Pain Reduction Research Articles

Effectiveness of Platelet-rich Plasma Injection as an Adjunct Treatment to Arthroscopy for TFCC Injury: A Retrospective Cohort Study.

Triangular fibrocartilage complex (TFCC) injuries can cause significant patient dysfunction. Platelet-rich plasma (PRP) has emerged as a potential adjunctive treatment for arthroscopic TFCC repair, with some studies suggesting improved outcomes. This study aims to evaluate and compare PRP as an adjunctive treatment in arthroscopic TFCC tear repair. This retrospective cohort study examined patients undergoing arthroscopic TFCC repair at Institut de la Main, Paris, France (December 2021-2022). Patients were split into two groups: arthroscopic repair alone (1) and repair with PRP injections (2). Physical examinations were conducted pre- and posttreatment, recording flexion, extension, and radial/ulnar deviation of the affected and contralateral wrists. A total of 33 patients (20 men and 13 women) with a mean age of 30.55 ± 9.17 years were included. PRP injections were given to 16 patients with arthroscopic TFCC repair; 17 had repair only. No significant differences existed preoperatively between groups in wrist function or pain (P > 0.05). The Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score differed significantly (P = 0.004). The non-PRP group demonstrated better postoperative upper extremity function, with a mean Quick DASH score of 7.75 ± 5.91 compared with 12.64 ± 6.79 in the PRP group. No significant difference between groups was observed in the pain visual analog scale (P > 0.05). PRP injections with TFCC repair did not improve function over repair alone. The non-PRP group showed better function (lower Quick DASH scores). Pain reduction was similar between groups. Larger trials and cost-effectiveness studies are needed to fully assess PRP's benefits in TFCC repair.

Comparative evaluation of various biomaterials as pulpotomy agents in molars with symptomatic irreversible pulpitis: A randomized single-blinded single-center control trial

Abstract Introduction: Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. Methodology: This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14–60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Results: Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Conclusion: Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials’ long-term clinical and radiographic outcomes is needed to enhance treatment efficacy.

Recommended Physiotherapy Modalities for Oncology Patients with Palliative Needs and Its Influence on Patient-Reported Outcome Measures: A Systematic Review

Background: This review aims to explore the role of physiotherapy in early and traditional palliative care (PC) for oncology patients, focusing on its impact on six patient-reported outcomes (PROMs), namely fatigue, pain, cachexia, quality of life (QoL), physical functioning (PHF), and psychosocial functioning (PSF). The purpose is to assess the effectiveness of various physiotherapy interventions and identify gaps in the current research to understand their potential benefits in PC better. Methods: A systematic literature search was conducted across PubMed, Embase, and Web of Science, concluding on 21 December 2023. Two independent reviewers screened the articles for inclusion. The Cochrane Risk of Bias Tool 2 was employed to assess the risk of bias, while the GRADE approach was used to evaluate the certainty of the evidence. Results: Nine randomized controlled trials (RCTs) were included, with most showing a high risk of bias, particularly in outcome measurement and missing data. Cognitive behavioral therapy (CBT) was the only intervention that significantly reduced fatigue, enhanced PHF, and improved QoL and emotional functioning. Graded exercise therapy (GET) did not yield significant results. Combined interventions, such as education with problem-solving or nutritional counseling with physical activity, showed no significant effects. Massage significantly improved QoL and reduced pain, while physical application therapies were effective in pain reduction. Mindful breathing exercises (MBE) improved QoL but had a non-significant impact on appetite. The overall certainty of the evidence was low. Conclusions: Physiotherapy can positively influence PROMs in oncology PC; however, the low quality and high risk of bias in existing studies highlight the need for more rigorous research to confirm these findings and guide clinical practice.

Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial

ObjectiveTo evaluate if prehospital administration of fentanyl and intranasal ketamine, compared to fentanyl alone, improves early pain control after injury. MethodsWe conducted a prehospital randomized, placebo-controlled, blinded, parallel group clinical trial from October 2017 to December 2021. Participants were male, aged 18-65 years, receiving fentanyl to treat acute traumatic pain prior to hospital arrival, treated by an urban fire-based EMS agency, and transported to the region’s only adult Level I Trauma Center. Participants randomly received 50mg intranasal ketamine or placebo. The primary outcome was the proportion with a minimum two-point reduction in self-described pain on the Verbal Numerical Rating Scale thirty minutes after study drug administration assessed by 95% confidence interval overlap. Secondary outcomes were side effects, pain ratings, and additional pain medications through the first three hours of care. ResultsIn the 192 enrolled, 89 (46%) were White, 36 [27, 53] (median [IQR]) years old, with 103 receiving ketamine and 89 receiving placebo. There was no difference in the proportion experiencing improved pain 30-minutes after treatment (46/103 [44.7%] ketamine vs. 32/89 [36.0%] placebo, difference in proportions 8.7% [95% CI -5.1% to 22.5%]. p=0.22) or at any timepoint through three hours. There was no difference in secondary outcomes or side effects. ConclusionsIn our sample, we did not detect an analgesic benefit of adding 50mg intranasal ketamine to fentanyl in prehospital trauma patients.

Thyroid Uncomplicated Surgery with Lack Placement of Drains. A Retrospective Analysis.

Thyroid drains after thyroid surgery are often used despite evidence. The aim of this retrospective study was to determine the post-operative complication rates following thyroid uncomplicate surgery without drain. The medical records of two hundred and thirty-nine patients who undergone thyroid surgery without and with drain were reviewed. The rate of post-operative either complications and pain were evaluated. The distribution of the operations performed were similar in two groups, in no-drain group (group A) there were total thyroidectomy 68.7% and lobectomy 31.3% while in drain group (group B) the total thyroidectomy were 70.8% and the lobectomy were 29.2%, this without statistical significant difference. Postoperative complications that occurred included seromas, hematoma and wound infections were without significantly differences. Postoperative pain was significantly lower in group A than in group B at two timepoint. The mean hospital stay was significantly shorter in the non-drained group. The no-drain uncomplicated thyroid surgery was safe and didn't increase a rates of post-operative complications. In addition, we achieved significant reduction of postoperative pain, hospital stay and overall costs.

CUPPING AND FEMALE REPRODUCTIVE PROBLEMS: A NARRATIVE REVIEW

Al-hijamah, or cupping therapy, uses a cupping device to vacuum suction the skin. The recommendation and virtues of cupping are found in various hadiths of the Messenger of Allah (peace and blessings of Allah be upon him). It has been used traditionally for centuries and is gaining recognition for its potential health benefits, especially in women's reproductive health. The aim of this review is to map the research results on the cupping method (Al-hijamah) as an evidence-based treatment method for addressing reproductive problems in women. This narrative review uses databases, including PubMed, ScienceDirect, EBSCO, and Grey Literature, as well as Google Scholar and Research Rabbit. Based on the results of the inclusion and exclusion criteria, 13 articles were retrieved, and 2 themes were obtained, namely the role of cupping therapy for women's reproductive health and various combinations of cupping with other methods. Cupping therapy can have a positive impact on various aspects of female reproductive health, including menstrual disorders and infertility. Studies have shown improvements in menstrual cycles, reduction in menstrual pain, and increased fertility rates in women who undergo cupping therapy. In addition, cupping therapy has also shown promise in treating conditions such as Polycystic Ovarian Syndrome (PCOS) and anemia associated with excessive menstrual bleeding.

ID: 314772 10 kHz SCS Treatment of Painful Diabetic Neuropathy: Significant Reductions in HbA1c, Weight, and Pain

ID: 314772 10 kHz SCS Treatment of Painful Diabetic Neuropathy: Significant Reductions in HbA1c, Weight, and Pain

The efficacy of loco-regional ropivacaine analgesia via intercostal catheters after lung resection: a randomized, double-blind, placebo-controlled, superiority study

Abstract OBJECTIVES Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. METHODS Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6–8 ml/h for 72 hours after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in NRS (numerical rating scale) associated with pain reduction of 1.5 points. RESULTS 14 patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the two groups. The mean NRS when coughing during the first 24 hours postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). CONCLUSIONS Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements.

