Pain Relief Research Articles

Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)

BackgroundBack pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies.MethodA qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners.ResultsCommunity leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session.ConclusionCommunity partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

Peripherally restricted PICK1 inhibitor mPD5 ameliorates pain behaviors in murine inflammatory and neuropathic pain models.

Chronic pain is a complex, debilitating, and escalating health problem worldwide, impacting one in five adults. Current treatment is compromised by dose-limiting side effects including high abuse liability, loss of ability to function socially and professionally, fatigue, drowsiness, and apathy. PICK1 has emerged as a promising target for the treatment of chronic pain conditions. Here, we developed and characterized a cell-permeable fatty acid conjugated bivalent peptide inhibitor of PICK1 and assessed its effects on acute and chronic pain. The myristoylated myr-NPEG4-(HWLKV)2 (mPD5), self-assembled into core-shell micelles that provided favourable pharmacodynamic properties and relieved evoked mechanical and thermal hypersensitivity, as well as ongoing hypersensitivity, and anxio-depressive symptoms in mouse models of neuropathic and inflammatory pain following subcutaneous administration. No overt side effects were associated with mPD5 administration, and it had no effect on acute nociception. Finally, neuropathic pain was relieved far into the chronic phase (18 weeks post SNI surgery) and while the effect of a single injection ceased after a few hours, repeated administration provided pain relief lasting up to 20 hours after the last injection.

Peripheral nerve stimulation for lower-limb postoperative recovery: A systematic review and meta-analysis of randomized controlled trials.

Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications. Although peripheral nerve stimulation (PNS) is a promising non-pharmacological approach that has been used in lower-limb postoperative recovery, the clinical efficacy of PNS remains inconclusive. This study systematically searched three databases (PubMed, Embase, and Cochrane Library) for randomized controlled trials (RCTs) that examined the treatment effects of PNSs in patients who underwent lower-limb orthopedic surgery up to September 29, 2023. Two investigators independently identified studies, extracted data, and conducted meta-analyses with Review Manager 5.4. The outcomes were pain relief (measured by reductions in pain intensity and analgesic consumption) and functional improvements (range of motion [ROM] and length of hospitalization [LOH]). A total of 633 patients including 321 in the experimental groupsand 312 in the control groups from eight RCTs were included. PNS showed no significant effect on pain intensity, while analgesic consumption was marginally significantly reduced in the experimental group. Furthermore, no significant differences were observed regarding functional improvements in ROM or LOH after the intervention. Although PNS had no significant effect on pain relief or functional improvements, the intervention exhibited a marginally significant reduction in analgesic consumption. Future trials should be conducted with larger sample sizes, longer follow-up periods, and more varied stimulation parameters.

Exploring the Confluence of Animal Medicine and its Implications for Human Health: A Systematic Literature Review.

The abuse of veterinary drugs has emerged as a concerning trend, with global fatalities on the rise. Our understanding of this phenomenon remains limited. This study aims to identify the veterinary drugs being misused, the reasons behind their misuse, and how they are obtained. Utilising PubMed, Scopus, and Web of Science databases, along with related grey literature, we applied the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework for data collection. Screening and cross-referencing yielded 66 relevant articles, encompassing case reports, surveys, reports, and systemic literature reviews. The analysis identified 28 distinct veterinary drugs being misused in humans, primarily falling into categories, e.g., α-2- and β-2-adrenergic receptor agonists, GABAergic receptor modulators, opioid receptor agonists, nonsteroidal anti-inflammatory drugs (NSAIDs), and N-methyl-D-aspartate (NMDA) receptor antagonists. These drugs were used for various purposes, including recreational use, weight loss, bodybuilding, pain relief, and self-medication for stress-related symptoms. Routes of administration predominantly included parenteral, oral, and inhalation methods. Veterinary workers/assistants and individuals connected to animals were identified as contributors to the misuse of these medications. Motivations for their utilisation ranged from affordability and accessibility to the ease of obtaining multiple prescriptions from various veterinary sources, often in conjunction with other illicit substances. Dependence and addiction were common outcomes of the misuse of veterinary medicines by humans. Overall, this systematic review underscores the increasing popularity of veterinary prescription drug misuse despite being under-reported with limited available data. Healthcare professionals are urged to remain vigilant to potential overdose events involving these medications.

