Local Pain Research Articles

Combined external radiotherapy and single-fraction palliative high-dose-rate interstitial brachytherapy for a patient with a base of tongue cancer who had a previous radiation history.

Only a few studies have explored whether high-dose-rate interstitial brachytherapy (HDR-ISBT) can be indicated as a palliative/symptomatic treatment. We present the good results of palliative treatment using HDR-ISBT combined with external beam radiotherapy (ERT) in a patient of base of tongue cancer (cT4aN1M0). The patient was an 81-year-old male who complained of local pain. He had a previous irradiation history for head and neck cancer receiving ERT with systemic chemotherapy and radical surgery 15years ago. Since it might be difficult for him to receive radical radiation doses using ERT alone, palliative ERT of relatively lower doses of 37.5Gy in 15 fractions was selected. One month after ERT, HDR-ISBT was implemented as a booster. Considering the burden on physical condition, single-fraction HDR-ISBT was selected. We employed a new technique in which we did not penetrate the ventral surface of the tongue to reduce the risk of infection and bleeding. The planning-aim dose was 9.5Gy. The dose that covered 90% of the clinical target volume was 9.6Gy. The treatment ended without any problems. Acute complications were not observed. The tumor size decreased, and local pain disappeared at post-treatment day 84. No late complications were observed. Two years and 8months after the treatment, the patient is alive without any obvious recurrence. Additional single-fraction HDR-ISBT boost may be a useful modality as a palliative/symptomatic intent. The implantation technique and dose-fraction schedule may be important for the safe treatment of older patients or those with poor performance status.

Exploring Hemophilic Pseudotumors: A Comprehensive Case Series

Introduction: This case series investigates four hemophilic pseudotumors, which are rare but significant complications of hemophilia. All patients presented with localized swelling and pain, with imaging revealing mass-like lesions that mimicked tumors. Treatment involved a combination of surgical intervention and factor replacement therapy. The findings underscore the importance of diagnostic vigilance and highlight the necessity of a multimodal approach to manage these challenging cases effectively. Aim(s): The major aim of this study is to highlight the prevalence of hemophilic complications like pseudotumors in India. Along with this, this series also aims to shed some light on the multi-disciplinary approach required to manage these complications of Hemophilia. Study Design: Case series. Methods and Materials: 4 cases were followed at a tertiary care centre who presented with various complaints but were each linked by hemophilic pseudotumor. It takes into account the management approach in each case. Conclusion: Early detection of compressive symptoms in hemophilic pseudotumors is crucial for accurate surgical planning. Recent hemorrhages should be managed conservatively, while chronic cases with pain and pressure symptoms often require surgery. Surgical intervention, though complex, is essential and should involve a multidisciplinary approach to prevent morbidity and mortality.

Predictors of moderate-to-severe side-effects following COVID-19 mRNA booster vaccination: a prospective cohort study among primary health care providers in Belgium

