Painful Situations Research Articles

INFLUENCE OF PHYSICAL ACTIVITY AND TIME IN THE SITTING POSITION ON THE CONDITION OF LOW BACK PAIN AMONG UNIVERSITY STUDENTS

ABSTRACT Objective: To verify the influence of sedentary behavior and physical activity on the prevalence and situation of low back pain in medical students at a higher education institution. Methods: Cross-sectional study with a quantitative approach, conducted with 220 students. Data were collected between January and February 2021, using the Roland-Morris Disability Questionnaire. Data were analyzed using the Statistical Package for the Social Sciences Program. Values of p ≤ 0.05 were accepted as statistically significant. Results: Sixty-five percent of the participants were female, the average student age was 24.19 years, and a predominance of students were in the clinical cycle (60.9%). Of the total sample, 75.9% (n=167) stated that they performed physical activities and 28.2% (n=62) responded that they spend between 7-10 hours sitting studying. The prevalence of low back pain was high (84.1%; n=185), however, only 1.5% (n=3) had scores indicative of functional disability. Women (Mean=5.07, SD=0.35) had greater functional disability than men (Mean=3.33, SD=0.35; p=0.008). Sedentary students had greater disability (Mean=5.79, SD=4.55) than active students (Mean=4.04, SD=3.62; p=0.007); individuals who spent more than 7 hours a day sitting also had higher scores (p=0.02). Conclusion: The findings indicated a significant self-reported prevalence of low back pain among medical students, with greater functional disability in females, sedentary individuals, and those who sat for more than 7 hours a day. Level of Evidence II; Cross-sectional study .

Important blood pressure changes in clinical practice: narrative literature review

ABSTRACT The aim of this study was to emphasize the importance of monitoring vital signs, especially blood pressure, during dental care. Through a narrative review, the changes in blood pressure that may occur during outpatient procedures and the measures to be taken were discussed. The available literature was consulted in databases (PubMed, Scielo, Web of Science and Google Scholar), complemented by the analysis of the bibliographic references included and updated until April 2021. The keywords were used: “Anamnesis”, “Arterial Pressure”, “Arterial Hypertension”, “Hypertensive Crisis”, “Risk factors”, “Stroke”, “Subclavian Theft Syndrome” and “Atherosclerosis”. It was concluded that care should be applied to all patients, but mainly to those over 50, hypertensive or not, with hypercholesterolemia, diabetes, anxious and fearful. All vital signs must be monitored, including the pain score. The situations of anxiety, pain and fear are triggers for changes in blood pressure even in normotensive patients as in controlled hypertensive patients. The blood pressure measurement, in the first consultation, must be performed in both arms and repeated annually or whenever there is a change in the patient’s health status. In all other consultations, blood pressure control, as well as the assessment of all vital signs, must be performed before, during, after the procedure and before discharge. In the face of any major change, it is necessary to assess the risk/benefit ratio of the continuity of the procedure, so that risks to patients are avoided or minimized, as well as for the necessary referrals to be made.

Dilated Cardiomyopathy with Congestive Hepatopathy in Post COVID-19 PatientA Case Report

In the current situation of pandemic, Coronavirus Disease 2019 (COVID-19), main organ involvement is of respiratory system ranging from mild symptoms to acute severe respiratory distress syndrome. Some studies are showing an increasing number of patients being hospitalised for COVID-19 with acute heart failure and multi-system inflammatory state. A 17-year-old boy, with no known co-morbidities, presented with breathlessness and jaundice. He was diagnosed as a case of Dilated Cardiomyopathy (DCM) with congestive hepatopathy. He was treated with diuretics and supportive medications for which he showed symptomatic improvement, and there was a significant improvement in his ejection fraction during the course of treatment. The patient had Coronavirus Disease 2019 (COVID-19) infection 15 days prior to the onset of the above symptoms. The progression of COVID-19 complications seems potentially life-threatening, if associated with cardiac and hepatic manifestations. This case illustrates the probable course of the ailment that has led to DCM. There was liver involvement too which was monitored and treated meticulously. These patients have high chances of deterioration even in simple situations of fever or pain, due to an increase in metabolic demands. It is a unique case which shows a strong association between COVID-19, acute heart failure, and congestive hepatopathy.