Comparison of the effect of warm saline irrigation versus negative gas suction on reduction of postoperative pain in patients of laparoscopic cholecystectomy

ABSTRACT OBJECTIVE: To compare warm saline irrigation and negative gas suction in terms of frequency of severe postoperative pain in patients of laparoscopic cholecystectomy. PATIENTS AND METHODS: A comparative clinical trial was conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad over a period of six months. After ethical approval from the hospital ethics committee, all patients who had laparoscopic cholecystectomy for gallstones were enrolled in the study. Patients were randomly divided into two equal groups by lottery methods. One group had warm saline irrigation of the operative field while the other group had negative gas suction at the end of the procedure. The pain score was recorded postoperatively by visual analog score. SPSS version 21 was used for descriptive analysis of the variables. RESULTS: A total of 102 patients were included according to the study's inclusion criteria. All the patients were observed for 24 hours for severe postoperative pain. The mean age (years) of the patients was 40.40+11.55 years. There were 28 (27.5%) male and 74 (72.5%) female patients in the study. The frequency of severe postoperative pain in patients of laparoscopic cholecystectomy among warm saline irrigation and negative gas suction was 33 (64.7%) and 14 (24.5%) respectively which was statistically significant (p-value ˂0.001). CONCLUSION: Patients in the negative gas suction group have better modalities in reducing severe postoperative pain after laparoscopic cholecystectomy. This helps in early pain relief that reduces the agony of the patients and shortens the post-operative hospital stay. KEYWORDS: Cholelithiasis, Laparoscopic Cholecystectomy, Postoperative Pain

Evaluating the Efficacy of Wrist-Ankle Acupuncture Combined With Patient-Controlled Intravenous Analgesia for Managing Post Uvulopalatopharyngoplasty.

The aim of this study is to investigate the impact of combining wrist-ankle acupuncture with patient-controlled intravenous analgesia (PCIA) on active pain and food intake in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) after undergoing uvulopalatopharyngoplasty (UPPP). Sixty patients with OSAHS who underwent UPPP at our hospital's Department of Otorhinolaryngology from January 2020 to October 2023 were selected and randomly divided into 2 groups of 30 each: an observation group and a control group. The control group received general anesthesia administered by an anesthesiologist and used a PCIA pump. In addition to this treatment, the observation group received the combined intervention of wrist-ankle acupuncture. Active pain levels were monitored at 0, 6, 12, 24, 36, and 48 hours after UPPP, and food intake was observed at 24, 36, and 48 hours postoperation. The results were compared and recorded for both groups. The analgesic effect on active pain in the observation group was significantly greater than in the control group at 6, 12, 24, 36, and 48 hours postoperation, and the differences were statistically significant (P<0.05). In addition, when comparing food intake scores at 24, 36, and 48 hours postoperation, the observation group had significantly higher food intake than the control group, and the differences were statistically significant (P<0.05). The combined intervention of wrist-ankle acupuncture and PCIA provides effective pain relief for OSAHS patients after UPPP, enhances their food intake, improves their quality of life, and supports early recovery.

Diabetic Peripheral Neuropathy: Emerging Treatments of Neuropathic Pain and Novel Diagnostic Methods.

Diabetic peripheral neuropathy (DPN) is a prevalent and debilitating complication of diabetes, often leading to severe neuropathic pain. Although other diabetes-related complications have witnessed a surge of emerging treatments in recent years, DPN has seen minimal progression. This stagnation stems from various factors, including insensitive diagnostic methods and inadequate treatment options for neuropathic pain. In this comprehensive review, we highlight promising novel diagnostic techniques for assessing DPN, elucidating their development, strengths, and limitations, and assessing their potential as future reliable clinical biomarkers and endpoints. In addition, we delve into the most promising emerging pharmacological and mechanistic treatments for managing neuropathic pain, an area currently characterized by inadequate pain relief and a notable burden of side effects. Skin biopsies, corneal confocal microscopy, transcutaneous electrical stimulation, blood-derived biomarkers, and multi-omics emerge as some of the most promising new techniques, while low-dose naltrexone, selective sodium-channel blockers, calcitonin gene-related peptide antibodies, and angiotensin type 2 receptor antagonists emerge as some of the most promising new drug candidates. Our review concludes that although several promising diagnostic modalities and emerging treatments exist, an ongoing need persists for the further development of sensitive diagnostic tools and mechanism-based, personalized treatment approaches.

Successful Treatment of Lipschütz Ulcer with a JAK Inhibitor, Upadacitinib

Lipschütz ulcer (LU), is a rare non-venereal diagnosis of exclusion. Typically affecting sexually inactive, young women, LU presents with acute pain and edema along with necrotic ulcerations on the vulva, labia minora, or lower vaginal region. The pathogenesis of LU remain unknown. Published cases suggest that LU may heal spontaneously or with supportive and symptomatic treatment focused on pain relief and inflammation reduction using oral or topical steroids. Here, we present a case of persistent LU that required continuous treatment with a janus kinase (JAK) inhibitor, upadacitinib.