BackgroundCOVID-19 vaccine effectiveness declines months after vaccination. Therefore, it is likely that during the next few years, people may be repeatedly offered a booster vaccine to enhance humoral immunity levels. A growing number of people are questioning whether the benefits of a booster vaccine outweigh the side-effects.ObjectiveThis study aims (1) to identify the most frequently reported side-effects after different doses of COVID-19 mRNA vaccines, (2) and the longest lasting symptoms; and (3) to predict the likelihood of having moderate-to-severe side-effects after a booster COVID-19 mRNA vaccine given individual- and vaccine-specific characteristics.Design, setting, and participantsSecondary analysis of a prospective cohort study in primary health care providers (PHCPs) in Belgium conducted between December 2020 and December 2021, and in February-March 2023.MethodsIn nine subsequent surveys over a period of 2 years vaccine dose-number and side-effects after COVID-19 vaccines were collected. A Generalized Estimation Equations approach on the data of the first and second booster dose was used to investigate the probability of having moderate-to-severe side-effects after mRNA booster vaccination. Predictive performance of a binary classifier was assessed by looking at discrimination (i.e., quantified in terms of the area under the receiver operating characteristic curve). The final prediction model was validated using data with regard to the third booster by assessing misclassification rate, sensitivity and specificity.ResultsIn total, 11% of the PHCPs had moderate-to-severe side-effects after their booster COVID-19 mRNA vaccine. The most common side-effects of COVID-19 mRNA doses included fatigue, local pain at the injection site, general pains, and headache. These side-effects typically lasted for a median of 1 to 2 days. The final model included five predictors: sex, alcohol consumption, history of moderate-to-severe side-effects after any previous dose, recent COVID-19 infection, and the booster dose-number (first, second). Having experienced moderate-to-severe side-effects after any previous dose was the strongest predictor of moderate-to-severe side-effects following an mRNA vaccine booster, with an odds ratio (OR) of 3.64 (95% CI: 2.80–4.75). The OR for female sex was 1.49 (95% CI: 1.21–1.84) implying that females have a higher odds of moderate-to-severe side-effects following booster vaccination. The differences in effect for booster dose-number, alcohol consumption and recent COVID-19 infection was not significant.Conclusion and relevanceCOVID-19 mRNA booster vaccination implies a low prevalence of moderate-to-severe side-effects among PHCPs, with a short median duration of symptoms if any. The strongest predictors are a history of moderate-to-severe side-effects after any previous dose and being female. These reassuring findings can help addressing concerns about booster vaccination and encourage their uptake.Trial RegistrationNCT04779424 (registration date: 2021-02-22).

Inhibition of LPS-induced inflammatory response in RAW264.7 cells by natural Chlorogenic acid isomers involved with AKR1B1 inhibition

Inflammation is the physiological response of the immune system to injury or infection, typically manifested by local tissue congestion, swelling, heat, and pain. Prolonged or excessive inflammation can lead to tissue damage and the development of many diseases. The anti-inflammatory effects of natural ingredients have been extensively researched and confirmed. This study investigated the effects of Chlorogenic acid (CGA) isomers —— 3-Caffeolyquninic acid (3-CQA), 4-Caffeolyquninic acid (4-CQA), and 5-Caffeolyquninic acid (5-CQA) —— on the inflammatory response and oxidative stress reaction induced by LPS in RAW264.7 cells. Overall, 3-CQA exhibited the most significant reduction in levels of TNF-α, IL-6, NO, and ROS. 4-CQA showed superior inhibition of TNF-α compared to 5-CQA (p < 0.05), while no significant difference in other parameters. We further used DARTS and CETSA to demonstrate that CGA isomers have stable affinity with AKR1B1. As a positive control, the AKR1B1 antagonist epalrestat exhibited similar effects to the CGA isomers. 3-CQA having the smallest half-inhibitory concentration (IC50) for AKR1B1, while 4-CQA and 5-CQA have similar values. AutoDock simulations of the docking conformations revealed minimal differences in the average binding energies of the CGA isomers. The main differences were that VAL47 formed a hydrogen bond with 3-CQA, whereas GLN49 formed hydrogen bonds with 4-CQA and 5-CQA. Additionally, the number of hydrophobic bonds involving PHE122 and LEU300 varies. Our conclusion is that differences in non-covalent interactions result in the varying inhibitory abilities of CGA isomers on AKR1B1, which further affect the anti-inflammatory and antioxidant effects of CGA isomers.

Severity of pain syndrome, functional activity, and quality of life in male patients with inguinal hernias in the preoperative period

