Severe Pain Research Articles

Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain

Background: Low back pain is a prevalent symptom worldwide, with various underlying causes, making differential diagnosis essential. This study aims to investigate the efficacy of dry needling treatment added to exercise in patients with chronic Nonspecific Low Back Pain (NLBP). The McKenzie exercise program was applied to all participants.Materials and Method: The study comprised sixty participants, randomly allocated into two groups: the dry needling (DNG) and the exercise group (EG). The participants in DNG received a total of six sessions of dry needling treatment, two days a week, to the gluteus medius and quadratus lumborum and multifidus muscles. All participants were given a McKenzie exercise program two sets per day for three weeks.Results: A significant difference was noted in the VAS-night values of the patients within the DNG before treatment (p: 0.004), and the EG also exhibited a significant difference in the VAS-activity (p: 0.017) and VAS-resting (p: 0.024) values following the treatment. A statistically significant decrease was observed in favor of DNG in VAS-rest, VAS-night, VAS-activity values (p>0.001) in the comparions of the groups.Conclusions: Dry needling treatment added to exercise therapy in chronic NLBP patients is effective on activity and rest pain severity in the shortterm results. However, no additive efficacy of dry needling treatment was found on the number of trigger points, disability, and depression.

Delirium risk profiles in a population-based study of United States older adults undergoing common noncardiac surgeries.

Older adults often require surgical care and are at elevated risk of delirium. We explored delirium risk profiles across the population of U.S. older adults who underwent one of 10 common noncardiac surgeries. We analyzed Health and Retirement Study (HRS) participants linked with Medicare billing data who underwent the following 10 noncardiac surgeries from 2000 to 2018 at age 65 or more: total knee arthroplasty (TKA), total hip arthroplasty (THA), spine surgery, cholecystectomy, colorectal surgery, hernia repair (ventral, umbilical, or incisional), endarterectomy, prostatectomy, transurethral resection of the prostate (TURP), and hysterectomy. Demographic and health covariates were obtained from the HRS dataset. Latent cognitive ability was calculated from cognitive testing, proxy reports, and demographics at the preoperative HRS interview. We compared standardized differences for delirium risk factors across the 10 surgeries and qualitatively clustered them into phenotypical subgroups. We analyzed 7424 older adults (mean age 76 ± 6 years, 45% male). Endarterectomy patients presented with the highest burden of nearly all health and cognitive factors, implying higher delirium risk (e.g., stroke, 22%; depressive symptoms, 30%; high school or less education, 73%; frailty, 42%; lowest latent cognitive ability). A second "general surgery" phenotype, including cholecystectomy, colorectal, and hernia surgery patients, experienced more frailty (29%-32%) and depressive symptoms (24%-26%), with moderate comorbidity burden. A third "pain" phenotype, which included TKA, THA, and spine surgery patients, commonly reported moderate or severe pain (47%-53%) and impairment in activities of daily living (ADL, 23%-30%), but fewer comorbid medical conditions. The remaining surgery types (hysterectomy, prostatectomy, TURP) were not phenotypically grouped and generally had lower risk features for delirium. In an epidemiological cohort of US older adults, we identified clinically meaningful heterogeneity in delirium risk profiles across different surgical types, which may have implications for delirium risk stratification and delirium prevention or treatment.

Fibromyalgia is associated with increased odds of prior pain-precipitated relapse among non-treatment-seeking individuals with opioid use disorder

Background/Objectives Chronic pain is an opioid use disorder (OUD) treatment barrier and associated with poor outcomes in OUD treatment including relapse. Fibromyalgia is a chronic pain condition related to central nervous system substrates that overlap with the brain disease model of OUD. We know of no studies that have looked at non-treatment seeking individuals, to see if fibromyalgia might represent a barrier to OUD treatment. Given many non-treatment-seeking individuals previously attempted recovery before experiencing relapse, and chronic pain is a known precipitant of relapse, fibromyalgia might be a currently unappreciated modifiable factor in OUD relapse and, potentially, a barrier to treatment reengagement among those not currently seeking treatment. This study aimed to determine if fibromyalgia is associated with greater odds of agreeing that ‘I have tried to stop using opioids before, but pain caused me to relapse’ among non-treatment seeking individuals with OUD. Methods This cross-sectional study recruited non-treatment-seeking individuals with OUD (n = 141) from a syringe service program. Ordinal logistic regression was used to determine if the presence of fibromyalgia increased the odds of agreement with prior pain-precipitated relapse. Results Fibromyalgia was identified in 35% of study participants and associated with 125% greater odds of strongly agreeing that pain had previously caused them to relapse, even after accounting for relevant covariates, including age, sex, depression, anxiety, OUD severity, and pain severity. Conclusions This study provides early evidence that the presence of fibromyalgia may be associated with increased odds of pain-precipitated OUD relapse.