The Success of Treatment for Osteoarthritis with a Genicular Nerve Block is Associated with Patients’ Body Mass Index

Background: While the mainstay of treatment for severe osteoarthritis of the knee has been total knee arthroplasty, a prognostic genicular nerve block (GNB) followed by cooled radiofrequency ablation (CRFA) has been shown to provide long term relief of osteoarthritic knee pain and its disability. The goal of this study is to determine if there is a difference in the demographic makeup of those who had a successful prognostic genicular nerve block compared to those who did not. Methods: A retrospective chart review of 224 genicular nerve blocks was completed. The nerve block was considered successful if the patient reported a 50% or greater pain reduction for a week or more at follow up. Demographic cohorts that were compared include sex, age, race, and BMI. Results: Those who were categorized as non-obese, 36 out of 69 (52.2%) had unsuccessful blocks while 33 out of 69 (47.8%) in this BMI category had successful blocks. Of those who were categorized as obese, 25 out of 75 (33.3%) had unsuccessful blocks while 50 out of 75 (66.7%) in this BMI category had successful blocks. Of those who were deemed morbidly obese, 22 out of 75 (29.3%) had unsuccessful blocks while 53 out of 75 (70.7%) in this BMI category had successful blocks. These results were found to be statistically significant with a p-value of .011. Furthermore, GNB success was not found to be significantly impacted by patient age, race, or gender. Conclusions: These findings demonstrate the utility of prognostic genicular nerve blocks in all patients with osteoarthritis of the knee, but, in particular, the obese patient, who experiences a greater chance of pain relief on average.

Abstract B031: Alternate pain management strategies: targeting pancreatic cancer-related pain with Flavonoid

Abstract Purpose For up to 90% of cancer patients, pain is a substantial symptom, contributing to morbidity and, possibly, mortality. In this study we sought to test the hypothesis that a flavonoid, derived from Cannabis, and previously shown to suppress cancer cell growth in vitro and tumor progression in mice in vivo, could also reduce the pain caused by pancreatic tumors in vivo. Methods A subcutaneous tumor in the dorsum of C57BL/6 mouse was generated by sub- dermal injection of KPC mouse pancreatic cancer cell line (ATCC). All the mice were video recorded to observe and analyze their spontaneous pain-related behaviors, including facial washing, dorsal hunching, dorsal skin twitch, licking of dorsal skin and overall locomotion around the cage. Two five minute recording sessions were analyzed by a blinded observer during times before the cancer cell injection (Baseline), after tumor growth, to about 8mm diameter (30d and 37d post-injection) and just before and then 24h after intra-tumor injection of the flavonoid ( Group A: FBL-03G, 1 nmole in 100µL) or Vehicle(100µL; Group B). Pain-related behavioral changes were averaged from the two recording sessions and analyzed from Baseline, just before FBL-03G and 24h after and compared between test compound-and vehicle injected groups (n=7 in each), using non-parametric statistics. Results Facial washing (events/5min) was: reduced to 87% of Baseline in tumor-bearing mice, then increased by 150% at 24h post-injection in Group A (FBL-03G); reduced to 65% of Baseline in tumor-bearing mice of Group B, then reduced a further 9% by Vehicle. Dorsal hunching, which events occur only after tumor growth (Baseline =0), was reduced at 24h by 62% in Group A but increased by 75% in Group B. Dorsal twitch, also absent before tumor growth, was reduced by 64% in Group A, but increased by 19% in Group B. Dorsal skin licking was reduced from Baseline by 33% in tumor-bearing mice of Group A, then increased by 76% after FBL-03g injection whereas licking, reduced by 22% by tumors in Group B and then by an additional 4% by vehicle (Group B). Tumors reduced locomotion by 58% in Group A, which was reversed by 32% after FBL-03g (Group A); vehicle injection resulted in a 38% reduction in locomotion (Group B). Thus, in 4 of the 5 pain-related behaviors from tumors quantitated symptoms were reversed by FBL-03G and oppositely affected, or not at all, by Vehicle. Conclusions These results indicate a substantial relief of spontaneous pain-related pain in this mouse model of pancreatic cancer. Such an acute effect occurs much more rapidly than the previously published in vitro suppression of KPC cell growth (assayed after 9-12d of treatment) or the reduction of tumor size (1-7 weeks) in vivo and suggest that the anti-hyperalgesic affect is due to mechanisms that do not involve reduction in tumor mass. The findings, using a single dose and a small number of mice, appear promising for further studies that examine a range of doses or FBL-03G and its actions in intra-pancreatic tumors. Citation Format: Sayeda Yasmin-Karim, Suheera Haq, Mike Makrigiorgos, Gary Strichartz, Geraud Richards, Natasha Rayman. Alternate pain management strategies: targeting pancreatic cancer-related pain with Flavonoid [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr B031.