According to the European Hernia Society (EHS) and the Hernia Surge Group (HSG), males with inguinal pain syndrome make up the majority of candidates for planned inguinal hernia surgeries. Chronic groin pain in the preoperative stage typically has a negative impact on such patients’ functional activity and quality of life. It is therefore considered a significant indication for planned surgery. According to recent research, appropriate functional outcomes, such as improved physical activity and patient quality of life, are as important as an accurate anatomical restoration of the inguinal region after planned inguinal hernia surgery. Objective — to assess the severity of preoperative inguinal pain syndrome, functional activity, and quality of life in male patients with inguinal hernias. Materials and methods. The study focuses on the preoperative clinical examination of 50 patients (males) with primary unilateral inguinal hernias. The patients were treated in the surgical department of the State Scientific Institution «Centre for Innovative Medical Technologies of the National Academy of Sciences of Ukraine» between 2018 and 2024. A questionnaire method was employed to assess the functional activity, quality of life, and severity of pain syndrome in patients before surgery. This method involved the use of the modified Carolinas Comfort Scale (MCCS), the European Questionnaire for the Assessment of Quality of Life (EQ‑5D‑3L), and the Visual Analogue Scale (VAS). Results. The average pain severity index on the VAS was 2.1±0.9 points. The MCCS was used to assess patients’ functional activity, resulting in an average total score of 33.7±12.1 points, which corresponded to 44.9%, classifying the patients as «not satisfied» in the clinical group. The EQ‑5D‑3L descriptive system was used to assess patients’ quality of life. We found that 30% reported moderate mobility limitations, 18% reported moderate self‑care issues, and 34% reported limitations in their daily activities. 24% of patients exhibited moderate anxiety or depression‑related symptoms. At the same time, all patients noted the presence of pain syndrome, with 76% experiencing moderate pain and 24% suffering severe pain. Conclusions. The «symptomatic» group of males with inguinal hernias exhibits a high level of local pain syndrome in the area of the hernia protrusion (2.1±0.9 on the VAS, and 24 % of patients reported a significant degree of pain severity before planned surgical intervention (&gt; 3 points) according to the EQ‑5D‑3L system). In the vast majority of cases, it significantly impairs their functional activity and quality of life (66% of patients are not satisfied with their quality of life (32.4±5.6 points on the MCCS)). Effective local pain management is an important objective in the planned surgical treatment of inguinal hernias. This necessitates further investigation into surgical technique selection and procedure adjustments.

Surgery for non-Meckel’s small-bowel diverticular perforation: two case reports and a literature review

BackgroundSimilar to colonic diverticula, small-intestinal diverticula are often asymptomatic, but may cause life-threatening acute complications. Non-Meckel’s small-bowel diverticular perforation is rare, and the rate of mortality is high. However, there is currently no consensus regarding its therapeutic management.Case presentationCase 1: A 73-year-old Japanese man with localized lower abdominal pain was referred to our hospital. Enhanced computed tomography (CT) revealed diverticulitis of the small intestine, which was managed conservatively. Four days after admission, abdominal pain worsened, and repeat CT revealed extraintestinal gas. Emergency surgery was performed for the segmental resection of the perforated jejunum with anastomosis. Case 2: A 73-year-old Japanese woman was transferred to our hospital with small-bowel perforation. CT revealed scattered diverticula in the small intestine and extraintestinal gas around the small-intestinal diverticula. Emergency surgery was performed for the segmental resection of the perforated jejunum with anastomosis.ConclusionsConservative treatment for small-bowel diverticular perforation may be attempted in mild cases; however, surgical intervention should not be delayed. Segmental resection of the affected intestinal tract with an anastomosis is the standard treatment. Residual diverticula should be documented because of the possibility of diverticulosis recurrence.

Exploring Chronic Pain Patterns and Associations With All-Cause Dementia: Results From UK Biobank

The count of locations with chronic pain is widely used in research and clinical practice. However, this approach might be too simplistic to fully capture the complexity of chronic pain experiences. This study identified prevalent patterns of chronic pain locations and evaluated their associations with incident dementia among middle-aged and older adults in the UK. Data were from 445,530 participants who were free of dementia at baseline (2006–2010) in the UK Biobank. We calculated the incidence rates of all-cause dementia by the 20 most prevalent combinations of pain locations assessed at baseline. Cox models were utilized to examine the hazard ratio of incident dementia among each of these 20 combinations compared to 3 groups: 1) participants without chronic pain, 2) participants with only a single chronic pain location not included in the combination, and 3) participants with only a single chronic pain location included in the combination. The 3 most prevalent combinations were neck and back (5.7%), back and knee (5.4%), and neck and knee (4.5%). Chronic back, neck, and knee pain was commonly present either individually or simultaneously in combinations associated with higher dementia rates than persons without chronic pain. The combinations involving back, neck, and knee were associated with higher dementia rates than groups with 1 pain location not included in the combination. Chronic pain is not randomly present in body locations. Understanding how different patterns of chronic pain locations relate to dementia provides new insights into dementia prevention through pain relief. PerspectiveThis article unveils chronic pain patterns and dementia risks in the UK Biobank. Chronic pain in back, neck, and knee presents frequently, either individually or in combinations associated with increased dementia rates. Chronic pain combos correlate with diverse dementia rates, guiding targeted prevention strategies through pain management.

