Pain Syndrome Patients Research Articles

Possibilities for pain relief in acute pancreatitis: a narrative review

Currently, there are no recommendations for managing pain syndrome in patients with acute destructive pancreatitis. A literature search was conducted using PubMed, Cochrane Controlled Clinical Trials Register, and Google Scholar, without restrictions on language, type, or date of the publication. The analysis revealed several possible options for anesthesia in acute destructive pancreatitis. The most commonly used methods for pain relief include narcotic analgesics and nonsteroidal anti-inflammatory drugs. However, in severe forms of acute pancreatitis, nonsteroidal anti-inflammatory drugs should be used with caution due to the risk of acute kidney injury, while opiates may adversely affect the sphincter of Oddi and contribute to the disease progression due to increased ductal pressure. Epidural analgesia also presents limitations, such as risks of hypotension and incompatibility with anticoagulant or antiplatelet therapy. As alternatives, regional anesthesia techniques (paravertebral block and erector spinae plane block) should be considered. Choosing an optimal analgesia method should take into account several factors: pain intensity, disease severity, etiology of acute destructive pancreatitis, comorbidities, and concurrent use of anticoagulants and antiplatelets. Further research into effectiveness of regional analgesia methods is warranted, as they may address both somatic and visceral components of pain and may prove effective and safe in the most severe cases.

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 (> 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.

The role of gut microbiota involved in prostate microenvironment and symptoms improvement in chronic prostatitis/chronic pelvic pain syndrome patients treated with low-intensity extracorporeal shock wave.

Low-intensity extracorporeal shockwave therapy (Li-ESWT) is emerging as a promising and safe treatment for Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this study, we aimed to investigate the role of the gut microbiota involved in the prostate microenvironment and symptom improvement during the Li-ESWT for CP/CPPS patients. CP/CPPS patients not taking antibiotics or other treatments were included. NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were used to evaluate the effectiveness of Li-ESWT at the end of treatment. Visual analogue scale/score was used to evaluate the pain during procedure. Stool and semen samples were collected before and after Li-ESWT. Shotgun metagenomics analyzed gut microbiota, while ELISA and other diagnostic kits detected biochemical changes in seminal plasma. Of the 60 enrolled patients, 52 completed treatment. Li-ESWT response rate was 78.8% (41/52) at end of treatment. Among responders, the subitems of the NIH-CPSI; IPSS; and IIEF-5 scores improved significantly, and the seminal plasma analysis showed decreased TNF-a and MDA levels and increased SOD and Zn2+ levels posttreatment. Gut microbiome analysis indicated that posttreatment, both α and β diversity increased, and the abundance of certain specific species significantly increased. Fifty-eight pathways significantly enriched posttreatment, notably in branched-chain amino acid synthesis and butyrate synthesis. The abundance of several specific species was found to be significantly higher in non-responders than responders. Among responders, at the species level, some bacteria associated with NIH-CPSI and its subscales, IPSS, IIEF-5, and prostate microenvironment markers (TNF-a, MDA, Zn2+, and SOD) were identified. Our study demonstrates for the first time that Li-ESWT improves the prostate microenvironment and gut microbiota in CP/CPPS patients. Treatment nonresponse may be associated with a high abundance of specific pathogens before treatment. The gut microbiota could have a significant impact on Li-ESWT response and the prostate microenvironment.

Myofascial pain syndrome in patients with cancer: a narrative review.

Myofascial pain syndrome (MPS) is a chronic musculoskeletal pain syndrome. The purpose of this review is to describe the epidemiological and treatment evidence and to address the future research agenda in patients with cancer. A narrative review of previous reports investigating the prevalence and treatment of MPS in the oncology field is presented. The target population is patients with cancer and cancer survivors. There have been three prospective and two retrospective studies investigating the prevalence of MPS. MPS is as high as 38%-45% in patients with advanced or incurable cancer and 11.9%-44.8% in cancer survivors. A total of nine reports investigated the efficacy of the following interventions: trigger point injection (TPI), myofascial techniques and ischaemic compression. TPI has been reported to be effective in four observational studies. One randomised study reported the efficacy of myofascial techniques, but two randomised studies reported no added beneficial effects of it in breast cancer survivors. Two randomised studies investigated the efficacy of ischaemic compression, but the obtained results were contradictory. MPS is highly prevalent. We should know that non-cancer pain is also common in both patients with cancer and survivors. In treating such pain, careful physical examination is essential. Then, non-pharmacological treatment should be considered as well as pharmacotherapy. As evidence regarding MPS in the oncology field is scarce, further research is warranted.

