Prolonged Pain Research Articles

Platelet-Rich Plasma Injections Decrease the Need for Any Surgical Procedure for Chronic Epicondylitis versus Conservative Treatment-A Comparative Study with Long-Term Follow-Up.

Background: Platelet-rich plasma (PRP) injections may alleviate symptoms of chronic medial or lateral epicondylitis. Methods: We retrospectively analyzed a total of 55 patients with chronic ME or LE who had undergone at least 6 months of any conservative treatment before intervention. The patients were divided into two groups: the PRP group (n = 25), who received a single injection of autologous PRP to the medial or lateral epicondyle, and the PT group (n = 30), who continued with PT and pain medication. The primary outcome measures were pain and functional outcomes measured in terms of the following: Patient Related Tennis Elbow Evaluation (PRTEE), Visual Analogue Scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH), which were detected at preintervention, 6-, 12-, 24-, and 36-month follow-up. Secondary outcomes included complications and the need for any surgery at follow-up. Results: Primary outcome measurements showed significantly better results favoring the PRP group (6-month PRTEE total 43.2 ± 19.2 vs. 62.8 ± 24.0, p < 0.001; 12-month PRTEE total 6.9 ± 15.0 vs. 28.1 ± 24.4, p < 0.001; 24-month PRTEE total 4.8 ± 9.8 vs. 12.7 ± 14.5, p = 0.029), and significantly better results in VAS and DASH sub-scores. The PRP group required significantly fewer surgical procedures (n = 0/0% vs. n = 6/20%, p = 0.027) at follow-up (mean 38.3 ± 12.3 months), and one case of prolonged pain after injection was detected. Conclusions: Patients who underwent PRP injections for epicondylitis resulted in better pain and functional outcomes compared to physiotherapy, and this improvement lasted at least 24 months. They required fewer surgical procedures and achieved faster recovery than the PT group. We recommend PRP for chronic epicondylitis of the elbow before considering surgery when other treatments have failed.

Age matters if you are cheese, wine or a third molar: Correlating age with the indications for and complications following third molar removal

AbstractObjectiveAdvanced age is a well‐recognised risk factor for complications following third molar surgery. However, age is largely exempt as consideration in published guidelines regarding the indications for third molar removal. This cross‐sectional study aimed to examine changes in the indications for third molar removal with increasing age.Materials and MethodsThis was a retrospective cross‐sectional study of 500 consecutive patient records totalling 1446 third molar extractions. The primary measures examined were the patient's age and the surgeon's documented indication for third molar removal. Secondary measures included gender, smoking status, IAN proximity, number of teeth extracted per patient, and short‐term postoperative outcome.ResultsOlder patients were significantly more likely to undergo third molar extraction for periodontal disease and caries of adjacent teeth. Prolonged socket pain at 2 weeks was the most common complication encountered by patients across all age groups. Adults below age 25 were 1.69 times more likely to have uneventful healing (p &lt; 0.02).ConclusionOlder patients are more likely to experience a slower postoperative course following third molar removal, as well as increased complications. Prophylactic removal of symptom‐free third molars may be justified to prevent adjacent caries, periodontal disease and odontogenic infections later in life.

Prolonged Scrotal Pain Resulting from Testicular Schistosomiasis: Case Report

Testicular Schistosomiasis causes acute and chronic scrotal pain causes, typically by one or more species of blood flukes of the genus Schistosoma, which are rarely seen. Therefore, specimens for the diagnosis are usually biopsies from the testes and tissue sections from orchidectomy. This case report was aimed to present the diagnosis of testicular Schistosomiasis resulting from orchidectomy due to prolonged scrotal pain. Microscopic examination of a histological specimen stained by hematoxylin and eosin revealed dispersed viable and calcified ova of Schistosoma haematobium. This finding provided a rare case of testicular Schistosomiasis that clinicians and other healthcare professionals should be mindful of when dealing with cases with scrotal involvement, especially in endemic areas, to avoid unnecessary orchidectomy. J Microbiol Infect Dis 2022; 12(4):167-170.

Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review.

Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon's inappropriate decision to resort to a second surgical treatment. We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. We retrieve 20 articles. Most of the papers are clinical cases showing the disorder's rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately.