Psychopathic traits modulate functional connectivity during pain perception and perspective-taking in female inmates

The ability to share and understand the distress of others is critical for successful social interactions and is a fundamental building block of morality. Psychopathy is a personality disorder that includes lack of empathy and concern for others. In the present study, functional MRI was used to examine neural responses and functional connectivity associated with empathy and affective perspective-taking in female inmates (N = 109) with various levels of psychopathic traits, as measured with Psychopathy Checklist-Revised (PCL-R). Participants viewed hands and feet in painful or non-painful situations while adopting a first person or third person perspective. All participants demonstrated robust neural responses in anterior insula (aINS), anterior cingulate (ACC), temporoparietal junction (TPJ) and supplementary motor area (SMA) when viewing pain, both during imagine-self and imagine-other blocks. Psychopathy shifted the functional connectivity seeded in core nodes of the salience and social cognition networks. Perceiving stimuli depicting somatic pain led to decreased functional coupling from right temporoparietal junction to superior temporal sulcus, which correlated with scores on PCL-R Factor 1 (Affective/Interpersonal). In contrast, connectivity from right insula to precuneus increased with Factor 2 (Lifestyle/Antisocial) scores. When adopting a third-person perspective, psychopathic traits modulated connectivity from the social cognition network, but not the salience network, with Factor 1 scores associated with increased connectivity to sensorimotor cortex and temporal pole, while Factor 2 scores were associated with decreased connectivity with ACC/SMA and inferior frontal gyrus. Overall, these results demonstrate that psychopathic traits in incarcerated females are associated with atypical functional connectivity within the salience network during pain-empathy processing and within the social cognition network during affective perspective-taking.

Patient participation in care after hip fracture surgery: A systematic review

Introduction: Hip fractures constitute a painful and unpleasant situation which is more common in the elderly population. The relevant literature revealed that the management of the care of patients with hip fracture remains a major concern for the global scientific community, as it is related with a variety of socio-economic and psychosocial consequences. The purpose of this systematic review was the investigation of patient participation in their care after a hip fracture surgery. Methods: The search strategy of the literature was conducted in the data bases Pubmed/Medline, Scopus, Science Direct and Google Scholar. Results: The main issues the patients faced and prohibit their participation in the rehabilitation phase were pain, fear of a new fall, postoperative complications, negative emotions, ineffective cooperation with staff, unrealistic expectations and difficulty in accessing a physiotherapist. On the contrary, positive attitude and support of the health professionals, community care services, adequate information, positive patient disposition, daily exercise and access to a physiotherapist were factors that facilitated the care rehabilitation, as well as the process of their participation. Conclusions: Emphasis should be placed on active involvement of the patients in their care, as there is evidence that it is correlated with a positive effect on health outcomes during rehabilitation. These findings could be used to encourage greater participation according to patients’ preferences and needs, while highlight the need for changes in health care organizations and for further research.