Unique Profile of Post Mastectomy Pain Syndrome in Breast Cancer Patient in an Oncologic Center Surabaya, Indonesia

Background: Post Mastectomy Pain Syndrome (PMPS) is chronic neurophatic pain that is localized around the surgical site and can occur immediately or some time after surgery and lasts up to more than three months. Breast cancer is the most malignancy in women worldwide. Mastectomy is one of the treatment options for breast cancer that is often performed. Goal: This research aims to provide an overview of the profile of breast cancer patients who experience PMPS at the Oncology Clinic at RSUD dr. Soetomo Surabaya in Desember 2023. Method: This research uses a cross sectional to all breast cancer patients who experience PMPS. Samples were taken by consecutive sampling based on inclusion and exclusion criteria. We present our data descriptively in the tabulation of diagrams and tables. Results: Based on the quality of pain, most patients complained of radiating pain (52.7%), followed by stinging (33.33%), and dullness (14%). Pain was mainly felt at the surgical area (94%) with the remaining 6% feeling pain in ipsilateral arm. A total 108 samples (60%) answered that they felt pain continously, and most of samples (86.7%) had a history of taking anti-pain medication to reduce complaints. Only about 36% of the samples said that pain improved over time. Conclusion: At the Tertiary Oncologic Centre in Surabaya, most post-mastectomy pain syndrome patients were older, with luminal A type, and at higher TNM stages. The majority reported pain radiating from the surgery site, typically manifesting more than six months after the surgery.

Multimodal nature of pain syndrome in patients with rheumatoid arthritis in relation to the course of the disease and clinical characteristics

Purpose of the study. To evaluate the character of pain syndrome in patients with rheumatoid arthritis in correlation with the course of the disease and comorbid pathology.Material and methods. Sixty-six patients with a verified diagnosis of RA were examined. Of them 84.9% were women (n=56) and 15.1% men (n=10). The median age was 59 [52; 63] years. Disease activity was assessed by DAS28-CRP, with a median of 5.2 [4.54; 6.0]. Patients with moderate (31.8%) and high activity (57.5%) predominated. Disease duration averaged Me 156 [93; 246] months. Seropositive RA was suffered by 89.3% of patients. The distribution by radiological stage was as follows: 2 radiological stage – 36.3% (n=24), 3 radiological stage – 30.3% (n=20), 4 radiological stage – 33.4% (n=22). Baseline anti-inflammatory therapy was taken by 84.8% of patients (n=56), genetically engineered biological drugs were received by 28.7% (n=16). To assess the multicomponent nature of pain syndrome, the following were used: Pain Detect questionnaire — to verify neuropathic pain (NP), CSI questionnaire — to verify central sensitisation (CS). The EQ-5D-3L questionnaire was used to assess quality of life, and the Charlson index was used to assess comorbid pathology. Structural changes were assessed by modified Sharpe method on hand and foot radiographs, synovium vascularisation was assessed by joint ultrasound.Results. 84.8% of patients had pain syndrome of mixed nature. NP correlated with pain intensity by VAS (rSp=0.458, p<0.001), DAS28-CRP (rSp=0.509, p<0.001), number of peripheral arthritis (rSp=0, 414, p<0.001), number of comorbidities (rSp=0.337, p=0.006), Charlson index (rSp=0.323, p=0.009), EQ-5D-3L (rSp= –0.268, p=0.031). CS–with VAS pain intensity (rSp=0.250, p=0.045), DAS28-CRP (rSp=0.251, p=0.044), number of painful joints (rSp=0.353, p=0.004), number of comorbidities (rSp=0.368, p=0.003), BMI (rSp=0.266, p=0.032), systolic blood pressure level (rSp=0.403, p<0.001), number of erosions on hand and foot radiographs (rSp= –0.299, p=0.016), EQ-5D-3L (rCp= –0.408, p<0.001). Patients with the presence of synovial vascularization by ultrasound had three-component pain in more than half of cases, and the combination of inflammatory pain and CS did not occur in them.Conclusions. 84.8% of patients had multicomponent pain, with pain associated only with clinical parameters of disease activity. Associated pathology and local chronic inflammation in the joint potentiate the development of other types of pain and have a mutual negative influence.