Comparative analysis of the effectiveness of quadratus lumborum and transversus abdominis muscle blocks for postoperative pain relief during laparoscopic robot-assisted total hysterectomy.

The purpose of this study was to compare and evaluate the analgesic effectiveness of quadratus lumborum block (QLB) and transversus abdominis plane bloc block (TAPB) after laparoscopic robot-assisted total hysterectomy. Materials and methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blocks were performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After surgery, pain was assessed using a 10-point digital visual analogue scale, and postoperative nausea and vomiting were assessed. (PONV) Average arterial pressure and heart rate were recorded. Additionally, the next morning, a survey was conducted to assess the well-being and satisfaction of patients. Results. There were no differences between the groups in terms of demographic characteristics, duration of surgery, and analgesic consumption during the intraoperative period. The severity of postoperative pain was higher (p<0.05) in the control group than in the blockade groups. Both block groups demonstrated lower pain scores at all time points assessed. The latest need for analgesics was in the QLB group. Mean arterial pressure (MAP) values differed only in the first 2 hours after surgery between the CON and TAPB groups (p<0.05). PONV one hour after surgery was more observed in the control group and less in the QLB group (p<0.05). According to the results of a survey conducted on the day after surgery, the number of patients satisfied with the anesthesia and assistance provided in the recovery room in the groups with blockade (TAPB, QLB) was 2.1-5.3% higher (p>0.05). More patients from the QLB group (p<0.05) noted very good and good health, and most patients (p<0.05) from the CON and TAPB group noted satisfactory health. Conclusion. The use of interfascial blocks for postoperative pain relief (TAPB, QLB) after laparoscopic robot-assisted hysterectomy improves the quality of pain relief and the well-being of patients. Benefits of QLB include better pain relief, reduced incidence of PONV, and greater patient satisfaction. TARP has shown equally good results, and this method is easier to perform.

Chronic post-surgical pain after total knee arthroplasty: a narrative review.

Total knee arthroplasty (TKA) is an efficacious treatment for end-stage knee osteoarthritis, often accompanied by severe postoperative pain. In certain patients, this pain can persist for over 3months and is referred to as chronic post-surgical pain (CPSP). Postoperative persistent pain has emerged as a significant and noteworthy issue impacting patient quality of life following TKA. The etiology of CPSP after TKA is multifaceted. Peripheral or central sensitizations resulting from inflammatory reactions, nerve injury, and neurobiological mechanisms are the primary mechanisms contributing to chronic persistent pain after TKA. Preoperative, intraoperative, and postoperative factors can induce pain sensitization. Once CPSP occurs after TKA, it significantly hampers patient recovery with challenging treatment options. Currently, among the preventive and therapeutic strategies for chronic pain after TKA, it is widely believed that early comprehensive preventive treatment to prevent acute to chronic pain transition can substantially reduce the incidence of CPSP following TKA. In recent years, studies have investigated perioperative strategies aimed at reducing the occurrence of persistent pain after TKA. This article provides an overview of advancements in understanding the pathogenesis, high-risk factors, and preventive measures for chronic pain following TKA. We hope that this review will guide future research directions on CPSP after TKA while contributing to clinical perioperative pain management.

Post-procedural Brachial Neuritis: Clinical, Electrodiagnostic and Neuroimaging features.

Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis is common. Imaging is important to confirm the diagnosis of post-procedural brachial neuritis and exclude other etiologies. Clinical, electrodiagnostic, and neuroimaging features of patients with post-procedural brachial neuritis from a single quaternary care institution were identified and analyzed. Six (2 female) patients were identified with median age 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1-day to 2-weeks. The initial symptom for 5/6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root, and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions of these nerves were seen in 3/6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. Post-procedural brachial neuritis is an underrecognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of hourglass constrictions in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings. HGC = hourglass constriction; EDX = electrodiagnostic; IRB = Institutional Review Board; ACDF = anterior cervical discectomy and fusion; NRS = Numerical Rating Scale; MUAP = motor unit action potential.