Emergency practitioner-administered ultrasound nerve blocks in the emergency department: A retrospective analysis

Abstract OBJECTIVES: In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound-guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician-performed USGNBs and changes in patient-reported pain (pre- and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied. METHODS: Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single-center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner-performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre- and postpain scores on a Numerical Rating Scale. RESULTS: The study demonstrated a significant reduction in pain scores post-USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively. CONCLUSION: This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.

A Discrete-Choice Experiment Assessing the Patient Preferences and Real-World Experiences of Patients with Migraine in Japan.

Migraine is a debilitating headache disorder with a high prevalence in Japan that imposes significant societal burden. Although the Japanese Clinical Practice Guideline for Headache Disorders 2021 recommends both acute and preventive migraine treatments, the usage of preventive treatments is still limited. Therefore, it is crucial to understand the treatment preferences of patients with migraine pertaining to both acute and preventive treatments. A mixed-methods study including a discrete choice experiment (DCE) was conducted with Japanese patients with migraine (10 for the qualitative interviews, and 400 for the DCE) who were recruited from the Rakuten Insight panel. The DCE presented hypothetical treatment options including oral acute, oral preventive, and injectable preventive medications. Six attributes (method of delivery, reduction of pain, impact of headaches on daily routines, dosage adjustability, and temporary and persistent side effects) each with three levels were included in the survey. A hierarchical Bayesian model was used to estimate relative attribute importance scores (RAI) for all attributes. For the 400 participants in the DCE, the most common age bracket was 40-49years old, and the majority were female (66.75%). RAI estimates indicated that "method of delivery" was the most important attribute for patients (RAI 51.92, SD = 10.20), followed by "reduction of pain when experiencing a headache" (RAI 17.00, SD = 7.74). Oral preventive treatments were preferred over injectable preventive treatments. The qualitative interviews showed that patients prefer oral medications to injectable treatments, and a lack of awareness regarding preventive treatments. This study found that the "method of delivery" was the most important driver of treatment preferences of patients with migraine in Japan, with oral acute medications being preferred. Oral preventive treatments were found to be preferred over injectable treatments. These results may indicate the need for increased education regarding preventive treatments, as well as the need for further development of these treatments.

Factors affecting the therapeutic effects of multiple intra-articular injections of platelet-rich-plasma for knee osteoarthritis

BackgroundPlatelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I). MethodsThis is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added. ResultsAge, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy. ConclusionsAge, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA. Trial registrationRetrospectively registration.

Exploring intradermal sterile water injection as an alternative to natrium diclofenac for kidney-stone related pain relief: A systematic review and meta-analysis of randomized controlled trials.

Kidney stone-related pain often presents significant challenges in clinical practice, mainly due to the adverse effects by NSAIDs, which are the current first-line treatment for urolithiasis. Patients presenting with gastrointestinal tract disorders and contraindications toward NSAIDs are particularly susceptible. Intradermal sterile water injection (SWI) has evidently become apparent as one of the promising alternatives, offering rapid pain relief with minimal adverse effects. This purpose of this study to assess the safety and efficacy of SWI in comparison to NSAIDs particularly Natrium Diclofenac in the management of kidney-stone related pain. A systematic review and meta-analysis was performed on papers published up to January 2024 obtained from scientific databases, guided by the PRISMA flowchart. The Cochrane risk of bias 2.0 tool was used to assess quality of the included studies. Statistical analyses were then performed using Review Manager 5.4.1 on studies that provide the baseline and complete follow-up numerical outcomes (e.g. mean and standard deviation) required. After screening was done, 3 retrievable studies met the inclusion and exclusion criteria with a total of 770 participants with kidney stone related pain. The result revealed no significant difference in pain reduction between SWI and Natrium diclofenac at 30 min (MD -0.12, 95% CI -0.68 to 0.44) and 60 min (MD -0.23, 95% CI -0.65 to 0.18). Furthermore, patients treated with SWI display a reduced need for rescue analgesia compared to Natrium Diclofenac (OR 0.73, 95% CI 0.36 to 1.49). Adverse events result was more superior in SWI, having lower occurrence when compared to Natrium Diclofenac, although not significant (OR 0.14, 95% CI 0.05 to 0.39). Intradermal sterile water injection (SWI) appears to be a promising alternative to NSAIDs for kidney stone related pain management, offering comparable efficacy in pain reduction, reduced need for rescue analgesia while maintaining a favorable safety profile. However, further research with larger sample sizes and standardized treatment protocols are required to further validate its safety and efficacy.