12394 "Sugar And Tumors: A Case Report On New-onset Diabetes In Metastatic Pheochromocytoma With Elevated Dopamine Levels"

Abstract Disclosure: B. Agrawal: None. V. mehta: None. R. naseem: None. M. Renzu: None. R. rashid: None. Introduction: Metastatic pheochromocytoma is a rare neuroendocrine tumor with potential complication of new-onset diabetes mellitus (DM). We present a case highlighting the challenges in managing a patient with metastatic pheochromocytoma and concurrent DM. Case presentation: A 66-year-old male with a history of hypertension and gout initially presented in 2010 with an adrenal mass, later identified as pheochromocytoma and resected. In 2018, he presented with bilateral leg pain, revealing metastatic disease-causing spinal cord compression along with metastatic lung nodules and metastasis in adrenalectomy bed. Despite interventions including T6,7,8 laminectomy in 2020 and radiation therapy, metastases persisted. In 2024, he presented with polyuria, polydipsia, and hyperglycemia (blood glucose &amp;gt;500 mg/dL). Laboratory findings showed elevated a1c of 15 in addition to elevated normetanephrines, metanephrines, and dopamine with levels of 3880, 48 and 488 respectively. He was diagnosed with new-onset DM and started on insulin therapy in addition to metformin and jardiance. Discussion: Secondary diabetes mellitus (DM) in secretory pheochromocytoma occurs in approximately 50% of cases, manifesting from mild insulin resistance to severe presentation like DKA. Epinephrine-secreting tumors contribute to glucose intolerance by activating beta receptors, thereby stimulating gluconeogenesis. Patients with higher levels of epinephrine and preoperative glucose intolerance were more prone to developing postoperative hypoglycemia, requiring close monitoring during the postoperative period. Additionally, research by DiSalvo et al. Epinephrine-secreting tumors have a more significant impact on hyperglycemia by impairing insulin secretion and stimulation GLP-1. Tumor resection has been found to be more effective effective in restoring normal glucose homeostasis in these patients. Dopamine-secreting pheochromocytomas are rare neoplasms characterized by the presence of immature catecholamine vesicles that inhibit dopamine conversio owing to localized dopamine beta hydroxylase. Typically presenting around the age of 48, these tumors often lack excess catecholamines, leading to atypical symptoms such as local discomfort or pain from tumor compression. These neoplasms are less detectable on metaiodobenzylguanidine (MIBG) scans, necessitating positron emission tomography (PET) for accurate diagnosis. Surgical resection is the treatment, with preoperative management involving metyrosine instead of alpha blockers. These tumors are frequently diagnosed late, often in a malignant stage, contributing to poor prognosis Conclusion: Overall, understanding the complex interplay between catecholamines and glucose metabolism is crucial for the comprehensive management of patients with pheochromocytoma and secondary DM. Presentation: 6/1/2024

Current advances in the treatment of myofascial pain syndrome with trigger point injections: A review.

Myofascial pain syndrome (MPS) caused by trigger points in muscles is a common cause of local or generalized pain, which is clinically common, has a high incidence, and has no specific cure. The most popular and widely used clinical method mainly targets the trigger point for treatment, i.e. trigger point injection (TPI) therapy. The injectable drugs mainly include glucose, saline, local anesthetics, botulinum toxin type A, platelet-rich plasma, platelet-poor plasma, steroid preparations, etc. This method is low cost and less invasive, and early clinical applications have shown good efficacy. In this paper, we have reviewed clinical research progress in treating MPS with TPI therapy.

