Painful Situations Research Articles

University non-admittance and anomie: Reconsidering the promise of an egalitarian society

The core theme of this article is the emerging tension between the egalitarian discourse that increases the general aspiration of people to become more educated and actual admission constraints. A desire to attend a university and not being allowed to (i.e. non-admittance) is a loss that can potentially result in an anomic condition. Anomie theory gives a sociological explanation for a painful situation in which there is a cultural overemphasis on success combined with structurally limited opportunities. In this study, the focus is on the experiences of prospective students who have been applying to a selective university in Finland without gaining admission. The data consists of 50 personal online narratives. The analysis is presented in accordance with a conceptual typology of individual responses to the conditions of non-admittance. The findings yield important insights regarding university choice, meritocratic selection and formulation of equitable admission policies.

A STUDY ON THE KNOWLEDGE AND SKILLS OF ADOLESCENTS ON SEXUAL ABUSE PREVENTION

Sexual abuse among the adolescents has become a pressing issue of the contemporary society. The intensity of this issue lies on the undesirable consequences that create difficulties in the well being of the victim. For a child or adolescent, it is a painful situation where they did not aware of what is happening to them, to whom do they share this, and fear which isolate them completely. Many of the adolescent fall as victims unknowingly. The increasing incidents rate of adolescent sexual abuse points to the ignorance. The researcher has done the study to assess the knowledge and skills of adolescents in rural area on sexual abuse prevention. The quantitative study has been conducted among 60 adolescents belongs to the age group ranging from 13 to 16. The result of the study reveals that in some dimensions like types of abuse, body ownership, etc adolescents possess a greater knowledge whereas they are ignorant about juvenile sexual offenders, victimization of boys etc. When it comes to the skills, study shows that only few adolescents show assertive skill. The study suggests that more interventions needed to be given on improving adolescents’ knowledge on sexual abuse prevention. The interventions can be extended to parents and teachers so that the effectiveness of the prevention of sexual abuse can be enhanced.

Pengaruh Post Isometric Relaxation pada Kasus Myofascial Pain Syndrome Upper Trapezius terhadap Penurunan Nyeri di Ar – Rohmah Islamic Boarding School Malang

ABSTRACT
 Background: Myofascial pain syndrome is the situation of taut pain and tenderness pain, this syndrome is often found in trapezius muscle. The result of Preliminary study shows that the tahfidz program students in Ar – Rohmah Islamic Boarding School Malang spent time to learn Al – Qur’an for 6-8hour/day with static situation and complained about the pain in the neck. Purpose: To find out the effect of Post Isometric Relaxation on decrease pain of myofascial pain syndrome of the upper trapezius in Ar – Rohmah Islamic Boarding School Malang. Method: This study uses Pre-experimental one group pretest and posttest design. The respondents in this study are 26 students of thafidz program in Ar – Rohmah Islamic Boarding School Malang with technique of purposive sampling and were given intervention 3 times in a week for 2 weeks. Instrument of this research is Numerical Rating Scale (NRS) and the data analysis is using Wilcoxon test. Result: It shows 0,000 (α < 0,05) and show there is decrease pain from 0,742 to 0,633. Conclusion: There is an effect of post isometric relaxation on decrease the pain of myofascial pain syndrome of upper the trapezius in Ar – Rohmah Islamic Boarding School Malang.

An Online Pain Education Program for Working Adults: Pilot Randomized Controlled Trial.