La risa: niveles y factores demográficos, en el contexto de la COVID-19

Introduction: The pandemic does not stop, neither does the studies on it; This pandemic produces pain, sadness, despair and deaths, the numbers of which are incalculable. Faced with this difficult and painful situation, laughter raises its flag of hope. Objective: The study aims to describe the levels and demographic factors of laughter, in the context of COVID-19. Methods: The study corresponds to a quantitative, descriptive, cross-sectional approach. The data were obtained through a virtual survey, whose participants were 101, from the three regions. Results: Of the 101 participants, 87 (between 20 and 60 years old) are located in the high level and 14 in the medium level. Similarly, 14 (among single, married, divorced and cohabitants) in the medium level and 87 in the high level. Of the three regions (coast, mountains and jungle), 14 in the medium level and 87 in the high level. On the other hand, 6 men and 8 women are in the medium level, in the high 28 and 59, respectively. In the factor: religion, 14 (among Catholics, Adventists, Evangelicals and others) in the medium level, 87 in the high. According to the factor: educational level (primary, secondary and higher), 14 and 87 are located in the low and high level, respectively. In the family and friends circle, laughter is always experienced: 58.4% and 66.3%, respectively; for respondents it is easier to laugh, always, 54.5% and 66.3%, in the family environment and with friends, respectively. They declared that laughter prevents diseases, strengthens health, prevents covid-19, strengthens the immune system and limits the production of the hormone cortisol (responsible for stress), always 70.3%, 31.7%, 81.2; 31.7%, 71.3% and 83.2%, respectively. Conclusion: In the context of COVID-19, the most significant levels of laughter found in the study are two: medium and high; the most weighted demographic factors are: age, sex, religion, and employment status.

Modification in Pittsburgh Sleep Quality Index after low intensity transcranial magnetic stimulation in patients with fibromyalgia

Fibromyalgia is a disease of unknown origin in which sleep involvement is very prevalent, and one of the main symptoms, even as prevalent as pain. In fact, one condition has been linked to the other, and the two may feedback on each other. We investigated what happens if by applying low-field magnetic stimulation in patients with fibromyalgia, it could improve sleep variables, and if this would be related to an improvement in the pain of the patients. We compared the results of a group of female patients with fibromyalgia, who underwent treatment for 6 weeks, with another group of patients with similar characteristics, who were not treated. The results were also compared with a group of healthy women, who served as a second control group. The Pittsburgh sleep scale was used as a sleep scale and a global clinical scale was used to assess general state. A significant improvement was observed in the different items of the sleep scale applied, from the four weeks of treatment, being even more evident at the end of treatment at six weeks. A total of 82% of patients improved at the end of treatment. There was a correlation of this improvement with the overall pain situation of the patients. In addition, there was a trend towards equal sleep outcomes between treated patients and healthy subjects. Treatment with low intensity magnetic stimulation could improve the sleep of fibromyalgia patients, as well as their overall clinical situation, and both processes could be interrelated.

Validation and Cross-Cultural Adaptation of the Spanish Version of the Pain Sensitivity Questionnaire (PSQ-S).

Experimental pain testing requires specific equipment and may be uncomfortable for patients. The Pain Sensitivity Questionnaire (PSQ) was developed to assess pain sensitivity, based on the pain intensity ratings (range: 0–10) of painful situations that occur in daily life. The main objective of this study was to carry out a cross-cultural adaptation and validation of the Spanish version of the PSQ (PSQ-S). A total of 354 subjects (296 healthy and 58 chronic pain patients) filled in the PSQ-S. A subgroup of 116 subjects performed experimental pain testing, including two modalities (cold and pressure), with different measures: pain intensity rating, pressure pain threshold, and tolerance. The validation results showed two factors: PSQ-S-moderate and PSQ-S-minor and, for the total scale and the two factors, an excellent internal consistency (Cronbach’s alpha coefficient > 0.9) and a substantial reliability (Intraclass Correlation Coefficient > 0.8). We obtained strong correlations with all the experimental pain rating parameters, catastrophizing, and depression variables, as well as moderate correlations with anxiety, central sensibilization, and impact on the quality of life. Chronic pain patients received elevated PSQ-S scores compared to healthy controls, and three cut-off values (PSQ-S-total = 7.00, PSQ-S-moderate = 7.57, and PSQ-S-minor = 6.29) based on ROC curve analyses were shown to be able to discriminate between healthy adults and adults with chronic pain. Therefore, PSQ-S may be a simple alternative to experimental pain procedures for clinical and experimental pain research.