Acute pancreatitis following asparaginase treatment in pediatric acute lymphoblastic leukemia with a heterozygous SPINK1 c.194 + 2T>C intronic variant: a case report

BackgroundAsparaginase is a critical component of chemotherapy for pediatric acute lymphoblastic leukemia (ALL), but its use is often complicated by asparaginase-associated pancreatitis (AAP). Genetic predispositions, such as variants in the SPINK1 gene, have been linked to an increased risk of pancreatitis. However, the role of genetic factors in relation to asparaginase treatment remains incompletely understood, partly because mutations in pancreatitis-causing genes are rarely found in pediatric ALL.Case descriptionA four-year and three-month-old Chinese girl was admitted to our hospital due to fever for half a day, with no history of significant prior medical history. Initial blood tests revealed hematological abnormalities, including leukopenia, anemia, and thrombocytosis. Bone marrow aspiration identified 81.5% blast cells with B-lymphocyte morphology and immunophenotype, leading to a diagnosis of B-cell acute lymphoblastic leukemia (B-ALL). The patient began treatment under the CCCG-ALL-2015 protocol, which included PEG-asparaginase (PEG-asp). On day 10 of induction, she developed AAP, which was primarily characterized by severe epigastric pain and elevated serum amylase. Despite effective symptom management with analgesics and anti-inflammatory therapy, AAP recurred following administration of L-asparaginase (L-asp). Genetic analysis revealed a heterozygous SPINK1 c.194 + 2T>C variant (rs148954387), a well-known pathogenic variant associated with increased susceptibility to pancreatitis. Sanger sequencing confirmed that the SPINK1 variant was inherited from her asymptomatic mother. The patient's AAP was managed conservatively, and an asparaginase-free regimen ultimately achieved complete remission without recurrence of pancreatitis.ConclusionsThe identification of the SPINK1 c.194 + 2T>C variant, which is recognized as pathogenic, provides valuable information for understanding the heightened risk of AAP in our pediatric ALL patient. Our case underscores the potential role of genetic predisposition in the development of AAP and highlights the importance of considering genetic screening prior to asparaginase therapy in pediatric ALL patients to identify those at increased risk.

Association of Clinical and Paraclinical Factors with Pain Crisis Severity in Sickle-Thalassemia Patients in Iran

Objectives: This study aimed to evaluate the effects of several factors, including hospitalization frequency, inflammatory and hemolytic markers, and the numbers of blood transfusions and crises, on the severity of pain crises in sickle-thalassemia patients. Methods: Of all patients visiting hematologists in university-affiliated hospitals and clinics, only 75 sickle cell disease (SCD) and sickle-thalassemia patients met the inclusion criteria for this study. Disease severity was measured based on pain crises per year and laboratory markers, including hemolytic and inflammatory indicators, outpatient or inpatient status, the number of hospital admissions, and the number of blood units transfused over one year. Results: In sickle cell patients, a significant correlation was observed between hospital admission and WBC (0.01), ALP (0.001), MCHC (0.001), ferritin (0.021), and ESR (0.006). Additionally, pain crises were positively correlated with transferrin saturation (TS) (+0.28) and the number of transfused blood units (+0.49) and negatively correlated with Hb (-0.30) and total iron binding capacity (TIBC) (-0.23). Blood unit transfusions showed a positive correlation with serum iron (+0.44), RDW (+0.36), ferritin (+0.39), pain crises (+0.49), and TS (+0.49), along with a negative correlation with Hb (-0.75) and MCHC (-0.33). When categorizing pain crises into two groups, patients experiencing more frequent crises generally exhibited lower hemoglobin levels and a higher number of blood units transfused. Hemoglobin also showed a significant negative correlation with lactate dehydrogenase (LDH) level in both groups: -0.604 (P = 0.005) in patients with ≥ 3 crises per year and -0.368 (P = 0.006) in patients with < 3 crises per year. Patients with hemoglobin levels of 7.5 or higher tended to maintain an LDH level below 1000. Among patients referred with pain crises, hemoglobin was negatively correlated with hemolytic markers such as LDH (-0.41) and retic (-0.29). Conclusions: Hemoglobin and LDH can serve as follow-up markers, as they are routinely measured in all sickle cell patients and, in this study, hemoglobin levels of 7.5 or higher and LDH levels below 1000 were associated with fewer and less severe pain crises. Regular monitoring of hemolytic markers may help in pain crisis prevention, as this study found that hemolytic crises frequently coincided with pain crises. Further research is needed to provide conclusive evidence in this area.