BackgroundPain is a common public health concern, and the pain situation among the general population is serious in mainland China. Working adults commonly experience pain because of long sitting times, a lack of free time, and exercise. A lack of pain-related knowledge is also a significant factor. Educational and therapeutic programs delivered online were used more often in Western countries, and accessible programs in China are limited, especially for pain management. Therefore, we carried out an online pain education program for working adults to self-manage pain. The program was delivered through WeChat, a popular and secure social media with a large population base in China.ObjectiveThis study aimed to (1) provide pain-related knowledge and self-relief strategies, (2) help participants reduce pain and improve pain-related emotional well-being, and (3) explore participants’ learning performance and the acceptability of the online pain education program.MethodsThis was a randomized controlled trial. Chinese adults aged between 16 and 60 years with full-time employment, with pain in the past 6 months, and without any mental illness were recruited using snowball sampling through the internet and were randomly allocated to an experimental group and a control group in 1:1 ratio after the baseline assessment. The 4-week educational program that included basic knowledge of pain, pharmacological and nonpharmacological treatments, and related resources was provided only to the experimental group. Outcomes of pain, depression, anxiety, stress, and pain self-efficacy were measured at baseline (T0), posttreatment (T1), and 1-month follow-up (T2). Participants’ acceptability and satisfaction were explored after completing the educational program.ResultsIn total, 95 eligible participants joined in the program: 47 in the experimental group and 48 in the control group. Neck and shoulder, head, and back were most commonly reported pain sites with high pain scores. Pain intensity and interference of the experimental group were significantly reduced after the educational program. Depression, anxiety, and stress clinically improved and pain self-efficacy improved after the educational program. The difference in depression, anxiety, stress, and pain self-efficacy within a group or between groups was not statistically significant; however, clinical improvements were demonstrated. A significant correlation between dosage of the intervention and pain intensity and depression was demonstrated. After completing the educational program, more than half of the participants showed acceptance of and satisfaction with the program, and they were willing to recommend the program to others.ConclusionsOur findings highlight the significant potential of this online education program in the treatment of pain.Trial RegistrationClinicalTrials.gov NCT03952910; https://clinicaltrials.gov/ct2/show/NCT03952910

A Aprendizagem da Dor

Resumo: O interesse pela pandemia extrapola a área de especialistas em saúde pelas repercussões em todos os âmbitos da vida, particularmente na educação. Ao mesmo tempo que traz o estranho, o que é ameaçador, desestabilizando a ordem vigente, a dolorosa experiência mobiliza nossa capacidade de sentir e aprender. Dessa aprendizagem da dor já é possível recolher as primeiras lições da pandemia: o reconhecimento da vulnerabilidade da condição humana, a importância da verdade para enfrentar os problemas e a solidariedade com o outro. O artigo conclui que a aprendizagem e o saber mais amplo decorrentes dessas lições tem uma força transformadora, que se constitui numa espécie de superação, não no sentido de um sentimentalismo ingênuo, mas algo que surge da própria situação dolorosa, pois, como percebe Hölderlin, justamente onde há o perigo cresce a salvação.

Quality of Life and Graduation in Medicine

Abstract: Introduction: In recent years, the quality of life of medical students has been questioned, given the context in which they are inserted. Stress as a result of the number of long hours, difficulty in reconciling academic and personal life, exposure to situations of pain and suffering, have been shown to be the main factors for the decrease in quality of life of these students. The aim of this study was to assess the quality of life of medical students and its associated factors. Method: Cross-sectional study with 419 medical students from a public institution in Goiás. The study was carried out with students over 18 years old and enrolled in the second to the eighth semester of medical school, between 2017 and 2018. Sociodemographic and lifestyle questionnaires and the World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-BREF) were used. Results: The factors related to low quality of life were: female gender, the use of stimulants, thinking about giving up medical school and having comorbidities. Those related to a better quality of life were consuming fruits and vegetables, practicing physical activity, more sleeping time and stress management. Conclusion: This study found a set of factors capable of interfering with the quality of life of these students, suggesting the need for interventions aimed at pedagogical and psychological support.

Quality of Life and Graduation in Medicine

Abstract: Introduction: In recent years, the quality of life of medical students has been questioned, given the context in which they are inserted. Stress as a result of the number of long hours, difficulty in reconciling academic and personal life, exposure to situations of pain and suffering, have been shown to be the main factors for the decrease in quality of life of these students. The aim of this study was to assess the quality of life of medical students and its associated factors. Method: Cross-sectional study with 419 medical students from a public institution in Goiás. The study was carried out with students over 18 years old and enrolled in the second to the eighth semester of medical school, between 2017 and 2018. Sociodemographic and lifestyle questionnaires and the World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-BREF) were used. Results: The factors related to low quality of life were: female gender, the use of stimulants, thinking about giving up medical school and having comorbidities. Those related to a better quality of life were consuming fruits and vegetables, practicing physical activity, more sleeping time and stress management. Conclusion: This study found a set of factors capable of interfering with the quality of life of these students, suggesting the need for interventions aimed at pedagogical and psychological support.

The Righteous Suffering Servant: Observations about a Theological Problem in Four Individual Complaint Psalms

ABSTRACT This article examines the theological problem of a righteous sufferer in four psalms (Pss 22; 27; 69; 109), and what emerges is a coherent image. The psalmist(s) who refers to God feels himself like a righteous servant; he is a religious man, but he faces suffering. The righteous sufferer is also aware of his innocence and that his pain has no real, understandable explanation. The awareness of his innocence is also the motivation to complain and search for God because God is the only one who can give an answer and a meaning to the painful situation. In the end, the righteous sufferer also realise that he does not need to be healed from suffering, instead he had to recognise the importance of God's role in his life. This is the primary liberation that also allows him a real comprehension of his situation. Keywords: Psalms, Righteous, Suffering Servant, Individual, Complaint, Theology

An observational study on risk factors for prolonged opioid prescription after severe trauma.