Synergistic Gas Therapy and Targeted Interventional Ablation With Size-Controllable Arsenic Sulfide (As2S3) Nanoparticles for Effective Elimination of Localized Cancer Pain.

The elimination of localized cancer pain remains a globally neglected challenge. A potential solution lies in combining gas therapy with targeted interventional ablation therapy. In this study, HA-As2S3 nanoparticles with controlled sizes are synthesized using different molecular weights of sodium hyaluronate (HA) as a supramolecular scaffold. Initially, HA co-assembles with arsenic ions (As3+) via coordinate bonds, forming HA-As3+ scaffold intermediates. These intermediates, varying in size, then react with sulfur ions to produce size-controlled HA-As2S3 particles. This approach demonstrates that different molecular weights of HA enable precise control over the particle size of arsenic sulfide, offering a straightforward and environmentally friendly method for synthesizing metal sulfide particles. In an acidic environment, HA-As2S3 nanoparticles release hydrogen sulfide(H2S) gas and As3+. The released As3+ directly damage tumor mitochondria, leading to substantial reactive oxygen species (ROS) production from mitochondria. Concurrently, the H2S gas inhibits the activity of catalase (CAT) and complex IV, preventing the beneficial decomposition of ROS and disrupting electron transfer in the mitochondrial respiratory chain. Consequently, it is found that H2S gas significantly enhances the mitochondrial damage induced by arsenic nanodrugs, effectively killing local tumors and ultimately eliminating cancer pain in mice.

Clinical Efficacy of Microwave Ablation Combined with Percutaneous Osteoplasty in the Treatment of Flat Bone Metastases.

Evaluating the clinical efficacy and safety of microwave ablation combined with percutaneous osteoplasty (MWA + PO group) versus percutaneous osteoplasty (PO group) for the treatment of flat bone metastases. Patients with flat bone metastases and intractable pain who underwent PO and/or MWA from January 2016 to January 2023 in our hospital were included, with 36 cases in the MWA+PO group and 21 cases in the PO group. Changes in the visual analog scale (VAS), Oswestry Disability Index (ODI), and quality of life assessment scale(QOL) were evaluated regularly. Postoperative complications and target lesion tumor treatment responses were also observed. The VAS and ODI in both the MWA+PO group and the PO group significantly decreased at 1week, 1 month, and 3 months postoperatively, The VAS and ODI in the MWA+PO group were lower than those in the PO group postoperatively. The QOL in both the MWA+PO group and the PO group significantly increased at 1week, 1 month, and 3 months postoperatively, with the QOL in the MWA+PO group being higher than that in the PO group postoperatively. According to the mRECIST criteria (target lesion tumor treatment response), the ORR in the MWA+PO group and PO group was 52.8% and 9.5%, respectively, while the DCR was 94.4% and 57.1%, respectively (P <0.001 and<0.001). Different degrees of bone cement extravasation were observed in both the PO group (38.1%) and MWA+PO group(19.4%)(χ²=2.38, P=0.12), but none of the patients developed clinical symptoms related to bone cement extravasation. The average cost of surgery was ¥10,480.43higher in the MWA+PO group than in the PO group. The MWA+PO treatment is more effective in relieving patients' local pain, improving local dysfunction, and enhancing quality of life, and can effectively improve target lesion tumor ORR and DCR, but it is also more costly.

An exploratory data-driven approach to classify subgroups of patients with temporomandibular disorders based on pain mechanisms

