, cytokine profiles were investigated in mice injected with 0.1 mL of Shingrix®. Muscle tissue and serum samples were obtained on days 0, 1, 3, 5, and 7, and at 2 and 4 weeks after the first dose. The second dose was given 4 weeks after the first dose and samples were obtained on days 1, 3, 5, 7, and 14. IL-6 and G-CSF were detected in muscle tissues on day 1 of the first injection, decreased on day 3 and afterward, and enhanced production was demonstrated on day 1 of the second dose. In sera, the elevated levels of IL-6 were detected on day 1 of the first dose, and IL-10 was detected on day 1 with increased levels on day 3 of the first dose. IL-4 was detected in muscle tissue on day 1 of the second dose and IL-5 on day 1 of both the first and second doses. IFN-γ production was not enhanced in muscle tissue but increased in serum samples on day 1 of the first dose. These results in the mouse model indicate that the induction of inflammatory cytokines is related to the cause of adverse events in humans.

Correlation between Clinical Pain in Temporomandibular Disorders and Signal Intensity of the Retrodiscal Tissue Using Fluid Attenuation Inversion Recovery MRI – A Cross Sectional Study

Temporomandibular disorders (TMD) is a broad term referring to pain and dysfunction of temporomandibular joint (TMJ), nmasticatory muscles and its associated structures. TMD is the most common orofacial pain condition with prominent feature like regional pain in the face and preauricular area during static and dynamic movements. Methods of assessing clinical pain were subjective and not affirmative. There still remains element of drafting the clinical pain evaluation in TMD patients. This study correlated the pain range in TMD patients with the levels of signal intensity (SI) in FLAIR MRI (Fluid Attenuation Inversion Recovery magnetic resonance imaging) to devise an objective pain assessing system based on the SI values. Settings and design: The present study is institution based, observational cross sectional study. A 32 temporomandibular joints were evaluated in the study. Before imaging, subjective pain score were recorded using Visual Analog Scale (VAS). In FLAIR MRI, both grey matter and retro discal tissue were included in the Region of Interest and the SIRs were calculated. SIRs in painful temporomandibular joints were correlated with Visual Analog Scale score. Unpaired t test was used to compare the mean values recorded for SIR. P-value &lt;0.05 is considered to be statistically significant. Study results shows that SIRs of retrodiscal tissue were significantly increased in patient with higher VAS score (p&lt;0.05). Retrodiscal tissue in painful proteinous elements. Keywords: Temporomandibular disorders, Signal intensity, FLAIR MRI, Retrodiscal tissue

The prevalence of sacroiliac joint CT and MRI findings is high in large breed dogs.

Sacroiliac joint (SIJ) disease has been described as one of the possible causes of lumbosacral (LS) region pain in dogs. However, published information is currently lacking for the computed tomographic (CT) and magnetic resonance imaging (MRI) characteristics of canine SIJ disease. The objectives of this retrospective, observational study were to describe and quantify CT and MRI SIJ findings in a sample of large breed dogs and test associations between the numbers of SIJ findings and other variables. Data archives for a veterinary teaching hospital were searched for large breed dogs (≥22.7kg) that had CT or MRI scans of the LS and pelvic regions in 2015-2019. Dogs with a history of acute trauma or scans with incomplete SIJs were excluded. A veterinary student recorded medical record findings. A veterinary radiologist and graduate student recorded CT and MRI findings based on previously published criteria in dogs and humans. Fifty-three dogs were sampled (20 CT, 33 MRI). Categories of findings with the highest prevalence were subchondral erosion (100% CT, 100% MRI) and subchondral sclerosis (95% CT, 97% MRI). The total numbers of SIJ findings per dog were not associated with dog age, sex, weight, or concurrent findings in the LS or pelvic regions. The total number of MRI SIJ findings per dog differed between German Shepherds and Labrador Retrievers (P=0.0237) as well as between Labrador Retrievers and other breeds (P=0.0414). These results indicated that CT and MRI findings reported in humans with SIJ disease are common in large breed dogs.

Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block.

BackgroundAdvances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block.MethodsFifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire.ResultsThe time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be “satisfied/very satisfied” with the course.ConclusionsA 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.