Decreased Default Mode Network Connectivity Following 24 Hours of Capsaicin-induced Pain Persists During Immediate Pain Relief and Facilitation

Prolonged experimental pain models can help assess cortical mechanisms underlying the transition from acute to chronic pain such as resting-state functional connectivity (rsFC), especially in early stages. This crossover study determined the effects of 24-hour-capsaicin-induced pain on the default mode network rsFC, a major network in the dynamic pain connectome. Electroencephalographic rsFC measured by Granger causality was acquired from 24 healthy volunteers (12 women) at baseline, 1hour, and 24hours following the application of a control or capsaicin patch on the right forearm. The control patch was received maximum 1 week before the capsaicin patch. Following 24hours, the patch was cooled and later heated to assess rsFC changes in response to pain relief and facilitation, respectively. Compared to baseline, decreased rsFC at alpha oscillations (8-10Hz) was found following 1hour and 24hours of capsaicin application for connections projecting from medial prefrontal cortex (mPFC) and right angular gyrus (rAG) but not left angular gyrus (lAG) or posterior cingulate cortex (PCC): mPFC-PCC (1hour:P < .001, 24hours:P = .002), mPFC-rAG (1hour:P < .001, 24hours:P = .001), rAG-mPFC (1hour:P < .001, 24hours:P = .001), rAG-PCC (1hour:P < .001, 24hours:P = .004). Comparable decreased rsFC following 1hour and 24hours (P≤0.008) was found at beta oscillations, however, decreased projections from PCC were also found: PCC-rAG (P≤0.005) and PCC-lAG (P≤0.006). Pain NRS scores following 24hours (3.7±0.4) was reduced by cooling (0.3±0.1, P = .004) and increased by heating (4.8±0.6, P = .016). However, neither cooling nor heating altered rsFC. This study shows that 24hours of experimental pain induces a robust decrease in DMN connectivity that persists during pain relief or facilitation suggesting a possible shift to attentional and emotional processing in persistent pain. PerspectiveThis article shows decreased DMN connectivity that might reflect possible attentional and emotional changes during acute and prolonged pain. Understanding these changes could potentially help clinicians in developing therapeutic methods that can better target these attentional and emotional processes before developing into more persistent states.

The applications of cryoneurolysis for acute and chronic pain management.

Cryoneurolysis is a term used to describe the application of extreme cold to targeted nerve tissue. The primary goal of the application of a thermal neurolytic technique is to disrupt the conduction of pain signals from the periphery to the central nervous system and eliminate or diminish the experience of pain. Recent advancements in ultrasound technology coupled with the development and approval of handheld devices specifically designed to deliver cryoneurolysis has expanded the use of this modality in the perioperative setting. Surgical procedures including total knee arthroplasties, shoulder arthroplasties, thoracotomies, and mastectomies have all demonstrated long-term pain relief benefits when cryoneurolysis has been administered days to weeks prior to the planned procedure. In addition, the newly designed handheld device allows for office-based clinical use and has been utilized for various chronic pain conditions including neuropathic and phantom limb pain. The evidence clearly demonstrates that cryoneurolysis has a low risk profile and when administered appropriately, provides prolonged analgesia without promoting motor blockade. This narrative review article describes the unique mechanism of action of cryoneurolysis for prolonged pain relief and provides emerging evidence to support its applications in both acute and chronic pain management.

Utilization of a partial rib-sparing procedure in microvascular breast reconstruction for preserving intercostal nerve and nipple reconstruction.

In microvascular breast reconstruction, internal mammary vessel (IMV) exposure has been performed. The preservation of intercostal nerve (ICN) is effective for preserving sensibility and decreasing postoperative pain. In nipple reconstruction, cartilage grafting is performed to provide additional support and projection. We considered that ICN preservation and costal cartilage banking could be performed simultaneously. This method was described as the "partial rib-sparing procedure." The purpose of this study was to introduce this procedure. Surgical technique of this procedure was as follows. The second intercostal space was used. The width of the trimmed cartilage was kept within the superior half of the third costal cartilage. Soft tissue within 5mm of the inferior border of the second rib edge was preserved to save the second ICN. The length of IMVs in the partial rib-sparing procedure and that in the total rib-sparing procedure was compared. The number of patients in the partial rib-sparing and total rib-sparing groups was 137 procedures and 57 procedures, respectively. The length of IMVs was significantly longer in the partial rib-sparing procedure (median 20.5mm vs. 17.6mm, P < 0.001). In the partial rib-sparing group, no patient complained of prolonged local pain, and chest wall contour abnormalities were absent in all cases. The partial rib-sparing procedure is superior, especially for patients with narrow intercostal spaces and/or patients who decide to undergo nipple reconstruction with costal cartilage. This procedure could be performed to preserve the soft tissues around the ICN and decrease the postoperative pain.