Assessment of chronic pain syndrome after laparoscopic transabdominal preperitoneal plastic surgery in patients with inguinal hernia

Aim. To assess pain syndrome in patients with inguinal hernia after laparoscopic transabdominal preperitoneal (TAPP) plastic surgery. Materials and methods. The study involved 58 patients with unilateral Nyhus type 2 and 3 inguinal hernia. The patients underwent laparoscopic TAPP plastic surgery using a mesh implant that was not fixed independently. According to the method of graft fixation, the patients were divided into two groups. In the first patient group, staple fixation of the mesh was applied – 28 (48.3 %), the second group – 30 (51.7 %) patients without mesh fixation. Patients with a history of surgical interventions on the abdominal cavity and pelvis, complicated or recurrent inguinal hernia were excluded from the study. Pain syndrome was assessed using the visual analog scale and an independent survey during postoperative follow-ups of the patients every three months for two years. Results. In the assessment of postoperative pain in the first patient group, moderate pain intensity was noted, and it was minimal in the second group, p < 0.001. 9 (32.1 %) patients who underwent mesh implant fixation required opioid analgesics, compared with 4 (13.3 %) patients who did not undergo fixation, p = 0.043. At the first examination, chronic pain was detected in 6 (21.4 %) patients of the first group and in 3 (10.0 %) patients of the second group. During a year, pain syndrome gradually disappeared. After 9 months, pain was reported by 4 (14.3 %) patients in the group with mesh fixation and by 1 (3.3 %) patient without fixation. At the 6th examination in the first group, 2 (7.1 %) patients reported pain; 1 (3.6 %) patient underwent Lichtenstein hernioplasty due to recurrent, increasing acute pain. Conclusions. Laparoscopic TAPP plastic surgery without graft fixation shows a lower possibility of pain syndrome development than with mesh implant fixation. In the case of chronic pain syndrome development following the TAPP technique without mesh fixation, the general condition of patients improves more quickly.

Preoperative Rank of Expectations for Shoulder Surgery (PRESS): a novel survey

Patient expectations for orthopedic surgeries, and elective shoulder surgery in particular, have been shown to be important for patient outcomes and satisfaction. Current surveys assessing patient expectations lack clinical applicability and allow patients to list multiple expectations at the highest level of importance. The purpose of this study was to develop and evaluate the use of a novel, rank-based survey assessing the relative importance of patient expectations for shoulder surgery. The Preoperative Rank of Expectations for Shoulder Surgery (PRESS) survey was developed by polling 100 patients regarding their expectations for surgery. The PRESS survey consisted of 8 common expectations for elective shoulder surgery by importance and a 0%-100% scale of expected pain relief and range of motion improvement. After initial development of the PRESS survey, it was administered preoperatively to 316 patients undergoing surgery for shoulder arthritis, rotator cuff tear, subacromial pain syndrome, or glenohumeral instability between August 2020 and April 2021. Patients also completed preoperative outcome measures such as the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Physical Function 7a version 1.0 (PROMIS PF), and PROMIS Pain Interference short form 8a version 2.0 (PROMIS PI) surveys. Patient-reported outcome measure (PROM) surveys were administered 6 months postoperatively. Improvement in range of motion was the expectation most often ranked first for the entire study group (18%), arthritis subgroup (23%), and rotator cuff tear subgroup (19%). Subacromial pain syndrome patients most often ranked improving ability to complete activities of daily living and relieving daytime pain first (19%). Shoulder instability patients most often ranked improving ability to participate in sports first (31%). Patients who ranked improving range of motion or sports highly had better PROMs. Those who ranked relieving pain highly had worse PROMs. Patients with high (>90%) expectations of pain relief had better PROMIS PI scores. Patients with high pain relief expectations in the arthritis and subacromial pain syndrome groups had better PROMs, whereas patients with instability were less satisfied. The novel PRESS survey assesses patient expectations for shoulder surgery in a new, more clinically applicable rank-based format. The responses provided by patients provide actionable information to clinicians and are related to postoperative outcomes. Therefore, the PRESS survey represents a useful tool for guiding discussions between patients and surgeons, as well as aiding in overall patient-centered clinical decision making.