Temporomandibular disorders (TMDs) are a common musculoskeletal condition, presenting treatment challenges due to their non-specific nature. Categorizing patients with TMDs into clusters based on neurobiological pain mechanisms could provide a promising approach to facilitate targeted treatments. This observational study (1) used a network analysis (NA) to explore the complexity of TMDs by investigating relationships among biopsychosocial variables, and (2) validated potential TMD subgroups based on mechanism-specific pain categories. One hundred and two patients with TMD were included. Biopsychosocial variables covered: general health, psychosocial features, TMD pain, and TMD characteristics. A NA evaluated the associations between variables and determined the role of each feature within the network. Hierarchical clustering was used to identify TMD subgroups. The NA revealed significant correlations primarily within the same feature domains, indicating a strong interplay between symptoms and psychological factors. Cluster analysis identified two subgroups driven by nociceptive and nociplastic pain mechanisms; the nociplastic group exhibited higher levels of anxiety, depression, pain catastrophization, central sensitization, pain duration, and more pain locations, along with poorer sleep quality, quality of life, and health status. In contrast, the nociceptive group exhibited restricted maximal mouth opening (MMO), heightened pain during TMJ palpation and mouth opening, and a greater positive response to manual therapy. Across all features, psychological factors, pain locations, and MMO primarily contributed to the separation of subgroups. By adopting a data-driven approach, these results support the significant role of considering the neurobiological basis of pain to improve patient classification. This knowledge may facilitate clinical reasoning and personalized treatments. PerspectiveThis study used a network analysis to explore the complex biopsychosocial interactions present in people with TMDs, identifying important variables such as the Central Sensitization Inventory and pain-free maximal mouth opening. The findings distinguish potential nociceptive and nociplastic pain subgroups, offering important insights for targeted therapeutic strategies.

Risk Factors for Musculoskeletal Health: A Review of the Literature and Clinical Application.

Musculoskeletal disorders (MSKD) are currently the leading contributor to disability worldwide. Unlike other prevalent and disabling healthcare conditions such as CVD, risk factors associated with MSKD are not commonly discussed or integrated into current medical practice, rehabilitation practice or wellness programs. The primary purpose of this review is to describe the known risk factors most closely associated with MSKD. The secondary purpose is to propose a clinical model to manage MSK health aimed at maximizing the healthy pursuit of a physically active and healthy lifestyle. In this review the most common MSKD risk factors, with a focus on those that can be easily screened in clinical practice are presented. The importance of understanding the magnitude and number of risk factors present as well as the multidimensional nature of MSKD risk is discussed. A total of 11 MSKD risk factors were identified. Most of the risk factors are modifiable, and the evidence associated with modifiability for the most prominent risk factors is reviewed.Researchers have found that often patients are discharged from care with several known MSKD risk factors. In such instances, local pain and dysfunction are managed well, but expanding our rehabilitation care to include comprehensive risk factor management would ultimately benefit the patient and reduce healthcare costs. The most common MSKD risk factors are discussed and a clinical framework to individualize intervention is proposed. Addressing key risk factors within rehabilitation may be an important step to reduce the enormous and growing burden these disorders are having on society. 5.

Bengin Tuomrs of the Spine: A Systematic Review

Abstract Background Spine tumors are classified as primary tumors which originate from the spine itself and its adjacent structures and secondary (metastatic) tumors of distant organs which spread hematogenously and lymphatically and are located in the spine and its surrounding tissues. As the spine is well vascularized and has close relationship with regional lymphatic and venous drainage systems (especially Batson’s venous plexus), it is generally susceptible to metastasis. Metastatic tumors are the most common (97%) tumors of the spine. Aim of the Work to give an overview of the most important benign tumors of the spine, their clinical pictures and the typical features in imaging. Patients and Methods Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. We will search the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library) using the following keywords related to: Bengin tumors, spine. Results Giant cell tumors in the spine, particularly lumbar region, are rare but can present with pain and neurologic deficits. Osteoid osteomas and osteoblastomas, more common in the thoracolumbar spine, exhibit distinct radiological features. Osteoblastomas, locally aggressive, cause persistent pain, stiffness, and neurological deficits, often diagnosed in later stages. Spinal osteoblastoma diagnosis relies on CT scans, superior to plain radiography, and may necessitate biopsy for confirmation. Vertebral hemangiomas, usually asymptomatic, can cause compression-related symptoms and are identified through characteristic radiographic and CT appearances. Conclusion Searching the literature, Comparison between clinical picture in various types of begnin tumors we found that all begnin tumors have similar symptoms such as localized pain, neurological symptoms. Hence different methods of investigation should be used such as plain x-ray, CT scan and MRI.

A Review of Energy-Based Device Interventions to Treat Keloid Scars.