Understanding Medical Cannabis: A Simple Guide to CBD and THC

There is an ongoing debate in the literature about the place of cannabinoid therapy in everyday clinical practice. The overview examined systematic reviews and meta-analyses on the use of medical marijuana (MM) in specific or diseases, such as epilepsy, multiple sclerosis, pain, nausea and vomiting during chemotherapy, cachexia, and sleep disorders. We analyzed different cannabinoids like CBD, THC, dronabinol, nabilone, and THC:CBD combinations (Nabiximol) to understand their effects on various medical conditions, dose effectiveness, and side effects. CBD showed promise epilepsy, Nabilone showed a significant reduction in pain and insomnia, Nabiximol has been effective in reducing spasticity, pain, and sleep disturbance in multiple sclerosis patients. Nabilone and dronabinol improve nausea and vomiting due to chemotherapy, but the evidence is low. The results on the effectiveness of MM in the treatment of cachexia and cancer pain are inconclusive. Outcomes suggest that side effects typically were mild to moderate in severity. The type of cannabinoid (including CBD and THC content) and amount of dose, were found to potentially influence the results obtained in the trials, affecting both the effectiveness and the side effects experienced by patients. Young people, elderly, and children are particularly vulnerable and, despite ongoing research in these age groups, we still know too little about whether and in which clinical conditions the use of medical cannabis is justified. The analyzed studies faced limitations due to heterogeneity in methodology, dosages, and outcome measures and highlighting potential controversies in interpreting the results, so further research is needed.

A COMPARATIVE STUDY OF MANUAL TRACTION AND MECHANICAL TRACTION ON ACUTE DISCOGENIC PAIN

Background and purpose: Acute low back pain is defined as Low back pain that has been present for less than three months and it was estimated that 80% of the population suffers from low back pain (LBP) at some point of their lives. Low back pain is the primary factors which limit activity in patients less than 45 years old and it is of significant socio-economic relevance because it may lead to temporary loss of productivity, enormous medical and indirect costs or even leads to permanent disability. The purpose of study was to compare a manual traction versus mechanical traction for reduce acute discogenic pain. Method: The study was conducted at JKK Munirajah Medical Research Foundation college of physiotherapy Out Patient department 30 subjects were selected in random sampling method. They were divided into 2 Group, namely Group A and Group B with 15 subjects in each Group. The enrolled 30 subjects were randomly allotted to two Group A (15) &B (15).After recruitment on eligibility, informed consent is obtained on explaining the treatment to be given. Result: The result showed that there was statistical significant difference between Group A and B. The acute discogenic pain patient who was treated with manual traction had shown good improvement in reduction of acute discogenic pain. Conclusion: The study concluded that there was a statistically significant improvement in reduction of pain improving flexibility and functional ability after the treatment of manual traction for 4 weeks. Thus the study concluded that manual traction (MAT) was the effective treatment than mechanical traction (MET) of acute discogenic low back pain.