Hyperpolarized incoherent light in complex treatment of patients with patellofemorals pathology

Abstract. Currently, technologies for treating patellofemoral pain syndrome (medicinal and surgical) are not always successful. Purpose of the study: An open randomized controlled trial is to study the effect of hyperpolarized non-coherent light (HPL) and shock wave therapy (SWT) on pain syndrome in patients with patellofemoral pain syndrome (PFPS) in the subacute stage of the disease. Patients (n = 60), aged 39.2 ± 12.3 years old, were divided into two groups: 1st (control, n = 30) group, received standard therapy (medicines, exercise therapy, taping), 2nd (main, n = 30) group — received additional HPL and UVT according to the original method. Material and methods. HPNS was received from a Bioptron device with a fullerene filter, shock wave therapy from a Dornier Aries device, a course of 10–12 daily procedures with each exposure. The condition of the patients was assessed using the Kujala questionnaire before treatment, after the course, and after 6 and 9 months. The data was analyzed using statistical indicators, including Fisher’s f-test and Student’s t-test. Results. The conducted studies showed that before the start of treatment, according to the initial indicators of the Kujala questionnaire, patients in both groups were comparable and their distribution corresponded to normality. As a result of complex treatment, patients in the 2nd (main) group experienced clinical improvement for up to 9 months and the Kujala questionnaire scores were significantly higher than those in patients in the 1st (control) group at the same follow-up period. In patients in the 1st (control) group, treatment results were already unstable by 6 months. Conclusion. The chosen tactics for treating patients with PFMPS in the subacute stage using HPL and shock wave therapy was more effective than the standard technique.

Secondary Analysis of Interstitial Cystitis/Bladder Pain Syndrome Patients Enrolled in a Recurrent Urinary Tract Infection Prevention Study Provides a Novel Paradigm for Etio-Pathogenesis and Practical Management of This Infection Phenotype.