Trauma is one of the most common causes of morbidity and mortality in people of working age. Following surgery, approximately 10% of patients develop persistent postsurgical pain. Chronic pain is a complex phenomenon that can adversely affect quality of life and is associated with psychiatric conditions such as anxiety and depression. Pharmacological treatment is normally insufficient to fully alleviate chronic pain and improve functional capacity, especially in the long term. The appropriateness of opioid treatment in chronic non-cancer pain has become increasingly examined with high numbers of serious side effects including drug dependency and death. The present study was based on clinical observations suggesting that a problematic opioid use can be initiated during trauma care, which implies the importance of evaluating opioid therapy and its effect on trauma patients. Specific attention is given to patients with known psychiatric conditions which may render them more vulnerable to develop problematic opioid use. The aim of this observational study was to broadly characterize patients referred to a pain specialist after severe trauma regarding their trauma type, psychiatric co-morbidity, and opioid prescription pattern. This was done to tentatively investigate possible risk factors for long-term opioid use following trauma. Trauma patients referred to the Pain Center at Karolinska University Hospital, Sweden (n=29) were recruited for the study over a period of 2 years. Demographic information, trauma-related data as well as psychiatric diagnoses and pharmacological prescriptions were retrieved from the registry SweTrau and electronic medical records. Among the 29 participants (age range 21-55 years, median=34; 76% male), 14 (48%) were prescribed opioids at least once during the 6-months period preceding the trauma. For 21 patients (72%) opioids were prescribed 6 months after the trauma. One year after the trauma, 18 patients (62%) still had prescriptions for opioids corresponding to daily use or more, and two other patients used opioids intermittently. Twenty patients (69%) had psychiatric diagnoses before the trauma. According to the medical records, 17 patients (59%) received pharmacological treatment for psychiatric conditions in the six months period preceding the trauma. During the follow-up period, psychiatric pharmacological treatment was prescribed for 27 (93%) of the patients. For most of the participants opioids were still being prescribed one year after trauma. The majority presented with psychiatric co-morbidity before trauma and were also prescribed psychiatric medication. Findings support the notion that patients with a complex pain situation in the acute phase following trauma are at risk for prolonged opioid prescription. These results, although tentative, point at psychiatric co-morbidity, opioid use before trauma, high injury severity, extensive surgery and extended hospital stay as risk factors for prolonged opioid prescription after severe trauma. This study is purely observational, with a small sample and non-controlled design. However, these data further emphasize the need to identify patients at risk for developing problematic long-term opioid use following trauma and to ensure appropriate pain treatment.

Using ’White Flags’ to categorize socio-cultural aspects in chronic pain

Abstract Issue Persistent chronic pain is a major medical and health economic problem. To assess the individual pain situation, the classification of various factors (flags) has been established. Description of the problem Structural biomechanical factors are classified as “red flags”. Psychological or behavioral factors are summarized as “yellow flags”, psychiatric and mental illness as “orange flags”. Both last flags are important for planning adequate therapies or rehabilitation, as well as for decisions to prognoses and tailored reintegration programs. An extension of the flag model was achieved by naming personal factors at workplace as “blue flags”, and “black flags”, if there is a restriction for returning to work. All these groups do not consider other important reasons for unsuccessful rehabilitation or failed reintegration. Results In these cases, often described as ’therapy-refractory’, clients often exhibit a special subjective understanding of illness that reacts neither to psychological interventions nor to behavioral therapies. These include individual beliefs based, for example, on cultural socialization, religious education, or spiritual experiences. Since such individual mental illnesses are culturally ideologically or religiously justified, they should be classified in a separate group called ’white flags’. Lessons The advantages of categorizing sociocultural aspects separately from other flag classifications are avoidance of unnecessary therapies, including surgery,prevention of iatrogenisation,prevention of legal disputes. It is important to realize that only health restrictions for insurance benefits can be taken into account and that individual socio-cultural circumstances or health convictions are not evaluated. Main messages: A classification of ’white flags’ could contribute to a better classification of pain which are not accessible to various therapies and reduce reservations and misunderstandings by intercultural communication approaches. Key messages For medical professions it is important to recognize, that only health inabilities are taken into account for insurance compensation and not individual socio-cultural circumstances or health beliefs. In Future classifying ’white flags’ could help to properly assess persistent pain conditions.