Efficacy and Safety Profile of Gamma Knife Radiosurgery in Classic and Idiopathic Trigeminal Neuralgia.

BackgroundTrigeminal neuralgia is a debilitating disease, with severe recurrent paroxysms of shock-like facial pain. Although pharmacotherapy may suffice in the majority of cases, a proportion of patients require surgical treatment. Gamma knife radiosurgery (GKRS) represents a potential non-invasive alternative to surgery in these patients. MethodsWe retrospectively analysed all patients that underwent GKRS for classic/idiopathic TN between 2013 and 2023. Pain prior to GKRS was graded per the Barrow Neurological Institute (BNI) pain score, which was also used to define outcomes. “Complete pain relief (CPR)” was defined as a BNI pain score of I or II, while “Adequate pain relief (APR)” was defined as a BNI pain score of III, and “Failure” as a BNI score of IV or V. ResultsThe mean age of 70 patients (50 females and 20 males) was 47.4 ± 12.4 years. The mean follow-up was 51.3 ± 16.2 months. Although initial pain relief was achieved in 64 patients (91.4%), recurrence of pain at the latest follow-up occurred in 10 patients (14.3%). Overall, 41 patients (58.6%) achieved CPR, while 13 patients (18.6%) achieved APR. Multivariate analysis revealed that multiple prior failed procedures for TN predicted failure of pain relief. ConclusionGKRS is effective among patients with classic/idiopathic TN, with complete pain relief in 58.6% of patients, and adequate pain relief in 18.6% of patients. The most frequent complication is facial hypesthesia, affecting 38.6% of patients. Multiple prior failed procedures for TN significantly predict failure of pain relief at latest follow-up.

Classical, spaced, or accelerated transcranial magnetic stimulation of motor cortex for treating neuropathic pain: A 3-arm parallel non-inferiority study

BackgroundRepetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) at high frequency (HF) is an effective treatment of neuropathic pain. The classical HF-rTMS protocol (CHF-rTMS) includes a daily session for one week as an induction phase of treatment followed by more spaced sessions. Another type of protocol without an induction phase and based solely on spaced sessions of HF-rTMS (SHF-rTMS) has also been shown to produce neuropathic pain relief. However, CHF-rTMS and SHF-rTMS of M1 have never been compared regarding their analgesic potential. Another type of rTMS paradigm, called accelerated intermittent theta burst stimulation (ACC-iTBS), has recently been proposed for the treatment of depression, the other clinical condition for which HF-rTMS is proposed as an effective therapeutic strategy. ACC-iTBS combines a high number of pulses delivered in short sessions grouped into a few days of stimulation. This type of protocol has never been applied to M1 for the treatment of pain. Methods/DesignThe objective of this single-centre randomized study is to compare the efficacy of three different rTMS protocols for the treatment of chronic neuropathic pain: CHF-rTMS, SHF-rTMS, and ACC-iTBS. The CHF-rTMS will consists of 10 stimulation sessions, including 5 daily sessions of 10Hz-rTMS (3,000 pulses per session) over one week, then one session per week for 5 weeks, for a total of 30,000 pulses delivered in 10 stimulation days. The SHF-rTMS protocol will only include 4 sessions of 20Hz-rTMS (1,600 pulses per session), one every 15 days, for a total of 6,400 pulses delivered in 4 stimulation days. The ACC-iTBS protocol will comprise 5 sessions of iTBS (600 pulses per session) completed in half a day for 2 consecutive days, repeated 5 weeks later, for a total of 30,000 pulses delivered in 4 stimulation days. Thus, CHF-rTMS and ACC-iTBS protocols will share a higher total number of TMS pulses (30,000 pulses) compared to SHF-rTMS protocol (6,400 pulses), while CHF-rTMS protocol will include a higher number of stimulation days (10 days) compared to ACC-iTBS and SHF-rTMS protocols (4 days). In all protocols, the M1 target will be defined in the same way and stimulated at the same intensity using a navigated rTMS (nTMS) procedure. The evaluation will be based on clinical outcomes with various scales and questionnaires assessed every week, from two weeks before the 7-week period of therapeutic stimulation until 4 weeks after. Additionally, three sets of neurophysiological outcomes (resting-state electroencephalography (EEG), nTMS-EEG recordings, and short intracortical inhibition measurement with threshold tracking method) will be assessed the week before and after the 7-week period of therapeutic stimulation. DiscussionThis study will make it possible to compare the analgesic efficacy of the CHF-rTMS and SHF-rTMS protocols and to appraise that of the ACC-iTBS protocol for the first time. This study will also make it possible to determine the respective influence of the total number of pulses and days of stimulation delivered to M1 on the extent of pain relief. Thus, if their analgesic efficacy is not inferior to that of CHF-rTMS, SHF-rTMS and especially the new ACC-iTBS protocol could be an optimal compromise of a more easy-to-perform rTMS protocol for the treatment of patients with chronic neuropathic pain.