Efficacy of Strain Counterstrain Techniques in the Management of Complex Regional Pain Syndrome: A Detailed Case Study of a 42-Year-Old Female Patient

Complex Regional Pain Syndrome (CRPS) is a challenging condition associated with severe pain and functional impairment. This case study provides an in-depth examination of the treatment of a 42-year-old female diagnosed with CRPS following a traumatic injury to her left hand. The treatment protocol employed strain counterstrain techniques, followed by progressive resistive exercises (PRE) aimed at restoring functional capacity in the hand. Over a three-month period, the patient received weekly physical therapy sessions, with the treatment plan adjusted at the six-week mark to include PRE. Assessments were conducted at baseline, 3 weeks, 6 weeks, and 12 weeks, focusing on pain levels, grip strength, and range of motion. The results indicated a significant reduction in pain from 8/10 to 2/10 on the Numerical Rating Pain Scale (NPRS) and an improvement in grip strength from 5 kg to 28 kg. The patient’s active range of motion also improved, and there was a noticeable reduction in muscle atrophy and swelling. These findings suggest that strain counterstrain, in combination with PRE, can be an effective intervention for CRPS. This case study contributes to the limited body of research on physical therapy interventions for CRPS and highlights the need for further studies to explore the broader applicability of these techniques.

Analysis of painful situations during unsedated esophagogastroduodenoscopy

Background and study aim: Although esophagogastroduodenoscopy (EGD) is a widely used technique, the procedure is often associated with discomfort. This study aimed to analyze painful situations, their frequency, and factors associated with patient discomfort during EGD. Patients and methods: This prospective observational study included patients scheduled to undergo EGD. Seven endoscopists recruited patients scheduled for EGD screening or surveillance. Each endoscopist enrolled 20 patients, performing 10 EGD procedures using ultraslim endoscopes and 10 with standard-sized endoscopes. Data regarding painful situations and frequency were collected using specialized buttons pressed by the patients during EGD. A survey about overall discomfort was conducted after the procedure. Results: We analyzed data from 140 patients. Esophageal insertion and duodenal observation were associated with the highest incidence of pressing the pain button, accounting for 59.3% and 40.7% of the cases, respectively. The factor associated with pressing the pain button during esophageal insertion was endoscopist experience (<10 years). In contrast, younger age and female sex were the factors associated with pressing the pain button during duodenal observation. In the post-procedure survey, 63.6% of patients reported discomfort. Factors associated with patient discomfort included pressing the pain button during esophageal insertion (odds ratio [OR]: 2.84, p=0.01) and previous painful EGD experience (OR: 2.41, p=0.03). Conclusions: This study provides objective data on painful situations, their frequency, and related factors during EGD. Further research and interventions focusing on pain reduction during endoscopic procedures are warranted. The results of this study will help endoscopists manage painful situations and potentially improve skills.

Lentil Waste Extracts for Inflammatory Bowel Disease (IBD) Symptoms Control: Anti-Inflammatory and Spasmolytic Effects

Background/Objectives: In the contest of agro-industrial waste valorization, we focused our attention on lentil seed coats as a source of health-promoting phytochemicals possibly useful in managing inflammatory bowel diseases (IBDs), usually characterized by inflammation and altered intestinal motility. Methods: Both traditional (maceration) and innovative microwave-assisted extractions were performed using green solvents, and the anti-inflammatory and spasmolytic activities of the so-obtained extracts were determined through in vitro and ex vivo assays, respectively. Results: The extract obtained through the microwave-assisted procedure using ethyl acetate as the extraction solvent (BEVa) proved to be the most useful in inflammation and intestinal motility management. In LPS-activated Caco-2 cells, BEVa down-regulated TLR4 expression, reduced iNOS expression and the pro-inflammatory cytokine IL-1 production, and upregulated the anti-inflammatory cytokine IL-10 production, thus positively affecting cell inflammatory responses. Moreover, a significant decrease in the longitudinal and circular tones of the guinea pig ileum, with a reduction of transit speed and pain at the ileum level, together with reduced transit speed, pain, and muscular tone at the colon level, was observed with BEVa. HPLC separation combined with an Orbitrap-based high-resolution mass spectrometry (HRMS) technique indicated that 7% of all the identified metabolites were endowed with proven anti-inflammatory and antispasmodic activities, among which niacinamide, apocynin, and p-coumaric acid were the most abundant. Conclusions: Our results suggest that lentil hull extract consumption could contribute to overall intestinal health maintenance, with BEVa possibly representing a dietary supplementation and a promising approach to treating intestinal barrier dysfunction.