Time perspectives and pain: Negative time perspective profile predicts elevated vulnerability to pain

Former studies have revealed the impact of a negative view of the past on postoperative pain intensity and pain catastrophizing (i.e. pain vulnerability). In this study, we extensively examined the association between time perspective (TP) and pain vulnerability in a healthy sample. The Zimbardo Time Perspective Inventory, Pain Catastrophizing Scale and Pain Sensitivity Questionnaire were administered, along with evaluations of pictures about different painful situations (N = 226). Data analysis included examination of the impact of the unique contribution of the five TPs, the deviation from a balanced TP profile and defining different TP clusters on pain vulnerability. Results imply that a negative view of the past might increase sensitivity against physical pain and disrupt the affective processing of painful events, suggesting the relevance of TP in pain therapy.

The Role of Social Power in Neural Responses to Others' Pain.

Recent evidence has demonstrated that empathic responses are modulated by social power. However, there is little consensus regarding how an observer’s social power can shape empathic responses. The present study used event-related potentials (ERPs) to explore the role of social power in empathic responses. Specifically, to induce the sense of power, we asked participants to recall a past situation in which they were in a position of power (high power prime) or a situation in which they were lacking power (low power prime). Afterward, we used ERPs to record the responses when participants were viewing pictures depicting other people in painful or non-painful situations. The results revealed that larger amplitudes in the earlier P2 and the later P3 components in response to painful stimuli than to non-painful stimuli. Besides, participants primed with high power only showed larger P1 amplitudes than participants primed with low power. The present study extended previous studies by showing that social power tends to enhance the early sensory processing of both painful and non-painful stimuli, instead of directly decreasing the level of empathic responses to others’ pain.

Acute Pain Assessment in Prematurely Born Infants Below 29 Weeks: A Long Way to Go.

Neonates born extremely prematurely are at high risk of acute and prolonged pain. Effective treatment requires reliable pain assessment, which is currently missing. Our study explored whether existing pain assessment tools and physiological indicators measure pain and comfort accurately in this population. We prospectively collected data in 16 neonates born at less than 29 weeks' gestational age during 3 conditions: skin-to-skin care, rest, and heelstick procedure for capillary blood sampling in the incubator. The neonates were video recorded in these situations, and recordings were coded using 5 observational pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate, arterial oxygen saturation, regional cerebral oxygenation, and the number of skin conductance peaks. All measures across the 3 conditions were compared using general linear modeling. The median gestational age was 27.1 weeks (range: 24.1 to 28.7). Forty measurement periods across the 3 conditions were analyzed. Heart rate was significantly higher during heelstick procedures compared with during rest, with a mean difference of 10.7 beats/min (95% confidence interval [CI]: 2.7-18.6). Oxygen saturation was significantly higher during skin-to-skin care compared with during heelstick procedures with a mean difference of 5.5% (95% CI: 0.2-10.8). The Premature Infant Pain Profile-revised (PIPP-R) score was significantly higher during heelstick procedures compared with skin-to-skin care with a mean difference of 3.2 points (95% CI: 1.6-5.0). Pain measurement in clinical practice in prematurely born infants below 29 weeks remains challenging. The included behavioral and physiological indicators did not adequately distinguish between a painful situation, rest, and skin-to-skin care in premature neonates.

Effects of age and cognitive function on data quality of standardized surveys in nursing home populations

BackgroundData quality is of special concern when it comes to survey research in nursing homes. Very little is known about specifics of cognitively impaired elderly in responding to survey questions. This study examines effects of cognitive impairment, age, gender, and interview duration on the data quality in a sample of 659 nursing home residents (NHR).MethodsWithin a cross-sectional design, survey methodology was used to evaluate the pain situation in 13 nursing homes. Residents were stratified into NHR with no/mild (Mini-Mental State Examination MMSE: 18–30) and NHR with moderate (MMSE: 10–17) cognitive impairment. Data quality is measured by item nonresponse (INR). Correlation analyses, ANCOVA, linear and logistic regression models are applied.ResultsNeither interview duration nor gender have effects on item nonresponse. Age accounts for higher INR (β = 0.12, p < 0.001). Cognitive impairment strongly predicts INR (β = − 0.40, p < 0.001). INR significantly differs between NHR with no/mild (3.98%) and moderate cognitive impairment (11.85%). The likelihood of INR > 5% for residents with moderate cognitive impairment is 3.8-times (p < 0.001) of that for those with no/mild impairment.ConclusionsSurveys are adequate for residents with no/mild cognitive impairment but data quality is threatened in residents with moderate impairments. Precision and validity of responses from NHR with progressed cognitive impairment are potentially limited and results may be biased. The results clearly do support the need for a multidisciplinary ‘general theory’ of the question−/answer-process which has to be also inclusive for cognitively impaired elderly persons.