Reduction of neck pain severity in patients with medication-overuse headache

BackgroundNeck pain and primary headache disorders are highly prevalent in populations and clinical cohorts. Medication-overuse headache (MOH) is a treatable secondary headache, mainly developing in migraine sufferers, that accounts for the majority of patients presenting to headache clinics. Nevertheless, the association between neck pain and MOH has not been reported. This study evaluated the prevalence and clinical course of neck pain in patients with MOH before and after MOH treatment.MethodsWe analyzed 635 MOH patients enrolled in a nationwide, prospective, multicenter MOH registry. Demographics and clinical data were collected at baseline and 3 months to evaluate changes in the status and severity of neck pain and headache. Severity of neck pain was graded into 4 groups, and severe neck pain was defined as grade 3 or 4.ResultsAmong 635 patients with MOH, 366 (57.6%) reported neck pain at baseline. MOH patients with neck pain had an earlier onset of their primary headache disorder (23.4 ± 12.7 vs. 26.2 ± 13.3 years, p = 0.007). Although monthly headache days were comparable between the patients with neck pain and those without neck pain, the neck pain group had higher levels of anxiety (7.4 ± 5.8 vs. 6.4 ± 5.4, p = 0.017), more severe cutaneous allodynia (2.4 ± 3.3 vs. 1.8 ± 3.0, p = 0.038), and poorer quality of life (171.7 ± 70.4 vs. 184.0 ± 68.9, p = 0.029). At 3 months, 456 (71.8%) were followed-up, and 257 (56.4%) were recovered from MOH. Compared to the baseline, the proportion of severe neck pain (40.4% vs. 19.4%, p < 0.001) was decreased. The proportion of severe neck pain was much lower in patients with recovery from MOH compared to those without (4.7% vs. 15.1%, p < 0.001).ConclusionsNeck pain in MOH patients was associated with earlier onset of headache, higher levels of anxiety and allodynia, and poorer quality of life. Improvement in neck pain improvement was linked to recovery from MOH. These findings suggest the potential importance of integrating and management of neck pain into clinical practice for MOH.

Holistic approach to treating Vipadika (Palmoplantar Psoriasis) with Ayurvedic Therapies: A Case Report

In Ayurveda all skin disease has been considered under the headings of Kushta. Vipadika is one among such disease which has been included under the heading of Kshudra Kushta. It is characterized by Panipada Sphutanam (fissures), Teevravedana (severe pain) either in palms or soles or in both.[1] Its symptoms can be correlated with palmar-plantar psoriasis which is a chronic skin disease which mainly affects palms and sole region and is characterized by hyperkeratosis, fissures, erythema and occasionally inflammation and pustules. In present, case report a patient with complaint of dryness and cracking of both palms associated with burning and pain in the past 2-3 years, was successfully treated with Shodana (Virechana) and Shamana Aushadhi’s like Manjishthaadi Kashya, Kaishore Gugullu and Jatyadighrit externally for a period of one month. This is an effort to show the brighter side of Ayurvedic treatment not just in alleviating the symptoms but also in improving the immune strength and causing no recurrence of disease. Shodhana helps remove the root cause of the disease, and prevent from recurrence.

