Pain Syndrome Patients Research Articles

Nociceptive and Mixed Pain Syndromes in Patients with Multiple Sclerosis

Nociceptive and Mixed Pain Syndromes in Patients with Multiple Sclerosis

Frequency of typical complications of morphine during its intrathecal and epidural introduction in knee arthroplasty

The objective was to compare the efficacy and safety of morphine in neuraxial blocks during knee arthroplasty.Materials and methods. A retrospective analysis of 60 medical histories of patients who underwent total knee arthroplasty for the period from 2017 to 2019 was performed. All patients were operated under general anesthesia with mechanical ventilation in combination with epidural or spinal analgesia with opiates. Patients of the 1st group (n=20) after catheterization of the epidural space at the level of L1–2 were injected with a morphine solution 1% – 0.3 ml epidurally. Patients of the 2nd group (n=20) were injected with a morphine solution 1% – 0.01 ml intrathecally at the level of L3–4. Patients of the 3rd group (n=20) underwent standard combined anesthesia: general anesthesia with mechanical ventilation and epidural analgesia at the level of L1–2 with a solution of 0.2% ropivacaine in the form of an infusion of 6 ml/hour. All patients received infusion of 0.2% solution of ropivacaine epidurally 6 ml/hour at the level of L1–2 in the postoperative period.The incidence of nausea, vomiting, pruritus, headache and the level of postoperative pain syndrome were assessed on a numerical rating scale 6 hours after the end of the surgery.Results. The level of pain syndrome in patients who received intrathecal and epidural analgesia with morphine was equally low, while in patients who received epidural analgesia with ropivacaine, the level of pain syndrome was statistically significantly higher, which required the additional prescription of non-steroidal anti-inflammatory drugs and/or narcotic analgesics parenterally. The frequency of nausea, vomiting, pruritus and headaches was maximum in the 2nd group, significantly lower in the 1st, while in the 3rd, pruritus did not occur.Conclusion. The use of morphine in neuraxial block in knee arthroplasty has a positive effect on the quality of anesthesia and postoperative pain relief.

Relapses of pain syndrome in patients with polymyalgia rheumatica during reduction of glucocorticoid therapy

An analysis of causes leading to pain recurrence in patients with polymyalgia rheumatica (PR) after tapering down the dose of glucocorticosteroids (GCS) is presented. True exacerbations resulting from the main disease recurrence and pseudo-exacerbations when the resumption of pain syndrome is not due inflammation but because of other causes – steroid myopathy or chronic adrenal insufficiency (AI) are identified. The experience of using tocilizumab, an inhibitor of interleukin-6 receptors, as steroid-sparing agent in patients with PR is considered. The factors contributing to pain syndrome development, which can mimic exacerbations of PR (associated myofascial pain, vitamin D deficiency, etc.) are indicated. The methodology for AI diagnosis in patients receiving GCS therapy is discussed in detail. Recommendations for the rational AI therapy including acute cases are given.

Pain syndrome in patients with dementia in nursing practice

In elderly patients with dementia, chronic pain syndrome is often observed, which can be manifested by behavioral disorders, aggression, agitation and other mental disorders. The presence of pain in them is often ignored, underestimated and poorly diagnosed, especially in severe and severe dementia with speech disorders (aphasia). Therefore, it is treated incorrectly, which reduces the quality of life of patients and their daily activities. Two scales are given for assessing pain by nurses in patients with speech disorders (severe dementia). Approaches to the treatment of pain in elderly people with dementia are discussed.

Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial

BackgroundPost-mastectomy pain syndrome (PMPS) is a highly prevalent complication after surgical treatment for breast cancer, and it affects the patient’s quality of life in aspects of losing shoulder full range of motion, pain, and depression. Transcranial direct current stimulation (tDCS) is non-invasive brain stimulation technique that was used in numerous clinical applications and in pain reduction in cancer patients. However, the effectiveness of tDCS on PMPS has never been evaluated in an experimental study.AimTo investigate the effect of bilateral anodal tDCS of motor cortex (M1) on pain, depression, and shoulder range of motion (ROM) in post-mastectomy pain syndrome.Study designRandomized controlled trial.MethodsA total of 30 female patients with post-mastectomy neuropathic pain were randomized into two groups; the intervention group which received bilateral tDCS on motor cortex (M1) and the control group that received sham bilateral tDCS on M1. As pain affects shoulder range of motion (ROM), shoulder ROM was measured by electronic goniometer pre- and post-tDCS application. In addition, the levels of pain and depression have been measured pre and post treatment. Pain has been measured with visual analogue scale (VAS) and depression with Beck-Depression-Inventory-BDI questionnaire (BDI).ResultsA significant difference was noted in group A regarding pain, depression and shoulder ROM (p= 0.001, p= 0.003, and p= 0.003, respectively). Between group comparison revealed a significant difference of VAS scores and shoulder flexion ROM between groups, the study group and the control group (p=0.041 and 0.048, respectively). Pain decreased by 32% and Shoulder flexion increased by 4.8% post-treatment while there were no significant difference in group B (p=0.567 and p=0.866, respectively).ConclusionsThe application of tDCS decreases the severity of pain and improves shoulder range of motion suffered by breast cancer patients after total mastectomy surgery.

Mechanistic insights from genomic analysis of interstitial cystitis/bladder pain syndrome patient bladder tissue

Mechanistic insights from genomic analysis of interstitial cystitis/bladder pain syndrome patient bladder tissue

Anesthetic support during total laryngectomy: current status and feasibility of optimization

Topicality: Despite progress in global medicine, optimization of surgical treatment of laryngeal cancer remains an urgent task due to adverse postoperative consequences and poor patient survival. Anesthetic support during total laryngectomy needs to be improved due to the possible undesirable effect of the standard scheme of intraoperative management of patients. Aim: to evaluate the effectiveness of anesthetic support during total laryngectomy using standard doses of opioids, the severity of side effects in the early postoperative period, and the feasibility of finding alternative pain relief schemes. Materials and methods: 25 patients with T3-4N0-3M0 laryngeal cancer who underwent radical surgical treatment were examined. During total laryngectomy, patients were anesthetized using standard doses of opioids without the use of adjuvant components of anesthesia. Anesthesia control was carried out on the basis of monitoring the bispectral index (BIS) and changes in the index of analgesia and nociception (ANI). In dynamics, biochemical and immunological studies of the blood of patients were carried out. Assessment of pain syndrome was carried out according to VAS indicators. Statistical analysis was carried out using classical methods of descriptive and analytical statistics using the software product STATISTICA v.6.1 (Statsoft Inc., USA, license number AGAR909E415822FA). Results and discussion: An analysis of anesthetic support during total laryngectomy using standard doses of opioids showed that the condition of patients after surgery is characterized by a certain immunosuppression with lymphopenia, a decrease in the level of interleukin 2 and tumor necrosis factor alpha, which lasts 48 hours and is most pronounced at 2-day after surgery. As a result of the study, the dependence of the pain syndrome in patients with total laryngectomy on the injected dose of opioids was revealed – the more opioids are used intraoperatively, the more patients needed them after the operation. This phenomenon is associated with the sensitization of opioid receptors and the development of tolerance, which further leads to hyperalgesia. An increase in the dose of the painkiller also led to an immunosuppressive effect in the examined patients, which was manifested primarily in a decrease in the level of IL-2, which is a potentially unfavorable factor in the proliferation and subsequent invasion of cancer cells. Conclusions: From the given data, it follows that the introduction of new anesthetic schemes using the principles of multimodal anesthesia and the principles of opioid-limiting anesthesia should be used in patients with laryngeal cancer during total laryngectomy.

Detection of Bacteria in Bladder Mucosa of Adult Females.