Pain situation among older adults in need of care in the outpatient care setting and cognitively or physically unable to respond : Challenges and recommendations

Self-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65years) in need of care who are cognitively or physically unable to respond in the outpatient care setting. Our cross-sectional study is based on data from ACHE, astudy on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received apain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale. The study population (n = 81) was very old (mean age = 84.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8 ± 2.5 (range 0-8). We identified asignificant difference in the BESD score observed calmly (mean = 1.7 ± 2.5) and under mobilization (mean = 3.4 ± 2.3, p = 0.001). Moreover, only21 older adults in need of care received apain assessment 4weeks prior to our study. Our findings indicate adeficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be afirst step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.

Lesson Learned from Peer Volunteers in a Peer-Led Pain Management Program among Nursing Home Residents.

Background: Chronic pain is common among older adults and is associated with adverse physical and psychological outcomes. Given the burden of pain and limited healthcare resources, devising innovative and cost-effective ways of managing chronic pain is of high priority. The aim of this paper is to explore the experiences and perceptions of peer volunteers (PVs) in a peer-led pain management program among nursing home residents in Hong Kong. Methods: Forty-six PVs were recruited and trained to lead a pain management program (PAP). The PAP consisted of one 1 hour session per week for 12 weeks. It included 20 min of physical exercises performed under the supervision of PVs, followed by 30 min of pain management education, including information on pain situations, the impacts of pain, the use of drugs and non-drug strategies for pain management, demonstrations, and return demonstrations of various non-drug pain management techniques. Quantitative data were collected from questionnaires (demographics, pain situation, and pain knowledge) for all PVs. Qualitative data (PVs’ experiences in leading the PAP, their perceived benefits, barriers encountered, and recommendations for improving the PAP) were collected at week 12 (upon completion of the PAP). Data were analyzed using the Statistical Package for Social Sciences and content analysis for qualitative data. Results: A total of 46 PVs were recruited (34 females, 74%), with a mean ± SD age of 61.0 ± 5.1 years. Thirty-one of them reported having chronic pain. Before the training, their self-rated pain knowledge was 40.0 ± 20.5 (maximum 100 points) while their actual pain knowledge score was 86.1 ± 10.6 (maximum 100 points). The PVs reported an improvement in their knowledge and skills after leading PAPs. No PVs reported having received any negative comments about their role in leading the PAP but mentioned that they had received feedback on how to improve the program. Conclusions: This study provides further evidence that peer-led pain management programs are feasible and can lead to positive experiences for the PVs. Peer support models are coming into wide use because they show promise in helping patients to manage chronic conditions. Peer volunteers will become important resources in elderly care. The barriers that were identified may lead to improvements in the design and planning of future PAPs.

Pain situations among working adults and the educational needs identified: an exploratory survey via WeChat

ObjectivesThe aim of this study is to 1) investigate the pain situation among working adults in China; 2) explore the self-initiate pain reliving strategies applied by working adults; and 3) collect people’s interests and suggestions to the topics of the online pain education program.MethodsThis is an exploratory survey through WeChat. The study was conducted from May 2018 to December 2018. Participants were recruited following the snowball sampling. In total of 664 people were recruited and 502 satisfied the criteria. SPSS was used for data analysis. Descriptive statistical analysis were used to present the utilization of pain treatments and suggested topics. Chi-square test, independent multiple logistic regression and Spearman’s correlation were used to analysis the data.ResultsThe overall incidence of pain among the participants is 45% and higher among female (63%) than male (37%). Neck (68.72%, 4.10 ± 2.31), shoulder (62.56%, 3.78 ± 2.41) and head (49.34%, 4.23 ± 2.52) are reported as the most common and severe pain sites. Working is affected by pain and the results show that there is a negative correlation between pain intensity and work (rs = − 0.194) among the working population. Non-pharmacological treatments (55.77%) were chosen more by pain suffers. Totally 63.39% of participants show interests in the online pain education program and physical and psychological impact of pain is the most suggested topic (22.51%).ConclusionThe pain prevalence is high among working adults in China. Impact of pain on work is a significant problem for the working adults. It is important to identify people at risk and deliver timely intervention to reduce pain. People showed their willingness in joining the online program. Therefore, future online pain education program can be developed.