Keloids are thickened raised scars that develop due to injury and grow beyond the boundaries of their original wound, mostly affecting individuals with skin of color. This review explores the use of energy-based devices to treat keloids, both using laser monotherapy and in combination with other drugs. Laser therapy alone has shown efficacy in treating keloids. Combination laser therapy has better keloid reduction when administered with steroids, 5-fluorouracil (5-FU), and verapamil. However, monotherapy has had less adverse reactions including dermal atrophy and local pain. Therefore, physician discretion is essential when considering treatment. This review highlights the efficacy of energy-based devices (EBDs), alone and in combination. It also reveals the need to have tailored approaches with patients. Further research is needed to develop more comprehensive treatment standards for keloids using EBDs alone or in combination. J Drugs Dermatol. 2024;23(11):998-1002. doi:10.36849/JDD.8210R1.

Four Decades of OccipitalNerveStimulation for Headache Disorders: A Systematic Review.

Chronic headaches are a significant source of disability worldwide. Despite the development of conventional strategies, a subset of patients remain refractory and/or experience side effects following these treatments. Hence, occipital nerve stimulation (ONS) should be considered as an alternative strategy for intractable chronic headaches. This review aims toprovidea comprehensive overview of the effectiveness, safety, mechanisms and practical application ofONSfor the treatment of headache disorders. Overall response rate of ONS is 35.7-100%, 17-100%, and 63-100% in patients with cluster headache, chronic migraine and occipital neuralgia respectively. Regarding the long-term effectivity in all groups, 41.6-88.0% of patients remain responders after ≥ 18.3months. The most frequently reported adverse events include lead migration/fracture (13%) and local pain (7.3%). Based on our results, ONS can be considered a safe and effective treatment for chronic intractable headache disorders. To support more widespread application of ONS, additional research with larger sample sizes should be conducted.

Ultrasound-guided radial nerve release at the arm under WALANT

Radial nerve entrapment at the LIS is an aching pain in the distal, lateral upper arm and leads to weakness in wrist and thumb/index finger extension. Additionally, a positive scratch collapse test and localized pain on pressure at the entrapment site are observed.The described approach uses a minimally invasive percutaneous ultrasound-guided technique under local anesthesia.

Early Postoperative Pain is Similar after Arthroscopic Rotator Cuff Repair versus Short-Stay Shoulder Arthroplasty: A Prospective Study.

IntroductionOne of the barriers to counseling patients for shoulder arthroplasty (SA) is the anticipated pain after surgery. This can be contrasted with the common perception of arthroscopic rotator cuff repair (RCR) surgery being less painful due to the less invasive nature of the procedure. We conducted a prospective study comparing postoperative pain levels and narcotic consumption after SA compared to those after RCR. MethodsThis prospective study enrolled 102 patients undergoing short-stay SA and RCR at a single hospital. 50 patients underwent RCR and 52 underwent SA. All participants received a multimodal pain regimen consisting of an interscalene block with liposomal bupivacaine and one of two oral pain medication regimens. Patients were provided a daily pain diary to be completed for 14 postoperative days that tracked pain levels, narcotic consumption, and pain location. Patients were excluded for age <40, revision surgery, SA for fracture, history of chronic opioid use, or an inability to adhere to study protocol. Demographics, visual analogue scale (VAS) scores, and pain sensitivity questionnaires (PSQ) were collected preoperatively. Primary study outcomes were daily VAS pain scores and narcotic consumption during the 14 days after surgery. ResultsRCR patients were younger (60.6 vs. 68.9 years; p<0.01) but other demographics, preoperative pain, and PSQ scores were similar between groups. Peak mean VAS pain levels for RCR and SA each occurred on postoperative (POD) 2 and were 4.4 ± 3.1 and 5.1 ± 2.7 respectively (p=0.214). There was no significant difference in VAS pain during the 14-day postoperative period between RCR and SA patients (p>0.05) or between anatomic SA and reverse SA (p>0.05). Narcotic usage was greater for RCR patients at POD 7 (0.5 vs. 0.2 tablets; p=0.039) and 8 (0.5 vs. 0.2 tablets; p=0.015) compared to SA patients. ConclusionsOur study demonstrated that postoperative pain levels do not significantly differ between RCR and short-stay SA, with greater narcotic usage observed for RCR at one week after surgery. These findings support the notion that despite the increased invasiveness of SA, early postoperative pain is comparable with early pain after RCR.