Interstitial cystitis/bladder pain syndrome is a chronic urological condition diagnosed in nearly 8 million females in the United States. Whether urinary microbiota play an etiological role remains controversial. Most studies assessed the microbiota of interstitial cystitis/bladder pain syndrome patients with voided or catheterized urine as a proxy for bladder urothelium; however, urine may not be a true reflection of the bladder microbiota. Bladder biopsy tissue may provide a more accurate, and thus more clinically relevant, picture of bladder microbiota. Bladder biopsy tissues were obtained from: (1) 30 females with interstitial cystitis/bladder pain syndrome (18-80 years old) via cystoscopically guided cold-cup biopsy following therapeutic bladder hydrodistention, and (2) 10 non-interstitial cystitis/bladder pain syndrome females undergoing pelvic organ prolapse repair. To detect bacteria, technical duplicates of each RNAlater-preserved biopsy were subjected to 16S rRNA gene sequencing. To visualize bacteria, paraformaldehyde-fixed, paraffin-embedded biopsies were subjected to a combined multiplexed fluorescence in situ hybridization and fluorescence immunohistochemistry assay and confocal microscopy. Bacteria were detected by 16S rRNA gene sequencing in at least 1 technical duplicate of most biopsies. The most abundant genus was Staphylococcus, followed by Lactobacillus; Escherichia was common but not abundant. There was no significant difference between interstitial cystitis/bladder pain syndrome patients and controls (P > .05). Combined fluorescence in situ hybridization and immunohistochemistry reproducibly detected 16S rRNA in epithelial cells and shed cells in the urothelium and lesioned areas and capillary walls in the lamina propria of human bladder biopsy tissue. We conclude that urothelial and urinary microbiota are similar but not identical in adult females.

Comparison of Epidemiological Data of Complex Regional Pain Syndrome (CRPS) Patients in Relation to Disease Severity-A Retrospective Single-Center Study.

A retrospective data analysis of 159 complex regional pain syndrome (CRPS) patients (n = 116 women, 73.0%, mean age 60.9 ± 14.4 years; n = 43 men, 27.0%, mean age 52.3 ± 16.7 years) was performed from 2009 to 2020. The right side was affected in 74 patients (46.5%), the left in 84 patients (52.8%), and 1 patient (0.7%) developed a bilateral CRPS. Data were analyzed for the frequency and distribution of symptoms. The number of reduction maneuvers and the number of Budapest criteria were compared in relation to the severity of CRPS. Hand and wrist (n = 107, 67.3%), followed by foot and ankle (n = 36, 22.6%) and other locations (n = 16, 10.1%) were mainly affected by CRPS. The main causes included direct trauma (n = 120, 75.5%), surgery without previous trauma (n = 25, 15.7%), other causes (n = 9, 5.7%), and spontaneous development (n = 3, 1.9%); there was also missing documentation (n = 2, 1.3%). The most common symptoms were difference in temperature (n = 156, 98.1%), limitation of movement (n = 149, 93.7%), and swelling (n = 146, 91.8%). There was no correlation between the number of reduction maneuvers and the number of Budapest criteria. In summary, patients with the following constellation are at increased risk of CRPS: a female, over 60 years old, who has fallen and has sustained a fracture in the hand or wrist with persistent pain and has been immobilized with a cast for approx. 4 weeks.

Motor and autonomic disorders influence on pain syndrome of patients with Parkinson’s disease of the I—III H&Y stages

To evaluate the influence of motor and autonomic disorders on the pain of patients with PD of the I-III H&Y stages and possibility of correcting the pain with dopamine receptor agonists (ADR). 252 patients (128 women and 124 men, 42-80 years old) with PD of I-III Hoehn and Yahr stages (H&Y) were examined using the following scales: UPDRS, daily activity Sch&En, quality of life PDQ-39, MMSE, BDI, PFS-16, NMSQuest, GSRS, AUA; 53 patients were piribedil treated during 6 months. Our results indicated a wide prevalence of pain syndrome in PD patients (58.6%), starting from the early stages (50% for the Ist stage). The most stable pain associations were found with the PD stage, levodopa doses, severity of motor symptoms (postural disorders and hypokinesia manifestations) and motor complications («off-periods» and dyskinesias), as well as non-motor PD manifestations depression and autonomic dysfunctions (constipation, swallowing disorders, and frequent urination). The regression analysis showed, that the severity of motor complications and depression were the predictors of pain occurrence. The pain syndrome in patients with PD of I-III stages underwent significant regression (by 51% and 62%, after 1.5 and 6 months of therapy, respectively) after ADR (piribedil) addition to their therapy; it's probably due to improving the motor component and decreasing depressive disorders. The piribedil inclusion contributes to the reduction of pain syndrome, regardless is it used in monotherapy or in conjunction with levodopa preparations.