A subset of interstitial cystitis/bladder pain syndrome (IC/BPS) patients experience recurrent urinary tract infection (rUTI) associated with symptom flares. Recurrent UTI subjects with associated IC/BPS were enrolled in the first North American early clinical experience trial evaluating a new sublingual UTI preventative vaccine, MV140. It has been shown that women with rUTI develop an imbalance in the T helper 1 and 2 (Th2 over-expression) in the bladder mucosa. Our hypothesis-generating secondary analysis will suggest that this infection subcategory of IC/BPS patients develop a similar imbalance of Th1-Th2 response type to bacteria present in their urinary microbiome, leading to a bladder hypersensitivity that responds to mucosal immune modulation. Female participants with ≥3 documented UTI/year underwent a 3-month vaccination treatment period with a 9-month efficacy period after completion of vaccine treatment (total 12 months). There were no exclusion criteria for subjects in relation to baseline urinary symptoms and/or discomfort/pain. Primary outcome was no UTI following vaccination. Secondary outcomes included change in UTI incidence, overall patient-reported subjective global assessment (SGA responder defined as moderately or markedly improved on 7-point scale), and safety. Sixteen subjects with IC/BPS-related symptoms and rUTI (mean age 47; range 23-74 years; mean number of UTI episodes in previous year 6.1 +/- 4.2) were eligible to be included in the Health Canada-approved MV140 vaccine study for prevention of rUTI. All subjects completed the 3-month vaccination period. One subject was lost to follow-up after their 6-month visit. Six subjects were UTI-free, while all 16 subjects had a reduction in UTI episodes compared to the year pre-vaccination. The total post-vaccination reduction in UTI episodes compared to pre-vaccination was 80% (0.1 UTI/subject/month from 0.5 UTI/subject/month, respectively). At 12 months, 13 subjects (81%) were SGA responders (moderately or markedly improved), and the responders reported a reduction in IC/BPS symptoms, with 8 subjects reporting significant or almost complete resolution of their specific long-term bladder discomfort/pain and bothersome urinary frequency or urgency. Four subjects reported mild and self-limited adverse events during vaccination period, but none were related to MV140 vaccine. Sublingual MV140 vaccine in IC/BPS patients with rUTI not only achieved UTI-free or reduced UTI incidence status but also, after approximately 9 months post vaccination, resolution of patients' long-term treatment-refractory IC/BPS symptoms. This suggests some cases of IC/BPS may be etiologically based on Th2-driven hypersensitivity to bacteria within or entering the urinary microbiome that responds to a vaccine whose mechanism of action is to normalize or balance the bladder Th1/Th2 mucosal immune system.

Acute coronary syndrome in elderly and senile diabetic patients

Acute coronary syndrome (ACS) remains a common cause of hospitalization in diabetes mellitus (DM) patients. It is believed that diabetic neuropathy patients have a high atypical course incidence of acute coronary syndrome, because of the frequent neuropathy development in diabetes patients, but the data on this are quite contradictory. Aim: The study aimed to determine the features of the pain syndrome and its severity in ACS and concomitant diabetes patients. Materials and Methods: The study involved 36 diabetes patients (22 men and 14 women) aged 62-86 years, hospitalized urgently for ACS. Pain syndrome was assessed during hospitalization and immediately after coronary artery revascularization using the following criteria: visual analogue scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers. Results: Most of the patients (91.67%) complained of chest pain at the time of hospitalization, the rest were not bothered by any pain. Patients described pain as “burning” (30.56 %), “squeezing” (30.56 %), “tightness” (25.0 %), and “tingling” (5.56 %). There were also complaints of difficulty breathing (13.89 %), shortness of breath (11.1 %), and palpitations (41.67 %). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of VAS and NRS pain scores (p > 0.1). The mean blood glucose level at hospitalization was 8.19±3.45 mmol/l (in men – 8.17±3.61 mmol/l, in women – 8.28±3.13 mmol/L). Glycemia level higher than 10.0 mmol/l was detected in 8 patients, which accounted for 22.22% of all patients. Severe pain syndrome patients dominated in this category (62.5 %). Conclusions: In patients with myocardial infarction and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Before revascularization, moderate to severe pain occurred with equal frequency; there were no statistical differences between blood pressure, heart rate, and blood glucose level (p> 0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was detected in 22.22% of patients, among whom severe pain syndrome patients prevailed. _________________________________________________________________________________________ Keywords: elderly patients; diabetes mellitus; acute coronary syndrome; pain syndrome

The effect of full-spectrum cannabis leaf extract on pain, inflammation, and quality of sleep: Case series

Abstract Inflammation and pain are two of the most typical signs of a pain syndrome. Conventional treatments have been related to an increase in adverse effects like gastrointestinal issues. Medical cannabis (MC) has gained popularity as a new alternative treatment for pain syndrome patients. We hereby present a series of five cases with comparable clinical symptoms. All patients had raised C-reactive protein levels, severe pain, insomnia, and varying degrees of muscle stiffness. The patients were prescribed Cannazo India’s Painaid 3000 mg/15 mL, full-spectrum MC leaf extract-based tincture. The oil-based tincture was given sublingually at night for 1 month, and the initial dose of 5–10 drops was gradually reduced owing to Painaid’s rapid pain relief and anti-inflammatory actions. For symptom assessment, the screening tools Numeric Pain Rating Scale, Ashworth Scale, and Regensburg Insomnia Scale were employed. This study’s primary result was a 70%–99% reduction in pain, spasticity, and inflammation. There were no documented side effects. In addition, the patients’ sleep patterns and sleep quality improved with time. In a nutshell, full-spectrum cannabis extract-based medicines like Painaid, when taken as indicated, are the key in treating pain conditions.