PAIN: the Word, the Image and the Concept in the Dostoevsky’s Thought and Speech Space

The article is devoted to the study of the linguistic expression of the phenomenon of pain in the texts of F.M. Dostoevsky. The material of the analysis is the texts of works of fiction, journalism and letters of the Great Russian writer. The study of Dostoevskys texts is preceded by an analysis of entries in explanatory and specialized dictionaries and encyclopedias, including articles in the Dictionary of Dostoevskys Language. The relevance of the study is determined by the approaching bicentennial of F.M. Dostoevsky, in whose works the phenomenon of pain has become one of the important subjects of the image. The specificity of this work lies in the reliance on linguistic methods of studying the phenomenon of pain while maintaining the interdisciplinary focus of the research as a whole. Various associative connections of the word pain and its derivatives in the contexts of the writers works of different genres are being studied. At the initial stage, the selection of material is carried out by the method of continuous sampling using the DiaWin software system of the Department of Experimental Lexicography of the V.V. Vinogradov Russian Language Institute of the Russian Academy of Sciences. The material thus obtained, is subjected to a multilevel analysis, in course of which the specificity of the conceptualization of pain in language and culture is revealed and the features of the depiction and interpretation of the phenomenon of pain in the discourse of Dostoevsky and his characters are revealed. Conclusions are formulated about the stable associative connections of the lexeme pain, the specificity of the linguistic depiction of various states of pain in the writers texts is revealed, the original interpretations of the concept of pain in the discourses of heroes-ideologists are analyzed. As a result, the analyzed phenomenon appears in multidimensional illumination. The general structure of the frame is established. The relationship between external symptoms and internal sensations of physical and mental pain is revealed. It is postulated that the explication of the concept of pain by a native speaker is fraught with significant difficulties, since pain is introspective and subjectively experienced. This special state is experienced and lived on. The contextual combinations of meanings of the word pain in Dostoevskys texts are highlighted. The specificity of the figurative representation of pain situations in the writers works is revealed. The increments of meaning characteristic of Dostoevskys contexts are analyzed. As a result, pain is interpreted as a complex phenomenon of language and culture and an important concept in the discourse of F.M. Dostoevsky.

Emotional Intelligence and Perceived Health Related to Expressed Compassion Fatigue: A Study in Health Sector at Regional Level.

Background: The work of health professionals often involves physical as well as psychological strain. They constantly deal with traumatic situations of pain and suffering, which destabilize the sense of well-being. Compassion fatigue is a feeling that appears in these cases and is related to other variables such as burnout or emotional drain.Aims: The principal aim of this project was to deepen the analysis of compassion fatigue and how it could be explained through the relationship with other constructs such as emotional intelligence and perceived health.Methods: This work followed the STROBE checklist for cross-sectional studies. In this study 1,521 nurses (Mage = 47.32; SD = 8.44) participated. The responses reported by the nurses were analyzed by classifying them as high or low compassion fatigue and the differences of both groups were analyzed for the variables of emotional intelligence, perceived health and quality of professional life.Results: It was obtained significant differences for all factors except for emotional intelligence factor. A linear regression analysis showed both emotional intelligence and perceived health helped to explain (12%) compassion fatigue.Conclusion: This study provides light on comprehending the conception of compassion fatigue. It highlights the importance of intervention programs that improve the quality of professional life.

Studies in patients with temporomandibular disorders pain: Can scales of hypnotic susceptibility predict the outcome on pain relief?

ABSTRACT Many medical conditions are claimed to benefit when hypnosis is incorporated into their treatment. For some conditions, the claims are largely anecdotal, but the treatment of pain stands out in two ways. First, there is a strong body of evidence that hypnosis can produce clinically useful analgesic effects. Second, since innocuous pain can be induced in the laboratory, the process can be explored rigorously. This idea assumes that experimentally induced pain and clinical pain behave identically. We describe using experimentally induced pain in patients already suffering from temporomandibular disorders. Scanning results indicate that the pain and its amelioration are the same in the two circumstances. Moreover, the absence of any impact upon a nociceptive trigemino-facial reflex implies that the impact of hypnosis is purely cortical. Finally, we address the observation that clinical success correlates poorly with hypnotic susceptibility scores. It is proposed that a painful experimental situation induces anxiety. This, like hypnosis, has been associated with an emphasis on right hemisphere activity. Thus, clinical anxiety may render a person more responsive to hypnosis than would be indicated by a susceptibility test delivered in stress-free circumstances.