The use of a fixed combination of diclofenac and orphenadrine in the treatment of acute pain syndrome in patients with discogenic lumbosacral radiculopathy and lumboischialgia

Acute pain syndromes caused by discogenic lumbosacral radiculopathy and lumboischialgia are not uncommon in clinical practice and characterized by a high risk of becoming chronic. The pathogenetic aspects, features of the clinical picture, existing approaches to conservative treatment of these conditions are analyzed in this paper. Data on the efficacy and safety of a fixed combination of diclofenac and orphenadrine (Neodolpasse) use in the treatment of vertebrogenic pain syndromes based on the NEODOLEX study results are presented, and the authors' own clinical observations are given. Possible reasons for the high efficacy of Neodolpasse in patients with discogenic radiculopathies and nonspecific back and neck pain are discussed.

Frequency and Effects of Great Trochanteric Pain Syndrome in Patients with Chronic Low Back Pain: A Cross-Sectional Study

Frequency and Effects of Great Trochanteric Pain Syndrome in Patients with Chronic Low Back Pain: A Cross-Sectional Study

Local injection therapy for pain syndrome in patients with lumbosacral transitional vertebrae

Local injection therapy for pain syndrome in patients with lumbosacral transitional vertebrae

EFFECT OF NON-ALCOHOLIC FATTY LIVER DISEASE ON THE COURSE OF DIABETIC POLYNEUROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

The aim: To study the peculiarities of diabetic polyneuropathy in patients with type 2 diabetes mellitus and concomitant NAFLD. Materials and methods: We examined 75 patients with type 2 diabetes mellitus, including 31 (41.3%) women and 44 (58.7%) men. The main group included 35 patients with NAFLD (46.7%), and the control group included 40 patients without NAFLD (53.3%). The severity of polyneuropathy was assessed using the Toronto clinical neuropathy score. The presence of neuropathic pain syndrome in patients allowed us to divide patients into groups with painful or painless forms of diabetic polyneuropathy. The electroneuromyographic examination was used to study nerve conduction parameters, namely peroneal motor nerve conduction velocity (PMNCV), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV). Results: The proportion of patients who did not have diabetic polyneuropathy in the NAFLD group was 12.5%, and in the group without NAFLD - 87.2%. The frequency of diabetic polyneuropathy was higher in the main group, namely: mild, moderate, and severe polyneuropathy was 80%, 56% and 59.3%, respectively, compared to the control group - 20%, 44%, 40.7% (p=0.02). The painful form of DPN was more common in patients of the main group than in the control group, respectively 69.8% and 30.2% (p=0.01). The degree of liver fibrosis did not affect the course of DPN. The study of nerve conduction by PMNCV, SNAP, and SNCV parameters showed that PMNCV was higher in the NAFLD group, and SNAP and SNCV - in the control group, but without statistical significance (p>0.05). Conclusions: In patients with type 2 diabetes mellitus, the presence of NAFLD affects the severity of diabetic polyneuropathy and increases the risk of painful DPN. The degree of liver fibrosis did not show an effect on the development of diabetic polyneuropathy. ENMG parameters did not demonstrate a statistically significant difference in the study groups.

The impact of rehabilitation on pain complaints and functional efficiency of low back pain syndrome patients that resided at the CRR KRUS Center in Iwonicz Zdrój

The impact of rehabilitation on pain complaints and functional efficiency of low back pain syndrome patients that resided at the CRR KRUS Center in Iwonicz Zdrój

Understanding the Female Physical Examination in Patients with Chronic Pelvic and Perineal Pain.