Acute pain syndromes in injuries to the nerves and plexuses of the limbs

Injuries of peripheral nerves and plexuses cause serious disorders in the affected limbs. Unfortunately, the frequency of nerve injuries and limb plexuses is steadily increasing in our country, due to hostilities, which emphasizes the extreme relevance of this pathology. The aim of the review is to consider the current data on pathophysiological mechanisms, clinical manifestations, and treatment of acute pain syndromes in patients with injuries of peripheral nerves and limb plexuses. Materials and methods. Scientific databases PubMed, Google Scholar, Scopus, Cochrane Library, as well as the materials of the International Association for the study of pain were used to search for sources of research information. The main studies were found in Pubmed, Google Scholar and materials of the International Association for the study of pain and made up 191 sources of information, 150 of which were excluded from the review due to insufficient data on pathophysiological mechanisms, clinical manifestations, and treatment of pain syndromes in patients with damage to the nerves and plexuses of the limbs, thus 41 sources of information formed the basis of the review. Results: Brachial plexus and peripheral nerve injuries can be associated with any combination of nociceptive, neuropathic, phantom limb pain, and even complex regional pain syndromes. Acute neuropathic pain is an under-recognized condition, often difficult to treat and can progress to persistent pain and disability. Neuropathic pain develops because the main damage affects the somatosensory system. It is caused by peripheral nerve damage and associated changes in the central nervous system. The first line of pharmacological treatment for neuropathic pain according to current guidelines is anticonvulsant drugs that affect neuronal calcium channels, as well as tri- and tetracyclic antidepressants and selective serotonin/norepinephrine reuptake inhibitors. Conclusions: At the current stage, progress has been made in understanding the mechanisms of development of the pathological condition and in the development of therapeutic approaches, however, the chronicity of pain syndrome in patients with damage to the nerves and plexuses of the limbs is still high, which requires further research to develop complex pathogenetic therapy and better understanding of the mechanisms pain in this category of patients

New peptide analgesic, μ1-opioid receptor agonist tafalgin, in multimodal pain management. First results of using in a multidisciplinary hospital

Therapy of chronic pain syndrome and adequate perioperative pain management during treatment of malignant neoplasms are important problems at the current stage of clinical medicine development. Currently, multimodal pain management is effectively applied through drugs of various pharmacological groups prescribed depending on pain intensity in accordance with a digital rating scale. Associated adverse events as well as impossibility of using peroral or transdermal forms in some cases, limit the use of opioid analgesics. High bioavailability and fast absorption of μ1-opioid receptor agonist tafalgin shown during preclinical studies, relatively favorable safety profile allowed to use this drug in oncological clinic.An experience of using tafalgin in treatment of pain syndrome in patients with malignant tumors at the “Lapino” clinical hospital since 2022 is presented. The effectiveness of the drug is evaluated, and its niche in multimodal pain management is determined.

Unlocking the power of motor imagery: a comprehensive review on its application in alleviating foot pain.