The Effects of High Power and Low Power Posing on Students’ Pain Threshold

Background and Aim: Research has shown that social power affects information processing in many ways and can induce powerful movements or gestures. This study aimed to investigate the effect of pretending power gestures on changing the pain threshold of a group of female students. Methods & Materials: The method of the present study was quasi-experimental with a pre-test post-test design with a control group. The statistical population of this study included all female students of Arak University in the academic year 2016-2017, from which 60 people selected by convenience sampling method, and randomly divided into three groups: high power posing (sitting on a chair and putting your feet on the table, placing your hands behind your head and holding your head up), low power posing (sitting on a chair with your legs together, arms between your legs and bending your head to bottom) and control. Rosenberg self-esteem scale and tourniquet technique with cuff pressure gauge (to measure pain threshold) used to collect data. After the pre-test measurements and two minutes of gestures, the post-test was performed immediately. Data were analyzed using the analysis of covariance. Ethical Considerations: This study was approved by the ethics committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1399.276). Results: The results showed that pretending high/low power gesture significantly affects pain threshold; pretending to have a high-power gesture increases the pain threshold, and pretending to have a low-power gesture lowers the pain threshold. Conclusion: Based on the results, using power gestures as a simple tool in pain situations is recommended for pain management or as a supplement to analgesics.

Exploring the Grieving Process and Coping Strategies of Meranao Mothers over their Children’s Death

Death of one’s child is an unfathomable painful situation that a mother may feel. While literature reports different coping strategies across cultures, there has no research yet that explored the grieving process that Meranao mothers go through when they lost a child. Hence, this study explored the grieving process of the bereaved Meranao mothers from the Southern Philippines over the loss of their children and the strategies they used to cope with the feelings of grief. The study was conducted at different barangays located in Marawi City, Lanao del Sur, Philippines. The participants lost children with age range of 18-30 years old. It was discovered that these bereaved mothers ask several questions to themselves emerging after the death of their children. Nonetheless, it was found that after the mothers had worked through their grief brought by their child’s death, they were able to restore their life and become stronger and resilient individuals. This paper concludes that bereaved mothers go through a tedious journey wherein the existence of pain, longing, sadness, guilt and anger were felt, but these emotions only strengthen them as mothers.

P–509 Patients’ Uses and Experiences of Medically-Assisted Reproduction in France in 2020