(1) Background: The objective was to compare the exploration of chronic pelvic pain syndrome (CPPS) patients in different locations and establish the role of physical examination in CPPS patients. (2) Methods: We reviewed clinical data from 107 female patients with CPPS unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain, from May 2018 to June 2022. Patients were classified into three groups: (a) pelvic pain; (b) anorectal pain; or (c) vulvar/perineal pain. (3) Results: Although the demographics of patients with CPPS were different, their physical examinations were strikingly similar. Our study observed a comorbidity rate of 36% and 79% of central sensitization of pain. Seventy-one percent of patients had vulvar allodynia/hyperalgesia. Pain on examination was identified in any pelvic floor muscle, in any pelvic girdle structure, and neuropathic pain in 98%, 96%, and 89%, respectively. Patients with vulvar and perineal pain were more different from the other groups; these patients were younger and had fewer comorbidities and less central sensitization, less anorectal pain, more pain during intercourse, and greater nulliparity (p = 0.022; p = 0.040; p = 0.048; p = 0.000; p = 0.006; p = 0.005). (4) Conclusions: The findings of this study are related to the understanding of the pathophysiology of CPPS. The physical examination confirms the central sensitization of female patients with CPPS, helps us to determine the therapeutic management of the patient, and can be considered as a prognostic factor of the disease.

Regression of chronic pain syndrome refractory to opioid pharmacotherapy in a patient after implantation of a spinal cord neurostimulator: case report

BACKGROUND: Pain in cancer patients, often poorly treated, cause severe distress for patients and their caregivers, and significantly reduces quality of life. Modern guides for the medical treatment of chronic pain in cancer patients are not effective in all cases, especially when chronic neuropathic pain syndrome occurs. In this regard, there is a need for a multidisciplinary personalized approach to the tactics of chronic pain management in favor of surgical methods at earlier stages of this condition. Nowadays neuromodulation is widely used for the treatment of neuropathic chronic pain syndrome in patients with various pathologies, whereas it is not used routinely in cancer patients.
 CLINICAL CASE DESCRIPTION: We introduce a case report of successfully applied neuromodulation in patient with severe chronic pain syndrome due to rectal cancer. Epidural spinal cord stimulation at Th10Th12 levels allowed to stop the systemic use of opioids and achieve long-term remission. Spinal cord stimulation has shown itself to be very promising and significantly improved patients quality of life.
 CONCLUSIONS: Our case report evidently shows that current chronic pain management guides and treatment recommendations needs a revision and neuromodulation usage in category of cancer patients should be considered.

The effectiveness of ultrasound therapy and phonophoresis in the treatment of ankylosing spondylitis

BACKGROUND: In Bekhterev's disease, an autoimmune inflammatory process develops in the intervertebral joints and paravetebral muscles and leads to severe pain syndrome and progressive fusion of articular surfaces. Anti-inflammatory and analgesic therapy should be carried out daily with the use of large doses of nonsteroidal anti-inflammatory drugs. With the progression of the disease, drug therapy is not effective enough to relieve pain and to restore the volume of movement in the joints. In this regard, the use of non-drug treatment is a necessary measure for the treatment of such patients.
 AIM: comparison of the effectiveness of phonophoresis and ultrasound in the treatment of pain syndrome in patients with ankylosing spondylitis.
 MATERIALS AND METHODS: 30 patients with Bekhterev's disease were included in our study. All patients were found to carry the HLA antigen and high value of C-reactive protein with an increase in the rate of erythrocyte sedimentation. Radiographs revealed signs of arthrosis of the sacroiliac joint and signs of arthritis and arthrosis of the intervertebral joints of the spine in one or several departments. The severity of the pain syndrome was 9.4 points on the visual analog scale (VAS) and 31.1 points on the McGill Pain Questionnaire (MPQ). 10 patients underwent ultrasound therapy, 10 patients underwent phonophoresis with karepain and 10 patients underwent placebo (Simulation of ultrasound exposure).
 RESULTS: The analgesic effect of ultrasound therapy was 57.9% at rest, 55.3% with spinal movement. The overall reduction in pain syndrome determined by MPQ was 50%, 49.54% in the sensory class and 51.8% in the affective class. Regression of pain syndrome against the background of the use of phonophoresis with karipain was 60.4% at rest, 54.5% with spinal movement. According to MPQ, the pain syndrome decreased by 46.7% in the sensory class and 52.8% in the affective class and by 49.5% in general. In patients who underwent a placebo course, the pain syndrome according to VAS and MPQ remained without significant dynamics.
 CONCLUSION: The significant effectiveness of ultrasound therapy and phonophoresis in the treatment of severe pain syndrome in of patients with ankylosing spondylitis has been proven, but it was not possible, to identify significant differences in the analgesic effect between ultrasound therapy and phonophoresis.