Association of heavy bag lifting time with postural pain in secondary school students

To determine the association between heavy bag lifting with posture among secondary school students. METHODS: This study was a cross sectional survey. Based on sample of convenience, total 380 Students of both gendersbelonging to Beaconhouse School System, KIPS School System,Educators School and The Punjab School System were included with an age 14 to 17 years (school grade 9 to 12). The data was collected using the Reedco scale and Grimmer’s Questionnaire for assessment of posture and, use of heavy bags andits associated pain, respectively. RESULTS: The majority of participants in this consisted of young adults above 12 years (39%) and below 12years (34%) with male predominant (54%). 370 students out of 380 were carrying heavy bags. The types of bags they mostly carry were backpacks (51%), satchel (34%) and others (15%). 48% of these students never used lockers and 40% of them often use locker 55% of them never use waist belt to carry bag. Most of the students 48% spend 11 to 20 minutes for carrying bag per day.61% of them carry extra load (water bottles, lunch boxes, guide books) with them also. Out of 380 students 246 had pain in different body regions due to heavy bags 64% had neck pain and 53% had upper back pain while 19% had shoulder pain. Out of 184 students that carry bag from 11 to 20 minutes, 115 had poor neck posture, 133 had poor shoulder posture 25 had poor head posture and 5 had poor upper back pain and that carry from 21 to 30 minutes out of 167 students 122 had bad neck posture and 132 had poor shoulder posture 50 had poor head posture 105 had poor upper back posture. CONCLUSION: There was found significant association between heavy bag lifting and poor posture with related pain in regions of cervical followed by upper back in secondary school students.

Association of heavy bag lifting time with postural pain in secondary school students

To determine the association between heavy bag lifting with posture among secondary school students. METHODS: This study was a cross sectional survey. Based on sample of convenience, total 380 Students of both gendersbelonging to Beaconhouse School System, KIPS School System,Educators School and The Punjab School System were included with an age 14 to 17 years (school grade 9 to 12). The data was collected using the Reedco scale and Grimmer’s Questionnaire for assessment of posture and, use of heavy bags andits associated pain, respectively. RESULTS: The majority of participants in this consisted of young adults above 12 years (39%) and below 12years (34%) with male predominant (54%). 370 students out of 380 were carrying heavy bags. The types of bags they mostly carry were backpacks (51%), satchel (34%) and others (15%). 48% of these students never used lockers and 40% of them often use locker 55% of them never use waist belt to carry bag. Most of the students 48% spend 11 to 20 minutes for carrying bag per day.61% of them carry extra load (water bottles, lunch boxes, guide books) with them also. Out of 380 students 246 had pain in different body regions due to heavy bags 64% had neck pain and 53% had upper back pain while 19% had shoulder pain. Out of 184 students that carry bag from 11 to 20 minutes, 115 had poor neck posture, 133 had poor shoulder posture 25 had poor head posture and 5 had poor upper back pain and that carry from 21 to 30 minutes out of 167 students 122 had bad neck posture and 132 had poor shoulder posture 50 had poor head posture 105 had poor upper back posture. CONCLUSION: There was found significant association between heavy bag lifting and poor posture with related pain in regions of cervical followed by upper back in secondary school students.

Prevalence of Musculoskeletal Disorders and Self-Reported Pain in Artisanal Fishermen from a Traditional Community in Todos-os-Santos Bay, Bahia, Brazil.