Motor imagery is a cognitive process that involves mentally simulating movements without physical execution. It has been studied in the context of foot pain to understand the role of motor cortical reorganization and its impact on motor imagery abilities. However, further research is needed to establish consistent evidence regarding the relationship between motor imagery and foot pain. This review analyzed five relevant articles that investigated motor imagery in the context of foot pain. The studies involved participants with various conditions, including leg amputation, chronic leg pain, complex regional pain syndrome, and Achilles tendinopathy. Different methodologies were employed, including motor cortical mapping, foot laterality recognition tasks, EEG recordings, and treatment interventions incorporating motor imagery. The findings indicated that individuals with leg amputation exhibited functional reorganization in upper limb motor cortical maps, with a breakdown in the inhibitory relationship between foot and hand representations. Participants with chronic leg pain demonstrated slower and less accurate performance on foot laterality recognition tasks compared to healthy controls. Complex regional pain syndrome patients displayed distinct motor imagery strategies and responded differently to first-person and third-person perspectives. EEG studies revealed differences in brain activity during motor imagery tasks under pain-free and pain conditions. Treatment interventions incorporating motor imagery showed promising outcomes in improving functional outcomes and reducing pain levels. Motor imagery plays a significant role in foot pain conditions, although the evidence is still emerging. The findings suggest that motor imagery abilities may be affected by leg amputation, chronic pain, and complex regional pain syndrome. Further research is needed to establish standardized protocols for assessing motor imagery, identify specific patient populations that may benefit most from motor imagery interventions, and explore long-term effects. Integrating motor imagery into clinical practice has the potential to enhance rehabilitation approaches and improve outcomes in foot pain management.

Modern view of mechanisms of chronic pain syndrome in patients with knee joint damage

Modern view of mechanisms of chronic pain syndrome in patients with knee joint damage

Pain syndrome in patients with diabetes after hip and knee endoprosthesis operations

Hip and knee arthroplasty (HKA) are common surgical interventions in patients with diabetes mellitus (DM). An important factor in the postoperative recovery of these patients is the correction of the postoperative pain syndrome. Aim of the study To establish the features of the pain syndrome after hip and knee endoprosthesis operations in patients with diabetes and to develop optimal methods of its correction.

Effects of adding neuromuscular electrical stimulation to functional training on muscle recruitment, pain reduction, and knee joint function in patellofemoral pain syndrome patients.

Impaired lower extremity motor function and knee pain are common concerns in patients with patellofemoral pain syndrome (PFPS). It is essential to plan therapeutic techniques to therapy PFPS. The objective of this study was to determine the effect of neuromuscular electrical stimulation (NMES) combined with functional training on pain, lower extremity function and muscle recruitment in patients with PFPS. Twenty-four PFPS patients (male-13, female-11) were selected to conduct this study finally. Two groups were formed: the control group (n = 12) which included functional training only and the experimental group (n = 12) which functional training along with NMES-in both groups interventions were performed for 45 minutes/session, 3 days/weeks for 6 weeks. The functional training consisted of warm-up activities, strength training, balance training, and relaxation activities. All patients were evaluated with surface electromyography testing system for the root mean square and integrated electromyography of vastus medial oblique (VMO), vastus lateralis (VL), and VMO/VL ratio, visual analog scores (VAS) for pain, and Kujala functional score for knee joint function before and after 6 weeks. Normality was tested for all outcome variables using Shapiro-Wilk test. Nonparametric (Mann-Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data. A 2-way analysis of variance with repeated measures (group*time) was applied to analyze the data. A significant increases (P < .001) root mean square and integrated electromyography of VMO, VMO/VL ratio, and Kujala score in both groups, For VAS scores, significant decreases was observed in both groups. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison the control group for both knee pain, lower extremity function and muscle recruitment. However, there was no difference in VL muscle recruitment between the 2 groups. Functional training and NMES combined with functional training are helpful to improve pain, knee function and muscle recruitment of PFPS patients. NMES combined with functional training was more effective compared to the control group. This may help clinical trialists to use different NMES to synchronize other interventions in future studies to enhance rehabilitation efficacy in PFPS patients through passive training versus active stimulation.

Bioacoustic correction in treatment of phantom pain syndrome. (Pilot study)

To assess the severity of the phantom pain syndrome in patients with consequences of combat trauma before and after comprehensive therapy using the bioacoustic correction (BAC) method. A number of male patients equal 15 aged 24-60 years with consequences of combat traumas and confirmed phantom pain syndrome were examined. Patients were given 10 BAC therapy procedures with an average duration of 20 minutes per day after a comprehensive diagnostic assessment of state. The dynamics of pain syndrome was evaluated by visual analogue scale. It has been shown that the BAC procedures contribute to a significant reduction of the phantom pain syndrome severity. The decrease of the phantom pain syndrome after the BAC procedures was maintained at least 6 months in the catamnesis. The probable mechanism of reducing the phantom pain syndrome in BAC procedures is adaptive reorganization of thalamocortical detectors of affected limbs by modulation of neuroplasticity processes. The conducted preliminary studies have shown that the BAC therapy contributes to the reduction of the phantom pain syndrome intensity.