Ayurvedic management of Vipadika - A Case Report

Vipadika, categorized as a type of Kshudra Kustha in Ayurveda, presents as a chronic dermatological condition primarily affecting the palms and soles, characterized by symptoms such as Pani-Pada Sphutana (fissures), Teevra Vedana (severe pain), Manda Kandu (itching), and Saraga Pidika (red patches). Vipadika can be correlated to Palmoplantar psoriasis, which is a prevalent chronic inflammatory skin disorder characterized by erythematous plaques affecting the palms and soles significantly impairing daily function and quality of life. Ayurvedic management of Vipadika emphasizes Shamana Oushadhis aimed at pacifying aggravated Doshas, alleviating manifestations of Vipadika. Integral to this approach are Nidana Parivarjana and Pathya Ahara-Vihara Sevana to prevent recurrence. In the present case, a male patient with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months came to Kayachikitsa OPD and was diagnosed and treated as Vipadika with the Shamana Oushadhis. The patient's condition demonstrated a substantial improvement, with a marked reduction in symptoms evident within 21 days, suggesting effective management of Vipadika through Ayurveda.

Tingkat Nyeri Desminore pada Remaja dengan Massage Efflurage di SMAN 1 Cihaurbeuti

Efflurage massage is a method of massaging using the palms of the hands to apply gentle pressure to the surface of the body in a repeated direction of circulation. This technique aims to increase blood circulation, apply pressure and warm the abdominal muscles and increase physical and mental relaxation. Dysmenorrhea is pain or cramps that women feel in the lower abdomen area which occurs before or after experiencing the first day of menstruation (menarche) until the second day. The aim of this study was to determine the effect of massage efflurage on reducing desminorrhea pain. The method in this research is Quasi-Experimental research using the One Group Pretest-Posttest Design research method. The results of this study were that those who experienced desminore pain levels before efflurage massage were 14 respondents (47%) with severe desminore pain levels, 9 people (30%) with moderate pain levels and 18 (60%) respondents after efflurage massage. mild pain level. The conclusion from this study is that there is an effect of efflurage massage on reducing the level of desminore pain. Advice for teenagers is that when experiencing desminorrhea, they should try not to consume drugs and herbal medicines, and should do efflurage massage.

A unique presentation of trigeminal neuralgia related to a central nervous tissue choristoma along the trigeminal nerve root: illustrative case.

Trigeminal neuralgia (TNa), or tic douloureux, is characterized by severe facial pain triggered by everyday activities. Recurring and intense TNa pain results from localized demyelination within the affected nerve segment. The primary cause of TNa is typically vascular compression, with the superior cerebellar artery being the most common vessel. Tumors, multiple sclerosis, and infectious diseases such as herpes are less frequent causes of TNa. The authors present a unique case in which TNa was caused by an aberrant mass resembling a schwannoma during surgery. However, histological examination revealed heterotopic benign central nervous neurons and myelinated axons, which could represent a choristoma in the cisternal segment of the portio major of the trigeminal nerve. Following surgery, the patient's TNa was completely resolved. To the best of the authors' knowledge, this is the first documented case of a central nervous tissue choristoma causing TNa and responding positively to surgical intervention, aside from one previous report that did not specifically use the term "choristoma" in identifying the lesion. This case highlights the challenges involved in diagnosing and managing a rare TNa presentation, with a particular focus on pathology findings. It underscores the potential role of surgery for patients whose condition is resistant to medical intervention. https://thejns.org/doi/10.3171/CASE24384.

Pre-treatment DTI markers: predicting clinical outcomes in microvascular decompression for classic trigeminal neuralgia - a systematic review.

Trigeminal neuralgia (TN) is a severe chronic pain condition, typically affecting patients over 50-year-old, caused by the compression of the nerve at the root entry zone (REZ) by blood vessels. While the diagnosis is clinical, advanced imaging like diffusion tensor imaging (DTI) is crucial to identify underlying causes and assessing nerve damage. DTI may help develop neuroimaging markers to improve understanding of TN and predict surgical outcomes. The goal of the present systematic review is to evaluate the effectiveness of DTI and tractography in order to better assess treatment planning and outcome prediction through the analysis of trigeminal nerve alterations. The authors conducted a systematic review and meta-analysis of the literature to compare radiological parameters identified in pre- and post-operative MRI with DTI sequences, including fractional anisotropy (FA), quantity of anisotropy (QA), radial diffusivity (RD), and to correlate these findings with post-operative clinical outcomes. A comprehensive search of the PubMed and Scopus databases was carried out for studies published between April 2010 and January 2024. This review included 11 studies and 603 patients. Of the 363 patients with trigeminal neuralgia (TN), 193 underwent microvascular decompression (MVD), with 72.5% showing clinical improvement and 27.5% not improving, possibly due to chronic nerve damage. Four studies assessed radiological parameters before and after MVD, while two focused only on post-MVD data. The mean fractional anisotropy (FA) in affected nerves increased from 0.328 before MVD to 0.382 afterward. Five studies did not report postoperative outcomes, just comparing radiological parameters in TN patients versus healthy controls. Recent studies show that MRI-DTI parameters, including FA, RD, and QA, are useful for diagnosing trigeminal neuralgia and predicting treatment outcomes. Lower FA and higher RD values indicate better results after surgery. More research is mandatory to guide treatment decisions and enhance patients' care.