Abstract Study question What are the uses and real-life experiences of patients currently treated in France in medically-assisted reproduction (MAR) centers? Summary answer One in four patients is in a situation of significant pain in relation to MAR; half are not optimistic about the outcome of their treatment. What is known already Internationally, work on the quality of life and impact of treatments has been completed in the field of endometriosis (Culley et al. 2017). In the field of MAR in France, one study underlines an important level of general well-being, with nearly 4 people out of 5 who say they are rather content (Coudrière et al. 2020). A better understanding of this result is however still lacking, especially in respect to whether patients actually believe in the success of their treatments, or how dependent satisfaction is on variables, like age, secondary infertility or the number of years engaged in fertility treatments. Study design, size, duration We conducted an online self-administered questionnaire by means of a two-step process: a first survey dedicated to patients’ uses was carried out from January 15, 2020 to February 26, 2000; the following and complementary survey about real-life experience was conducted from March 3, 2020 to April 10, 2020. The initial sample included 1503 people before selecting relevant participants. Participants/materials, setting, methods The final sample of 967 patients targets patients that were enrolled in a French procreative medical center at the time of the study. Were excluded from the sample: ex-patients, patients who have not started treatment or are not followed in France, solo and homosexual care patient trajectories. The questionnaire was composed of 178 questions. In the questionnaire dealing with MAR uses, six fields were examined; in the case of real-life experience, eight themes were questioned. Main results and the role of chance The study shows that one in four patients suffers significantly in relation to MAR care; nearly half are pessimistic about treatment outcome and 65% claim that MAR prevents full enjoyment of everyday life. Further findings include: MAR is globally satisfying regarding the quality of care provided by practitioners and staff (80%), general administration of patients (77 to 87%), first encounters with staff and center (78 to 91%), quality of dialogue (81%), physical state of the premises (82 to 97%), continuum with professional activity (73%). Where centers/practitioners need to pay attention: one out of two patients wanted more means of communication; time management was an issue; 41% state that infertility prevents entrepreneurial outreach and general success; treatments strongly disrupt work for 83% and reduce performances for 79%; work rights, while known, were not respected in ¼ cases. Discoveries made: young women are not very positive, men are not well-identified in such medical trajectories, women’s body image is completely transformed for 95%, 85.5% of women are depressed by seeing a pregnant woman, and 15% do not think about wanting a child daily. Limitations, reasons for caution This research, carried out online, was distributed mainly through a grassroot organization, potentially biasing representativeness. Also, the study finished at the start of the first French confinement. Previous studies show that the general context does not impact results, but this limitation cannot be ignored (Fisher, Bayhem, 2019). Wider implications of the findings: These findings underline the need for a comprehensive conception of MAR, including more than medical support. It highlights anew the need to better take men into account in future research as well as people in their twenties as knowledge of these categories of people is still lacking. Trial registration number Not applicable

Ethical Dilemma: Autonomy Versus Veracity

Ethical principles have to be applied by health care providers as well as by organization even in challenging conditions. This case study discusses, through the case of a patient with poor prognosis of lung cancer. The ethical dilemma of telling truth and withholding information about diagnosis. The respect for autonomy is necessary for patients. Health care providers must respect for ethical principles. This case study also discusses the implication of controversies and issues related to telling truth relevant to clinical practice. A 50-years old female, having two children visits hospital with a history of lung tumor she has her last visit with doctor with the family. The family was shocked with the news that metastatic lung cancer was suspected. Due to worsened condition, she was suffering with intestinal obstruction, vomiting and difficulty in breathing. She came to know of her worse condition and denied to seek medical and surgical treatment. Laparotomy was performed, nasogastric tube and urinary catheter passed. Patient was refusing to any treatment which put the physician family in a complicated situation. They wanted to respect and honor her own wishes but on the other hand they also encouraged her to taking the treatments. Meanwhile, the medical team informed her family with an incurable diagnose. The family was nervous and requested the physician to hide this bad news from the patient. She was trusted that her disease is curable. A week later, was a wedding ceremony of her daughter and her family planned wedding her discharge from the hospital. Her family and physician were alert of her diagnosis but both were hiding the truth about her condition. They obscured the truth and this created a painful situation for the family and concerning health care professional. Veracity: Healthcare should tell the truth about terminal illness. Autonomy: The principle of autonomy states is individual right to make decisions. Social, political and ethical morals concepts that give individuals the right to make their own choices. Patient’s autonomy should be respected in any circumstances. In this case, autonomy is not respected by the family and Healthcare provider and the patient was unaware of her lung cancer which is terminal diagnose.

Experiences of Parents of Preterm Children Hospitalized Regarding Restrictions to Interact with Their Children Imposed Because of the COVID-19 Pandemic.

Objective.To describe the experiences of parents of hospitalized preterm children regarding the restrictions implemented in the neonatal intensive care unit -NICU- during the COVID-19 pandemic.Methods.Qualitative study. Semi-structured interviews were conducted between April and October 2020 with 12 parents of preterm children, whose children were hospitalized and discharged from NICU during the pandemic. The analysis was performed with tools from grounded theory through open and axial coding.Results.The study identified four categories regarding the experience: 1) needing information: refers to the need for clear and close information to compensate for the physical distance; 2) limiting the interaction with the children: expressed as a painful situation, which minimizes opportunities for learning to care at home for their preterm child; 3) the pandemic: adding to the fears: in which the virus appears as a new threat for the children, who are vulnerable given their premature condition; and 4) limiting social support after discharge: identifies that the parents had less family and professional support for care after discharge during times of pandemic.Conclusion.Parents of preterm children lived a difficult experience that became complex within the context of the pandemic. The experiences of parents of preterm children during times of COVID-19 indicate that restrictions to enter neonatal units to prevent the virus transmission limited the interaction with the preterm child and with the health staff and increased the needs for information.