A Review of Abductor Tendon Tears

Greater trochanteric pain syndrome consists of a group of associated conditions involving the lateral hip that can be debilitating to patients, mostly women between ages 40 and 60 years. Abductor tendon tears are becoming a more recognized cause of lateral hip pain in patients without hip osteoarthritis. Diagnosis of this condition is critical to patient care because misdiagnosis often leads to unnecessary prolonged pain and even unnecessary procedures that address different pathologies. Treatment strategies consists of nonoperative modalities such as nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy, but for refractory cases, surgical techniques including repair, augmentation, and reconstruction have been well-described in the literature providing patients with acceptable outcomes.

&lt;strong&gt;Prevalence of post odontectomy complications under general anesthesia in Rumah Sakit Gigi Mulut Universitas Padjadjaran&lt;/strong&gt;

ABSTRACTIntroduction: Odontectomy is a surgical procedure to remove an impacted tooth. Some cases of odontectomy are performed under general anesthesia because it has risks and complications that need to be considered, such as a patient with mental or physical disorder, difficulty level of the impacted tooth, number of impacted teeth extracted, and operative duration. This study aimed to determine the prevalence of post-odontectomy complications under general anesthesia in RSGM Universitas Padjadjaran Bandung. Methods: This study was a cross-sectional descriptive study using retrospective data of medical records of a patient who underwent odontectomy under general anesthesia from 2017 until 2018 in RSGM Unpad. Samples were taken using a purposive non-probability sampling technique by setting inclusion criteria such as undamaged medical records and providing patient data on the first and a week control visit. The variables, including age, gender, classification of impacted teeth, number of teeth, and complications, were assessed in this study. The minimum sample size was determined by using the Slovin formula. The minimum sample required is 94% - 95% confidence level and 5% margin of error. Result: The data that had been collected shows that the number of female patients (67%), male patients (37%), the most common age was 21-30 years (52%), and odontectomy in 4 third molars (73%). Odontectomy that performed on four third molars (73%) with the ordinary post odontectocmy complications found in the female patient, such as trismus (2%), prolonged pain (7%), edema (3%), paraesthesia (3%). Conclusion: The prevalence of post-odontectomy complications under general anesthesia in RSGM Universitas Padjadjaran Banding is relatively low.Keywords: prevalence; odontectomy; general anesthesia; complications; impacted tooth.

Nitinol stents placed in iliac veins are not associated with prolonged back pain.

Endovascular stenting is the standard of care for the management of symptomatic chronic venous obstruction. The increased radial resistive force and longer lengths of Nitinol stents have led to questions over persistent post-operative back pain. The purpose of this investigation was to assess the incidence and severity of post-operative back pain of Nitinol stents compared to Wallstents. A retrospective review of data at the Center for Vascular Medicine was performed. Patient demographics, pre-operative, oneweek, three-, six,- and 12month visual analog pain scores (VAS) for back pain, stent type, diameter, length, and vein locations were assessed. From April 2014 to November 2021, 627 (412 women/215 men) patients were assessed for the presence of post-operative back pain after an initial iliac vein stent placement. Stents utilized were Wallstents (n = 114), Venovo (n = 342), and Abre (n = 171). The most common Nitinol stent diameter and lengths were 14mm, 16mm, and 120mm, respectively (p ≤ .03). The incidence of back pain at oneweek was 66% (411/627). VAS scores at oneweek and one, three, and sixmonths post-operatively were the following: Wallstents-2.6 ± 3 (n = 66), 1.7 ± 2.6 (n = 43) 0.7 ± 2 (n = 51), and 0 ± 0 (n = 27); Abre-3.5 ± 3 (n = 130), 3.8 ± 3 (n = 19), 1.2 ± 2.5 (n = 12), and 1 ± 2 (n = 5); and Venovo- 2.5 ± 3 (n = 216), 2.4 ± 3 (n = 70), 0.9 ± 2 (n = 68), and 0.6 ± 1.7 (n = 49). There was no difference in the severity of back pain at any time point (p ≥ .99). The development of back pain was unrelated to stent type, diameter, length, or covered vein territory. Post-operative back pain was observed in 66% of patients at oneweek. The average pain score at oneweek for the entire cohort was three, which declined to less than one at onemonth. No difference in the severity of back pain between groups was observed at any time point, and the development of back pain is unrelated to stent type, diameter, length, or covered vein territory.