Оцінка лікування больового синдрому у пацієнтів з м’язово-суглобовою дисфункцією скронево-нижньощелепного суглоба за функціональним станом жувальних м’язів

Actuality. Treatment of temporomandibular joint dysfunction is an interdisciplinary problem that includes an interdisciplinary complex simultaneous approach to eliminate the factors that cause the development of a dysfunctional state of the temporomandibular joint. Objective. To study the dynamics of changes in the functional state of masticatory muscles and pain syndrome against the background of orthopedic treatment with a modified occlusive splint in the case of temporomandibular joint (TMJ) musculoskeletal dysfunction. Materials and Methods. Among the examined persons (421 persons), 85 patients were randomly selected for analysis: 63 (74%) women and 22 (26%) men with TMJ MSD. Mean age of patients M±SD 36.2±10.8 years. The determined population was divided into three groups according to the diagnostic criteria of temporomandibular disorders. Group I included 8 (10%) patients with disc disorders, group II - 30 (35%) patients with myalgias, group III - 47 (55%) patients with combined pathology (disc disorders and myalgias). The pain syndrome was evaluated using the visual analog scale (VAS) before and after treatment, the symptoms of physical pain and manifestations of temporomandibular joint dysfunction were studied according to the results of the questionnaire. The functional state of the muscles was studied based on the results of electromyography. The statistical evaluation of the research results was carried out by analysis of variance (ANOVA) and non-parametric Kruskel-Wallis and Mann-Whitney tests. Results. Statistically significant differences in the severity of the pain syndrome (p &lt;0.05) were established in groups (Gr.I, Gr.II, Gr.III: MeI=1.5 points, MeII=4.7 points, MeIII=4.3 points ). After treatment in each of the groups, the pain syndrome decreased and amounted to MeI = 0.7 points, MeII - 1.3 points and MeIII = 1.2 points in the absence of statistically significant differences between the indicators (p&gt;0.05). The torque index (To % ) in observation groups before treatment was established: GrI - 10.02±5.21, GrII - 9.29±5.91 and GrIII - 8.03±3.2 without statistically significant differences between groups (ð&gt; 0.05). After treatment, changes in To% indicators were determined in all groups: GrI - 7.69±3.52, GrII - 6.15±3.51, GrIII- 5.31± 1.97 with statistically significant differences between groups (ð&lt; 0.01). Before treatment, the asymmetry index As % was determined in GrI- 11.32±5.18, in Gr II- 11.55±7.81 and in Gr III- 14.04±4.58 without statistically significant differences between groups (p&gt; 0.05). After treatment, a decrease in As% was found in GrI - 5.7±3.47, in GrII - 6.54±3.47 and in GrIII - 11.54±3.72 with statistically significant differences between groups (ð&lt;0.01 ). Before treatment, the ATTIV % activity index was established in GrI -9.13±5.15, in GrII - 16.82±7.75 and in GrIII - 15.54±5.02 without statistically significant differences between groups (ð&gt;0, 05). After treatment, wed a decrease in ATTIV % indicators was determined: GrI - 6.76±3.34, GrII - 10.33±4.34 and GrIII - 11.51±3.87 with statistically significant differences between groups (ð&lt;0.01) . Conclusions. The use of a modified occlusive splint effectively improves the functional state of masticatory muscles and reduces pain syndrome in patients with musculoskeletal dysfunction of the temporomandibular joint. Key words: Temporomandibular dysfunction, temporomandibular joint, electromyography, masticatory muscles, torque index, asymmetry index, activity index.