Pain experience in an aging adult population during a 10-year follow-up.

This 10-year follow-up study aimed to examine the persistence of SF-36 pain intensity and pain-related interference and to identify baseline factors that may relate to pain experience among community-dwelling aging adults. Questionnaire and clinical data on a total of 1,954 participants (mean age at baseline 63years) were collected in 2002, 2005, 2008, and 2012. Based on pain reports, four pain intensity, pain interference (PIPI) groups were formed at each time point: PIPI group I: none to mild pain intensity and interference; II: moderate to extreme pain intensity, none to mild pain-related interference; III: None to mild pain intensity, moderate to extreme pain-related interference, IV: Moderate to extreme pain intensity and interference. Participants with the most pain at baseline improved their pain situation the most during the follow-up. Higher BMI was associated with pain interference, and metabolic syndrome (MetS) and musculoskeletal diseases with both pain intensity and interference (p<0.05, statistically significant interaction between pain intensity and pain interference) at baseline. According to multivariate logistic regression analysis the following baseline characteristics were associated with remaining in PIPI group I throughout the follow-up: presence of musculoskeletal disease (OR 0.22 [95% CI 0.16-0.30]), high BMI (OR 0.93 [95% CI 0.90-0.97]), high household income (OR 1.46 [95% CI 1.07-1.98]), good childhood home environment (OR 1.03 [95% CI 1.00-1.05]). Multiple factors may affect pain persistence in late adulthood with varying effect on pain intensity and pain-related interference. Pain situation of even those with most pain may be improved.

Physiological and Behavioral Mechanisms of Thermoregulation in Mammals.

Simple SummaryThe study of the hypothalamic neuromodulation of thermoregulation offers broad areas of opportunity with practical applications that are currently being strengthened by the availability of efficacious tools like infrared thermography (IRT). This review analyzes the effect of climate change on behavior and productivity; and the effects of exercise on animals involved in sporting activities; identifies the microvascular changes that occur in response to fear, pleasure, pain, and other situations that induce stress in animals; and examines thermoregulating behaviors.This review analyzes the main anatomical structures and neural pathways that allow the generation of autonomous and behavioral mechanisms that regulate body heat in mammals. The study of the hypothalamic neuromodulation of thermoregulation offers broad areas of opportunity with practical applications that are currently being strengthened by the availability of efficacious tools like infrared thermography (IRT). These areas could include the following: understanding the effect of climate change on behavior and productivity; analyzing the effects of exercise on animals involved in sporting activities; identifying the microvascular changes that occur in response to fear, pleasure, pain, and other situations that induce stress in animals; and examining thermoregulating behaviors. This research could contribute substantially to understanding the drastic modification of environments that have severe consequences for animals, such as loss of appetite, low productivity, neonatal hypothermia, and thermal shock, among others. Current knowledge of these physiological processes and complex anatomical structures, like the nervous systems and their close relation to mechanisms of thermoregulation, is still limited. The results of studies in fields like evolutionary neuroscience of thermoregulation show that we cannot yet objectively explain even processes that on the surface seem simple, including behavioral changes and the pathways and connections that trigger mechanisms like vasodilatation and panting. In addition, there is a need to clarify the connection between emotions and thermoregulation that increases the chances of survival of some organisms. An increasingly precise understanding of thermoregulation will allow us to design and apply practical methods in fields like animal science and clinical medicine without compromising levels of animal welfare. The results obtained should not only increase the chances of survival but also improve quality of life and animal production.