101. Posterior Gastric Perforation After Blunt Abdominal Trauma in Geriatric Patient: A Rare Case

Introduction: Blunt abdominal trauma commonly results from traffic accidents, with solid organ injuries being the most frequent. Gastric perforation, particularly of the posterior wall, is rare. We present the case of a 79-year-old male with a delayed diagnosis of posterior gastric perforation following blunt trauma. Case: A 79-year-old male, five days post-motorcycle accident, presented with severe abdominal pain and distension. He was fully conscious and hemodynamically stable. Physical examination revealed abdominal tenderness and guarding without external bruising. Radiography showed subdiaphragmatic free air, and hemoglobin was 11 g/dL. Exploratory laparotomy found 200 cc of free fluid, and a 1.5 cm full-thickness posterior gastric perforation near the prepyloric region was identified after opening the lesser sac. The perforation was closed with simple sutures. The patient developed pneumonia on day 6 postoperatively and was discharged on day 15 with uneventful recovery. Conclusions: Posterior gastric perforation following blunt trauma is uncommon but associated with high mortality. Early diagnosis and prompt surgical intervention are essential for improving prognosis.

The Role of Pain Medications in Modulating Peripheral Nerve Injury Recovery.

Peripheral nerve injuries (PNIs) are common, costly, and cause significant pain. Effective management of PNIs involves tailoring medications to the injury type as well as understanding the pharmacokinetics/pharmacodynamics to support nerve regeneration and reduce pain. Opioids act on opioid receptors to significantly reduce pain for many patients, but there are significant addiction risks and side effects. In addition, opioids may exacerbate pain sensitivity and affect nerve regeneration. Non-steroidal anti-inflammatory drugs or acetaminophen act on cyclooxygenase enzymes and are commonly used for nerve pain, with 34.7% of people using them for neuropathic pain. While effective for mild pain, they are often combined with opioids, gamma-aminobutyric acid (GABA) analogs, lidocaine, or corticosteroids for more severe pain. Corticosteroids, mimicking adrenal hormones like cortisol, treat PNI-related inflammation and pain. Their pharmacokinetics are complex, often requiring local injections in order to minimize systemic risks while effectively treating PNIs. Lidocaine, a common local anesthetic, blocks ion channels in the central nervous system (CNS) and peripheral nerves, providing strong analgesic and anti-inflammatory effects. If used improperly, lidocaine can cause neuronal toxicity instead of anesthetic effect. GABA acts as an inhibitory neurotransmitter in the CNS and its drug analogs like pregabalin and gabapentin can alleviate neuropathic pain by binding to voltage-gated Ca2+ channels, inhibiting neurotransmitter release. These pain medications are commonly prescribed for PNIs despite a limited guidance on their effects on nerve regeneration. This review will discuss these drug's mechanisms of action, pharmacokinetics/pharmacodynamics, and their clinical application to highlight their effect on the PNI recovery.

Gradation of the severity of myofascial pain syndrome of the masticatory muscles

Relevance. Due to the high prevalence of myofascial pain syndrome of the masticatory muscles, the issue of treatment of this pathology remains relevant. Due to the heterogeneity of the severity of clinical manifestations, these additional examination methods, the development of a treatment plan by a dentist causes certain difficulties. Materials and methods. Based on the data of a clinical and functional examination of 102 people aged 18 to 35 years, a gradation of the severity of MBS of the masticatory muscles was developed. In a clinical study, the presence and severity of pain during palpation, the degree of mouth opening, and an assessment of functional activity on the MAS scale were determined. Ultrasound examination was used to study the indicators of the area and thickness of the cross-section of the chewing muscles, visualization and size of trigger points. According to the electromyographic study, a comparative analysis of the average amplitude of the masticatory muscle, the total biopotential, and an assessment of the symmetry of the masticatory muscles was carried out. Results. The data obtained made it possible to develop a gradation of the severity of MBS by 3 degrees, depending on the indicators (mild, moderate, high). Conclusion. The development of this graduation will allow for an individual patient-oriented approach to the treatment of this category of people, which will contribute to improving the quality of medical care at a dental appointment