Who to Talk to About my Pain? A Brief Qualitative Study on Perception of Pain and its Management in Swiss Nursing Home Residents

BackgroundThe prevalence of pain in nursing home (NH) residents is high. Insufficiently treated pain reduces quality of life and often leads to negative health consequences. Pain experience in older people can be influenced by physical, psychosocial, emotional, and spiritual factors. AimsTo inform development of NH pain management interventions, we studied residents’ pain related perceptions and needs. DesignThis was a qualitative descriptive substudy (embedded in ProQuaS, a larger pain project). SettingsThree Swiss NHs. Participants/SubjectsA purposeful sample of eight NH residents with severe pain and no severe cognitive impairment, based on information from the Minimum Data Set. MethodsEight semistructured interviews were conducted between October and December 2016. The audio-recorded interviews were transcribed verbatim and analyzed inductively using thematic analysis. ResultsThree central themes were identified from the interview data: dealing with major life changes, managing pain, and using formal care. The interviews highlighted the multidimensionality of pain experience in NH residents. In complex pain situations, participants perceived that care workers did not respond adequately to their needs. They had learned to cope with their pain using self-developed strategies and direct consultations with their physicians. ConclusionsThe perceived lack of responsiveness may prompt NH residents to bypass care workers with their pain management concerns. This study's findings will inform the development of an educational intervention for NH care workers.

Involvement of the L-arginine/Nitric Oxide/Cyclic GMP/KATP Channel Pathway and PPARγ Receptors in the Peripheral Antinociceptive Effect of Carbamazepine

Carbamazepine has been shown to exert analgesic effects in clinical and experimental pain situation. This study was conducted to evaluate its potential peripheral antinociceptive effects and the possible involvement of L-arginine/NO/cGMP/KATP channel pathway and PPARγ receptors in an animal model of pain. The antinociceptive effect induced by intraplantar administration of carbamazepine (100-1 000 μg/paw) was assessed using the formalin test in rats. To evaluate the involvement of L-arginine/NO/cGMP/KATP channel pathway in the antinociceptive action of carbamazepine, rats were pre-treated intraplantarlly with L-arginine (a nitric oxide precursor, 100 and 200 μg/paw), L-NAME (NOS inhibitor, 50 and 100 μg/paw), methylene blue (guanylyl cyclase inhibitor, 100 and 200 μg/paw), glibenclamide (KATP channel blocker, 100 and 200 μg/paw), and diazoxide (400 μg/paw). Moreover, to investigate the possible involvement of PPARγ receptors, pioglitazone (10 μg/paw; a PPARγ agonist) alone or in combination with GW9662 (3 μg/paw; a PPARγ antagonist) were pre-treated with carbamazepine. The local ipsilateral, but not contralateral, administration of carbamazepine into the hind paw produced dose-related analgesia during both early and late phases of formalin test. Moreover, pre-treatment with L-NAME, methylene blue, and glibenclamide dose-dependently prevented carbamazepine (300 μg/paw)-induced antinociception in both phases of the test. In addition, administration of L-arginine and diazoxide before the sub-effective dose of carbamazepine (100 μg/paw) produced an antinociceptive effect. Also, antinociception induced by carbamazepine plus pioglitazone (10 μg/paw) was blocked by GW-9662 in both phases of the test. In conclusion, carbamazepine induced a peripheral antinociceptive effect through PPARγ receptors and L-arginine/NO/cGMP/KATP channel pathway, with potential for a new topical analgesic drug.

Síndrome de Ondina (hipoventilación central congénita), una amenaza contra la vida al dormir

El síndrome de Ondina, o síndrome de hipoventilación central congénita, es una enfermedad neurológica rara, donde hay fracaso en el control de la ventilación en el sistema nervioso central, llevando a la hipoxia e hipercapnia que pueden generar problemas del neurodesarrollo y, finalmente, ocasionar la muerte. Puede representar una situación muy dolorosa para los familiares de los pacientes que la padecen, despertando sentimientos difíciles de enfrentar, es por esto que es importante tener conocimiento acerca de esta condición para así impactar en la disminución de su incidencia.