Complementary, Traditional and Spiritual Practices Used by Cancer Patients in Turkey When Coping with Pain: An Exploratory Case Study.

This study was conducted to determine the complementary and traditional-spiritual practices applied by individuals diagnosed with cancer when experiencing significant pain. This descriptive and cross-sectional study was conducted with 110 patients who were receiving chemotherapy treatment in a university hospital outpatient treatment unit (Chemotherapy Unit) between 1st March and 30th June 2019. The study sample size was calculated using the 'unknown-population sample selection formula' (n = t2·p·q·/d2). Study data were collected using a patient information form comprising 13 questions about the participants' sociodemographic characteristics, diseases, and complementary practices. The data were analyzed using descriptive percentage tests and the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) software. The study found that 45.5% of the cancer patients took a walk, 38.2% listened to music, 27.3% watched movies, 24.5% received massages, 20.0% read newspapers or books, 20.0% did sports, and 10.9% dreamed in painful situations. Spiritual practices used by the patients were determined as praying (46.4%), engaging in salat (the daily ritual prayers of Islam) (30.9%) and reading religious books (23.6%). The herbal practices applied by the patients include the use of garlic, mulberry molasses, pomegranate, green tea; furthermore, herbs such as honey, sage, lime, black cumin, ginger, centaury, thyme, nettle, flaxseeds, and rosehip were also used. Most of the patients learned complementary practices from television programs (62.7%); only 8.2% learned these practices from healthcare professionals. Nurses should investigate patients' use of complementary practices and provide them with the necessary evidence-based information to prevent unconscious use of these practices. Considering that determining patients' spiritual needs and practices is seen as the first step in the holistic care of patients, it is important to satisfy cancer patients by providing necessary healthcare services and help them improve their physical and mental health.

Enhanced analgesic cholinergic tone in the spinal cord in a mouse model of neuropathic pain

Endogenous acetylcholine (ACh) is an important modulator of nociceptive sensory processing in the spinal cord. An increased level of spinal ACh induces analgesia both in humans and rodents while interfering with cholinergic signaling is allodynic, demonstrating that a basal tone of spinal ACh modulates nociceptive responses in naïve animals. The plasticity undergone by this cholinergic system in chronic pain situation is unknown, and the mere presence of this tone in neuropathic animals is controversial. We have addressed these issues in mice through behavioral experiments, histology, electrophysiology and molecular biology, in the cuff model of peripheral neuropathy. Our behavior experiments demonstrate the persistence, and even increased impact of the analgesic cholinergic tone acting through nicotinic receptors in cuff animals. The neuropathy does not affect the number or membrane properties of dorsal horn cholinergic neurons, nor specifically the frequency of their synaptic inputs. The alterations thus appear to be in the neurons receiving the cholinergic signaling, which is confirmed by the fact that subthreshold doses of acetylcholinesterase (AChE) inhibitors in sham animals become anti-allodynic in cuff mice and by the altered expression of the β2 nicotinic receptor subunit. Our results demonstrate that endogenous cholinergic signaling can be manipulated to relieve mechanical allodynia in animal models of peripheral neuropathy. Until now, AChE inhibitors have mainly been used in the clinics in situations of acute pain (parturition, post-operative). The fact that lower doses (thus with fewer side effects) could be efficient in chronic pain conditions opens new avenues for the treatment of neuropathic pain. Significance statementChronic pain continues to be the most common cause of disability that impairs the quality of life, accruing enormous and escalating socio-economic costs. A better understanding of the plasticity of spinal neuronal networks, crucially involved in nociceptive processing, could help designing new therapeutic avenues. We here demonstrate that chronic pain modifies the spinal nociceptive network in such a way that it becomes more sensitive to cholinergic modulations. The spinal cholinergic system is responsible for an analgesic tone that can be exacerbated by acetylcholinesterase inhibitors, a property used in the clinic to relief acute pain (child birth, post-op). Our results suggest that lower doses of acetylcholinesterases, with even fewer side effects, could be efficient to relieve chronic pain.