Clinical experience of the carboxytherapy method in the treatment of patients with temporomandibular joint pain dysfunction syndrome (К07.60)

Objective. Improving the effectiveness of treatment of patients with TMJ PDS myogenic origin. Material and methods. According to the purpose of the study, a group of 10 patients (8 women and 2 men aged 14 to 60 years) was formed with the coincidence of a triad of signs: pain during movements of the lower jaw, a feeling of heaviness and tension in the chewing and facial muscles, restriction of mouth opening. A set of diagnostic measures has been implemented in the following scope: clinical and radiological examination methods, TMJ MRI, ultrasound and surface EMG of the chewing muscles, digital axiography. In the treatment of patients in the study group, the method of invasive carboxytherapy was used, based on dosed injections of CO2 in the projection of trigger points of the masticatory muscles. The research examines the therapeutic value of using of CO2 in the protocol of functional rehabilitation of patients with TMJ diseases of myogenic origin. Results. The analysis of the effectiveness of treatment of patients in the study group was carried out to assess the dynamics of key parameters: the severity of the pain syndrome according to VAS, the magnitude of the IMPACT index values and the magnitude of mouth opening. The severity of pain in patients in the study group, according to average values, decreased by 86% from the initial values, an increase in the amplitude of mouth opening by 28.5%, a decrease in the IMPACT index values by 42.5% from the initial values of hypertonicity of the masticatory muscles, an increase in blood flow speed of superficial temporal artery at 52.5%. Conclusion. The results of the clinical application of the carboxytherapy method in the treatment of patients with TMJ PDS allow us to recommend this method for implementation in the rehabilitation protocols of patients with TMJ PDS of myogenic origin, trismus and hypertonus of the masticatory muscles. Carboxytherapy as a method of etiopathogenetic rehabilitation contributes to the early relief of pain syndrome, normalization of the bioelectric activity of the chewing muscles and restoration the physiological kinematics of the lower jaw’s movements.

A new portable negative pressure wound therapy device: a prospective study investigating clinical outcomes.

Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites. The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected. Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported. In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use.

Physical Activity Variability in Patellofemoral Pain: Relationships with Clinical and Psychological Outcomes

ObjectivesTo (1) compare physical activity variability between individuals with patellofemoral pain (PFP) and pain-free individuals and (2) evaluate the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts. DesignCross-sectional case-control study. SettingUniversity research laboratory. ParticipantsIndividuals with PFP (N=34) and pain-free individuals (N=34) aged 18 to 40 years. InterventionsNot applicable. Main Outcome MeasuresWe assessed physical activity (daily steps and moderate-to-vigorous physical activity [MVPA]) over a period of 14 consecutive days using a triaxial accelerometer. Variability (coefficient of variation) for daily steps and MVPA was calculated, where higher CV values indicate greater physical activity variability. We evaluated pain severity (numeric pain rating scale), symptom duration (months), disability (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral subscale), and pain catastrophizing (Pain Catastrophizing Scale). Independent t-tests or Mann-Whitney U tests evaluated group differences in physical activity variability. Spearman ρ correlation coefficients were calculated to determine the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts. Correlation coefficients were interpreted as weak (<0.40), moderate (0.40–0.70), and strong (>0.70). ResultsAge, height, and mass did not differ between individuals with PFP and pain-free individuals (P>.05). Individuals with PFP displayed greater variability in daily steps (P<.001) and MVPA (P=.001) compared to pain-free individuals. In individuals with PFP, greater variability in daily steps was moderately related to higher pain severity (ρ=0.41, P=.016), while greater variability in MVPA was weakly related to higher pain severity (ρ=0.36, P=.037). ConclusionsIndividuals with PFP demonstrated greater physical activity variability compared to pain-free individuals, which positively related to more severe pain. Future PFP research may explore the underlying factors contributing to increased physical activity variability and their potential implications for pain management.