Recurrent Vegetative Pyoderma Gangrenosum of the Face: A Case Report

A 46-year-old male presented with an erythematous papule progressing into a vegetative plaque on the right cheek that resolved with cribriform scarring. Eight months after, a similar looking erythematous papule appeared on his left cheek. This papule rapidly progressed into a vegetative plaque within a week, and was associated with a pain score of 7 out of 10. Histopathology of the second lesion revealed suppurative dermatitis with diffuse dense infiltrates composed mostly of neutrophils. Cultures revealed few colonies of Enterobacter cloacae which was inconclusive. Pathergy test was negative. High dose systemic corticosteroids were started, with an observed rapid reduction of pain, inflammation, and ultimately resolution of the lesion with formation of cribriform scarring, confirming a case of vegetative pyoderma gangrenosum. It is important to note that not all inflamed and purulent lesions are infectiousneutrophilic dermatoses should always be considered.

Exploring perspectives on engagement in interactive virtual reality for chronic pain management: insights from a content analysis study

To investigate perspectives of people with chronic pain regarding aspects of immersive virtual reality (IVR) that enhance and reduce engagement and the outcomes of engagement in IVR. This content analysis was performed on data obtained through open-ended interview questions from a study aiming to understand the influence of IVR on chronic pain study at a research lab at a university. Participants included a sample of 20 adults who completed the parent study. Results highlight that presence, agency, customization, and novelty are important aspects that enhance engagement in IVR, with agency and presence being mentioned most frequently. Meanwhile, secondary effects of IVR and usability were said to reduce engagement with the IVR. Outcomes of engagement with IVR include enjoyment, mood elevation, relaxation/calming, a distraction from pain, and a loss of reality. This study provides an initial understanding of individuals’ perspectives of engagement with IVR in relation to chronic pain management. Health professionals using IVR to treat people with chronic pain can use these elements to facilitate engagement in their clients. Further research should be done to study the association between engagement in IVR and pain reduction to improve the development of IVR programs for chronic pain management.

Cupping Therapy for the Treatment of Migraine Headache: a systematic review and meta-analysis of clinical trials.

Cupping therapy is a widely used complementary medicine for the treatment of migraine headaches globally. However, conflicting evidence exists on its effectiveness. To evaluate the safety and efficacy of cupping therapy in treating migraine headache disorder. Seven databases were systematically searched PubMed/MEDLINE, Clinicaltrials.gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library. The primary endpoints are the treatment success and the pain intensity reduction. The secondary endpoints were adverse events (AEs) risk and improvement in quality of life (QoL), which was based on the Migraine Disability Scale (MIDAS). Subgroup analyses were performed based on the cupping techniques (wet and dry cupping) and adjunctive complementary treatments (i.e. acupuncture and/or collateral pricking). Eighteen trials out of 348 records were included, pooling 1,446 participants (n = 797 received cupping therapy). Treatment success was significantly higher among those with cupping therapy (risk ratio [RR] [95% CI] = 1.83 [1.52-2.21]); with significant improvement observed only with wet cupping (RR [95% CI] = 1.88 [1.53-2.30]). The adjunctive complementary therapy did not achieve a greater amplitude of treatment success compared to cupping therapy alone. Furthermore, cupping therapy showed significant pain reduction compared to baseline (standardized mean difference [SMD] [95% CI] = 0.55 [0.39-0.70]) and achieved fewer risks of AEs (RR [95% CI] = 1.88 [1.53-2.30]). However, cupping did not improve the overall QoL (MIDAS SMD [95% CI] = -0.79 [-3.55-1.98]). Cupping therapy was an effective complementary modality to treat migraine headaches. However, it did not demonstrate improvement in QoL (PROSPERO CRD42024514509).