Post-COVID-19 Menstrual Symptom Disorders Relating to Anxiety and Long COVID-19 Symptoms

Objectives: Coronavirus disease 2019 (COVID-19) can affect the menstrual cycle and menstrual flow. To examine changes in menstrual symptoms of women recovering from COVID-19 and to identify factors that influence these changes. Materials and Methods: A questionnaire, prepared using Google Forms, was completed by 180 women (26.08±6.62 years) recovered from COVID-19. The menstrual symptoms, menstrual pain, fatigue severity and anxiety level of the participants were evaluated respectively with the Menstrual Symptom Questionnaire (MSQ), visual analogue scale (VAS), fatigue severity scale (FSS), and coronavirus anxiety scale (CAS). Results: Post-COVID-19 individuals’ MSQ totals, subgroup scores, FSS scores and menstrual pain levels showed significant increase compared to pre-COVID-19. Regression analysis identified that age at menarche, changes in FSS and VAS scores as contributors to 38.4% of the variance explained in the significant regression for change in MSQ score. Individuals with prolonged fatigue, muscle– joint pain and dyspnea symptoms showed increase in MSQ total scores (P=0.006, P=0.009, P=0.046 respectively) and MSQ negative effects/somatic complaints scores (P=0.004, P=0.002, P=0.017 respectively). Individuals with prolonged gastrointestinal symptoms showed increase in MSQ pain symptoms (P=0.029) and MSQ coping methods scores (P=0.002), while those with prolonged muscle and joint pain showed increase in MSQ coping methods (P=0.022) scores. Conclusions: The results of this study indicated that menstrual symptoms, fatigue, and menstrual pain severity are deteriorated in women recovered from COVID-19. Age at menarche, changes in fatigue and menstrual pain after COVID-19 were determiners of the deteriorated menstrual symptoms. Menstrual symptoms were more severe in those who have prolonged fatigue, dyspnea, muscle– joint pain and gastrointestinal symptoms.

ODP080 Bisphosphonate treatment for osteoporosis in children with Gorham-Stout syndrome: a case report

Abstract Background Gorham-Stout disease (GSD) is a rare disease defined by progressive bone disappearance due to massive unicentric or multicentric osteolysis with proliferation of vascular structures. Symptoms and signs vary depending on the site of invasion. Including some self-limiting GSD, most treatments are palliative and limited to symptom management. Various treatments have been tried for GSD, but there are no standardized treatment protocols. Treatment includes radiological treatment, surgery, and medications such as bone absorption inhibitors (calcitonin, bisphosphonate (BP)), vitamin D and immune modulators (interferon alpha-2b, Sirolimus) Case presentation: A 4-year-old female patient presented with prolonged back pain after a fall. Pathologic compression fracture in T9, L1 vertebrae identified in simple spine image, and GSD was confirmed by MRI and biopsy finding as hemangioma in vertebrae. This patient has been treated with a combination therapy of Sirolimus and BP for 1 year. BP treatment consist with oral BP (Alendronate) between 3 intravenous BP (Pamidronate) every 4 months. After a year of treatment, BMD improved from initial -1.3 TBLH (z-score) to -0.5/0.4/0.6 Spine/Both femur (z-score), but MRI findings suggest mild aggravation of multiple compression fractures of spines of T9-L5. After 1-year of treatment, at present, the girl is alive and staying with tolerable condition. Conclusions Combination treatment with bisphosphonate and Sirolimus for childhood GSD can be helpful in slowing the demineralization of GSD without any significant adverse effect. Presentation: No date and time listed

Pseudomeniscus after knee arthroplasty: A case series for arthroscopic management of this problem and systematic review of literature