Some features of the effect of different methods of medical rehabilitation on the intensity of pain syndrome in patients after an ischemic stroke in the late recovery period

BACKGROUND: All over the world, scientific research is being actively conducted aimed at the prevention, treatment and rehabilitation of patients with cerebrovascular pathology, but acute cerebrovascular accidents still remain an acute medical and social problem in the world. Post-stroke complications include pain in the upper limb, which affects the performance of simple movements, reduces the level of daily life activity and, as a result, the quality of life of patients.
 AIM: to evaluate the effectiveness of the influence of various complexes of medical rehabilitation on the intensity of the pain syndrome in dynamics and quality of life in patients with acute cerebrovascular accident in the late recovery period of medical rehabilitation.
 MATERIALS AND METHODS: The paper presents data on the effectiveness of the influence of various methods of medical rehabilitation in the late recovery period in 120 patients with ischemic stroke in the late recovery period on pain intensity (according to the digital pain rating scale, NRS, and the Verbal Descriptive Pain Assessment Scale), activity of daily life (according to according to the Barthel index) and quality of life (according to the EQ-5D questionnaire). All patients were divided into 3 groups comparable in terms of clinical and functional characteristics: according to the clinical and functional characteristics of the group: group 1 ― 40 patients who received standard drug therapy and medical rehabilitation (exercise therapy, medical massage, mechanotherapy), group 2 (40 patients) who, in addition to the standard treatment complex, were prescribed massage with a pulsed low-frequency electrostatic field from the Khivamat apparatus and broadband modulation currents, group 3 (40 patients), who, against the background of standard therapy and medical rehabilitation, were included in physiotherapy methods from the Alpha apparatus LED Oxy Light-Spa.
 RESULTS: The data obtained indicate the advantage of including in the standard complex of medical rehabilitation and treatment of patients who have had ischemic stroke with movement disorders in the form of hemiparesis of a pulsed low-frequency electrostatic field and broadband modulation currents. This was confirmed by the improvement in the index of activity of daily life.
 CONCLUSIONS: In the course of the work, it was proved that the inclusion of a pulsed low-frequency electrostatic field and broadband modulation currents in a standard medical rehabilitation complex contributes to a significant reduction in pain syndrome, and also positively affects the assessment of the quality of life of patients after a course of treatment.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ МЕТОДИК ОЦЕНКИ БОЛЕВОГО СИНДРОМА У ПАЦИЕНТОВ С ПАТОЛОГИЕЙ ПОЗВОНОЧНИКА

Relevance: currently, more than half of the population suffers from diseases of the musculoskeletal system. Among them, a significant part are people of working age from 30 to 50 years. As a rule, these diseases are caused by pathology of the spine, joints, ligaments and muscles. The most common symptom of them is pain in the lower back and neck. Such a problem carries a huge social, psychological and economic burden. The purpose of the study is assessment of pain syndrome in the spine using various scales to objectify its level and severity of movement disorders. Materials and methods: patients with pain syndrome of various parts of the spine were examined. A visual-analog scale was used to assess the intensity of pain, and specialized questionnaires were used to calculate the degree of locomotor limitations. Results of the study: according to the severity of the pain syndrome (depending on the localization of the affected spine) among the examined patients, about half of the cases had soft strength, in a third of cases – moderate, from 3 to 18% of individuals experienced severe pain. The use of the "Visual-analog scale" technique for differential diagnosis and determination of the localization of spinal lesions has shown its poor effectiveness. The use of specialized questionnaires "Assessment of the degree of move limitations" turned out to be more relevant for determining the topography of the pain syndrome. Correlation analysis revealed statistically significant positive strong and moderate correlations between the scores obtained from the methods of self-assessment severity of pain syndrome and the intensity of move limitations. The conclusion: the data obtained suggest the differentiated using of visual-analog scale methodic and indices of move limitations for a refined assessment of pain syndrome in patients, decision-making and prognosis in a particular patient.