ANODYNE study: A double-blind randomized trial of greater occipital nerve block of methylprednisolone and lignocaine versus placebo as a transitional preventive treatment for episodic cluster headache.

There is inadequate evidence of the efficacy of greater occipital nerve block (GONB) for the preventive treatment of cluster headaches. We assessed the efficacy and tolerability of GONB injections as a transitional preventive treatment for episodic cluster headaches (ECH). This randomized, double-blind, placebo-controlled, parallel-group trial conducted at GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India, included ECH patients diagnosed by ICHD-3 criteria, aged 18-65, with one or more attacks per 24 h for seven days before randomization (baseline). ECH patients were either not on preventive medications or on stable doses for at least three months. ECH patients were randomized to receive active GONB (2 ml methylprednisolone (80 mg) and 2 ml lignocaine (2%)) and placebo (4 ml saline injections). Before giving GONB, lignocaine jelly was applied topically to mask the effect of numbness following the GONB. The primary efficacy endpoint was the mean change in weekly attack frequency from baseline to Week 4. Efficacy analyses were performed in a modified intention-to-treat population that included all patients who received at least one injection of GONB and had a follow-up for one week following GONB. The safety analysis included treatment-emergent adverse effects (TEAE) in all patients who received at least one dose of investigational product. The trial was registered with the Clinical Trials Registry of India (CTRI/2021/21/038397). Forty ECH patients were randomized between December 2021 and January 2023. Thirty-nine patients (19 in the active and 20 in the placebo groups) were available for efficacy analysis. The change in weekly attack frequency from baseline to Week 4 was -11.1 (95% CI: -8.5 to -4.4) for the active group compared to -7.7 (95% CI: -11.8 to -9.8) for placebo (mean difference -3.4 (95% CI: -5.2 to -1.7, p < 0.001). We noted TEAE in 18 (90%) of 20 patients who received the active drug and in 18 (90%) of 20 patients who received a placebo (p = 0.38). The common TEAE were local site bleeding and pain, which were mild and transient. No serious adverse events were reported. This study found that GONB with methylprednisolone and lignocaine significantly reduced the weekly attack frequency from baseline to Week 1 through Week 4 in ECH patients compared to a placebo. GONB was well tolerated.

Acute local and non-local morphological, sensory and fluid responses to stretching and foam rolling in young females

BackgroundThis study aimed to compare and examine the local and non-local effects of a foam rolling (FR) and static stretching (SS) intervention applied to the plantar flexor (PF). MethodsFourteen female participants were investigated. Each participant underwent three conditions in a random order at least 48h apart and at the same time of the day: Control (CC), SS, and FR. Each condition was performed unilaterally in the dominant PF for 4 sets (apart from CC). SS was performed for 30 s. The FR included 30 rolls (15 in each direction) over a period of 30 s. A rest of 30 s was provided between each set for all conditions. Outcome variables were ankle dorsiflexion range of movement (ROM), tissue hardness, localized bioimpedance analysis at 50 kHz (L-BIA), and pain pressure thresholds (PPT). Tissue hardness, L-BIA, and PPT were measured in the lower leg and thigh. Measures were assessed pre (T0), immediately post (T1), and 10-min after (T2) the intervention. ResultsNo differences were found for time for the CC or between the T0 of each condition. Concerning the lower leg, ROM improved for SS and FR from T0 to T1 while returning to baseline in T2. A significant increase in PPT was observed only for SS in T1. L-BIA showed a significant increase for both phase angle and impedance only for FR in T1. Tissue hardness did not change for any group at any time-point. Concerning the thigh, no measure at any time point showed significant differences. ConclusionBoth, FR and SS were able to acutely improve ankle ROM. The observed changes were probably caused by a change in viscoelastic properties and local pain perception, without any variation in tissue morphology. FR was the only intervention to improve the intracellular-to-extracellular ratio and decrease fluids. Non-local effects were not observed.