IntroductionMost patients undergoing total knee arthroplasty (TKA) experience favorable outcomes. Some patients, however, experience prolonged post-operative knee pain and tenderness at the joint line. This has been attributed in some cases to soft tissue impingement due to pseudomeniscus. The purpose of this study is to evaluate patient outcomes for arthroscopic excision of pseudomeniscus for persistent knee pain after TKA and to perform a review of literature for pseudomeniscus after knee arthroplasty. MethodsA retrospective analysis of patients undergoing arthroscopy to remove soft tissue causing persistent knee pain after previous TKA was performed. Outcome scores were asked at three time points: prior to knee arthroplasty, prior to arthroscopy, and post-arthroscopy at final follow-up. Subjective satisfaction with surgery and willingness to repeat procedures were also recorded. A two-tailed distribution paired t-test was used to determine statistical significance (p < 0.05). We also performed a review of the literature for pseudomeniscus complications for comparison. ResultsNine out of eleven patients were considered eligible to be assessed for post-operative satisfaction. Seven out of nine patients reported complete satisfaction and eight participants stated they would undergo the procedures again if they have to. Among 9 included patients, five patients have successfully completed the clinical score evaluation survey. The mean age of the patients with clinical score evaluation at the time of TKA was 61 years (range, 53–72) and the time between TKA and undergoing arthroscopy was 8 months (range, 5–13). The average follow-up period for patient-determined assessment after the arthroscopic procedure was 71 months (range, 16–115). All 5 patients reported improved Oxford Knee Scores (p=0.017), Western Ontario and McMaster Universities Osteoarthritis Index (p=0.023), and pain scores (p=0.018) comparing pre-arthroscopy to post-arthroscopy at follow-up. ConclusionArthroscopic removal of pseudomeniscus after TKA provides promising results in patients who experience persistent knee joint line pain and tenderness. Considering our results and review of literature, we recommend including pseudomeniscus in the differential for post arthroplasty knee pain. Study designCase series with a review of literature.

Twelve-Month Results from a Prospective Clinical Study Evaluating the Efficacy and Safety of Cellular Bone Allograft in Subjects Undergoing Lumbar Spinal Fusion.

While autologous bone grafts remain the gold standard for spinal fusion procedures, harvesting autologous bone is associated with significant complications, including donor site infection, hematomas, increased operative time, and prolonged pain. Cellular bone allograft (CBA) presents an alternative to autologous bone harvesting, with a favorable efficacy and safety profile. The current study further investigates CBA as an adjunct to lumbar spinal fusion procedures. A prospective, multicenter, open-label clinical study was conducted in subjects undergoing lumbar spinal fusion with CBA (NCT02969616). Radiographic fusion status was assessed by an independent review of dynamic radiographs and CT scans. Clinical outcome measures included the Oswestry Disability Index (ODI) and visual analogue scale (VAS) for back and leg pain. Adverse-event reporting was conducted throughout 12 months of follow-up. Available subject data at 12 months were analyzed. A total of 274 subjects were enrolled into the study, with available data from 201 subjects (73.3%) who completed 12 months of postoperative radiographic and clinical evaluation at the time of analysis. Subjects had a mean age of 60.2 ± 11.5 years. A higher number of women (n = 124, 61.7%) than men (n = 77, 38.3%) were enrolled, with a collective mean BMI of 30.6 + 6.5 kg/m² (range 18.0-51.4). At month 12, successful fusion was achieved in 90.5% of subjects. A significant (<i>p</i> &amp;lt; 0.001) improvement in ODI, VAS-back, and VAS-leg clinical outcomes was also observed compared to baseline scores. One adverse event related to CBA (postoperative radiculopathy) was reported, with surgical exploration demonstrating interbody extrusion of graft material. This subject reported successful fusion at month 12. CBA represents a viable substitute for harvesting of autograft alone with a high rate of successful fusion and significant improvements in subject-reported outcomes, such as pain and disability. Positive benefit was observed in subjects reporting single and multiple risk factors for pseudoarthrosis.

This Month in Anesthesiology

This Month in Anesthesiology

Headache Disorders: Does Pain Affect Blood Pressure?

The perspective that pain corresponds to elevated blood pressure is overly simplistic. Our objective is to investigate and debunk misconceptions regarding the effect of pain on blood pressure. While pain can increase blood pressure in the acute setting, prolonged pain and migraine's effect on blood pressure varies and can result in lower-than-expected blood pressure. Therefore, attributing pain as a sole source of elevation of blood pressure may lead to delays in diagnosing hypertension. Based on limited studies available, comorbid pain and chronic hypertension have a higher concurrence than in the general population. We will review current literature to investigate the effect of pain on blood pressure and prevalence of hypertension in chronic pain sufferers. A better understanding of pain's effect on blood pressure will help practitioners appropriately diagnose and counsel patients without disproportionately attributing high blood pressure to pain.

P-022 USE OF SEPRAFILM ADHESION BARRIER® IN COMPLEX LARGE INCISIONAL HERNIA

Abstract Aim The short-term results of the use of seprafilm® as a reinforcement of the peritoneum are presented. Material and Methods Seprafilm® was used in 5 patients with large midline and lateral incisional hernia in which Transversus Abdominis Release Technique was performed in which it was necessary to explant mesh previously. This weakness of the peritoneum was reinforced with the seprafilm® plates, to isolate the intra-abdominal contents from the mesh. Results The patients treated had an average stay of 6.6 days. All of them carried drains. There were no infectious complications in surgical site. There were no prolonged pain. All of them began tolerance the day after the surgery. At one month of the surgical intervention, there were no signs of infection, seroma or higher pain than 3 on the EVA scale. Discussion Post-operative adhesions to mesh are related to intestinal fistulas. The use of preperitoneal space to place the mesh is a good option, although sometimes it can have continuity problems, especially when there are explants of previous materials. The use of barrier materials is appropriate in these cases. Conclusion The use of Seprafilm® can be a good option as a barrier between viscera and prostheses for the prevention of adhesions.