Musculoskeletal disorders (MSDs) can be characterized from their occupational etiology and their occurrence; their chronicity generates negative repercussions for the health of workers, especially of artisanal fishing. To investigate the prevalence of generalized musculoskeletal disorders by body region and self-reported pain in a fishing population of northeastern Brazil, an epidemiological cross-sectional study was carried out in Santiago do Iguape, Bahia-Brazil, in 2017. The Brazilian version of the Nordic Musculoskeletal Questionnaire (NMQ), in addition to a questionnaire containing the socio-demographic and labor conditions were applied to a random stratified sample of 248 artisanal fisheries. There were 170 female shellfish gatherers and 78 fishermen, with a mean age of 36.7 years (SD = 10.5 years) and 43.3 years (SD = 11.8 years), respectively. The beginning of the labor activity was initiated at approximately 11 years of age. The average weekly income varied from 17.64 USD to 29.10 USD. The prevalence of MSD independent of occupation occurred in at least one body region in 93.5% and the presence of musculoskeletal pain/discomfort over the last seven days in 95.2% of the fishing workers. The highest prevalence of MSD was found in shellfish gatherers in: lower back (86.4%), wrist and hand (73.5%), and upper back (66.8%). In relation to the presence of pain in the last year, the frequency of pain was greater in the fishermen compared to the shellfish gatherers. The generalized severity of the MSD in 93.5% of this community of fishermen is evident, with emphasis in the following regions: lower back, wrist and hand and upper back in both groups, with occurrence of pain in more than one body region at the same time.

Chest binding and respiratory complaints in transgender men

Abstract Introduction: Chest binders are an important resource for building masculinity in transgender men without mastectomy, although they can cause respiratory and thoracic damage if misused. Objective: To analyze the association between chest binding and chest complaints in transgender men. Methods: This was a quantitative cross-sectional study conducted at the Trans Space of the Hospital das Clínicas de Pernambuco and the LGBTQI Patrícia Gomes outpatient clinic of the Lessa de Andrade polyclinic in Recife (Pernambuco State, northeastern Brazil). Sixty transgender men aged &gt;18 years were included, and data on sociodemographics, general health, chest binding, and respiratory complaints in the thoracic region were collected. Descriptive analysis was performed, and prevalence ratios (PR) were estimated with a confidence interval (CI) of 95% to associate between binder use and complaints in the chest region. Results: The average was 27.25 years, of which 81.7% did not undergo mastectomy and 53.3% used chest binders. The use of chest binders was significantly associated with complaints in the chest region (PR = 2.73), difficulty breathing (PR = 2.27), and chest pain (PR = 1.82). Conclusion: This study demonstrated a higher prevalence of complaints in the chest and respiratory region in transgender men who use chest binders. This reinforces the need to broaden the view on the health of this population. Gender construction strategies are essential for the quality of life and mental health of transgender men, and binders are an important ally in this process.

Spinal Cord Stimulation: A Reasonable Alternative Treatment in Patients With Symptomatic Adult Scoliosis for Whom Surgical Therapy Is Not Suitable? A Pilot Study

In adult scoliosis, dorsal instrumentation and fusion can provide significant improvement of pain and disability scores (Owestry Index); however, complication rates of up to 39% have been reported. As such, recent attempts have been made at expanding the surgical spectrum to include less invasive techniques in patients such as neuromodulation, specifically spinal cord stimulation (SCS). We therefore aimed to evaluate its use in a larger cohort of adult scoliosis patients in the form of a pilot study. We analyzed prospectively collected data from 18 adult scoliosis patients receiving SCS treatment in our institution between February 2019 and May 2020. Clinical follow-up was performed at 3, 6, and 12 months following implantation of an epidural SCS System. Patients reported numeric rating scale (NRS) values for the categories of lower back pain (LBP) and regional pain (RP) both at rest and in motion. Further, SF-36, ADS-K, PSQI, and ODI forms were completed. The study was approved by the institutional Ethics Committee (EA2/093/13). Initial preoperative NRS of LBP at rest was significantly reduced following SCS at three (45% reduction, p=0.005) and six (43% reduction, p=0.009) months follow-up. LBP in motion was also reduced at three (27% reduction, p=0.002) and six (33% reduction vs. preoperative, p=0.005) months. RP at rest was reduced at three (38% reduction, p=0.003) and six (37% reduction, p=0.007) and in movement at three (29% reduction, 0.006) and six (32% reduction, p=0.011). Loss of thoracic kyphosis and increased pelvic incidence were associated with worse NRS response to SCS stimulation at six months follow-up. In overweight, older adults for whom the risks of corrective surgery must be carefully considered, neuromodulation can significantly reduce LBP as well as regional pain in the first six months following implantation. These findings may provide a reasonable alternative in patients not willing or eligible to undergo extensive corrective surgery.