Minimally invasive, sustained-release relaxin-2 microparticles reverse arthrofibrosis.

Substantial advances in biotherapeutics are distinctly lacking for musculoskeletal diseases. Musculoskeletal diseases are biomechanically complex and localized, highlighting the need for novel therapies capable of addressing these issues. All frontline treatment options for arthrofibrosis, a debilitating musculoskeletal disease, fail to treat the disease etiology-the accumulation of fibrotic tissue within the joint space. For millions of patients each year, the lack of modern and effective treatment options necessitates surgery in an attempt to regain joint range of motion (ROM) and escape prolonged pain. Human relaxin-2 (RLX), an endogenous peptide hormone with antifibrotic and antifibrogenic activity, is a promising biotherapeutic candidate for musculoskeletal fibrosis. However, RLX has previously faltered through multiple clinical programs because of pharmacokinetic barriers. Here, we describe the design and in vitro characterization of a tailored drug delivery system for the sustained release of RLX. Drug-loaded, polymeric microparticles released RLX over a multiweek time frame without altering peptide structure or bioactivity. In vivo, intraarticular administration of microparticles in rats resulted in prolonged, localized concentrations of RLX with reduced systemic drug exposure. Furthermore, a single injection of RLX-loaded microparticles restored joint ROM and architecture in an atraumatic rat model of arthrofibrosis with clinically derived end points. Finally, confirmation of RLX receptor expression, RXFP1, in multiple human tissues relevant to arthrofibrosis suggests the clinical translational potential of RLX when administered in a sustained and targeted manner.

Duelo egótico por el cuerpo doliente. Estudio fenomenológico y psicoanalítico del dolor intenso

The experience of an intense and prolonged physical pain reported by Rafael Argullol in his book "Davalú or pain" promotes a phenomenological and psychoanalytic analysis of mourning (combat) and mourning (elaboration within the self) due to loss of health, strength and autonomy. Pain is the cry of the body that remains in a prementalizing and meaningless space which challenges the environment but it remains outside of subjectivity and it breaks the link with the others, especially when it is located only in the body and it does not include the person as intentional being. From its radical corporeality, the pain closes to (corners) the self, it annihilates the previous identity and it reveals our maximum vulnerability and defenselessness. From the egotic retreat to a narcissism without language, the self plunges into a self-mourning that only ends when the pain stops. There is no pact with the suffering body’s ache, especially if it cannot be transformed into suffering

Post-COVID-19 pain syndrome: a descriptive study in Turkish population.

BackgroundThe new type of corona virus has a wide range of symptoms. Some people who have COVID-19 can experience long-term effects from their infection, known as post-COVID conditions. The authors aimed to investigate prolonged musculoskeletal pain as a symptom of the post-COVID-19 condition.MethodsThis is a descriptive study on the patients who were diagnosed with COVID-19 in a university hospital, between March 2020 and March 2021. Patient records and an extensive questionnaire were used to obtain relevant demographic and clinical characteristics, including hospitalization history, comorbidities, smoking history, duration of the pain, the area of pain, and the presence of accompanying neuropathic symptoms.ResultsOf the diagnosed patients, 501 agreed to participate in the study. Among the participants, 318 had musculoskeletal pain during COVID-19 infection, and 69 of them reported prolonged pain symptoms as part of their a post-COVID condition which could not be attributed to any other cause. The mean duration of pain was 4.38 ± 1.73 months, and the mean pain level was 7.2 ± 4.3. Neuropathic pain symptoms such as burning sensation (n = 16, 23.2%), numbness (n = 15, 21.7%), tingling (n = 10, 14.5%), stinging (n = 4, 5.8%), freezing (n = 1, 1.4%) were accompanied in patients with prolonged musculoskeletal pain.ConclusionsPatients with COVID-19 may develop prolonged musculoskeletal pain. In some patients, neuropathic pain accompanies it. Awareness of prolonged post-COVID-19 pain is crucial for its early detection and management.