Amandys® versus four-corner fusion in patients aged over 50 years: long-term retrospective study in stage 3 wrist osteoarthritis.

We compared the outcomes of the Amandys® implant and four-corner fusion in patients aged over 50 years with grade 3 wrist osteoarthritis and a mean follow-up of 5 years. Clinical assessments were of pain, mobility, strength, functional scores and satisfaction. Radiographs were taken. A total of 46 patients (mean age 63 years; 28 four-corner fusion and 21 Amandys®) were included. Pain relief, mobility and functional scores were not significantly different in the two groups at inclusion. At the last follow-up, wrist extension and grip were improved after Amandys® arthroplasty. Flexion decreased after four-corner fusion. One patient in the Amandys® group was not satisfied and one dislocation required repositioning of the implant. There were six nonunions, of which one required revision surgery in the four-corner fusion group. With the Amandys®, immobilization was shorter and mobility improved, making it a valid alternative to four-corner fusion especially in older patients.Level of evidence: IV.

Enhanced diclofenac sodium delivery through advanced self-microemulsifying pectin-based transdermal patches

Diclofenac sodium (DCFNa) presents significant challenges in local pain relief due to its poor solubility and limited skin permeability. This study aimed to enhance the solubility and skin permeation of DCFNa by developing DCFNa-loaded self-microemulsifying drug delivery system (SMEDDS) embedded pressure-sensitive adhesive (PSA) patch. The solubility of DCFNa in various solvents was evaluated, and a ternary phase diagram was constructed to optimize the SMEDDS formulation. The transdermal patch, composed of pectin and polyacrylate, was optimized using a simplex lattice experimental design to achieve the desired adhesion strength and to select the most suitable patch for skin drug accumulation study. Clove oil, Tween® 80, and propylene glycol were identified as the appropriate oil, surfactant, and co-surfactant, respectively, for achieving highest DCFNa solubility. The SMEDDS was formed with a ratio of 5:35:60 (oil: Smix [1:1 surfactant: co-surfactant]: water), yielding nano-sized droplets (22.64 ± 0.74 nm) and significantly enhancing DCFNa solubility (329.62 ± 10.16 mg/mL) compared to phosphate buffer (5.03 ± 1.01 mg/mL). The DCFNa-loaded SMEDDS demonstrated a 9-fold increase in skin permeability compared to the DCFNa solution. The optimized PSA patch, containing 20 % pectin and 40 % polyacrylate, exhibited superior tacking and peel strength. Additionally, a 1 % DCFNa-loaded SMEDDS patch delivered twice greater drug accumulation in the skin and showed no skin irritation, maintaining better adhesion for up to 24 h compared to commercial patches.

271 Does social buffering amongst familiar weaned beef calves mitigate castration stressors?

Abstract Co-mingling of beef feeder calves from multiple sources results in biological and behavioral stressors. This study is part of a project exploring social relationships between individual beef cattle and potential benefits of social buffering during stress events. Here, the specific objective was to explore whether feeder calves form preferential relationships which buffer them from surgical castration pain. Within the experiment, two treatment groups were established: Familiar calves were defined as calves who shared a source farm with two other calves in the pen, and Unfamiliar calves were defined as calves who did not share a source with any other pen-mates. It was hypothesized that Familiar calves would exhibit more lying, fewer pain-related behaviors, and fewer agonistic interactions following surgical castration than Unfamiliar pen-mates. Weaned beef bull calves [n = 102, body weight (BW) range ± SD = 112.95 to 370.10 ± 67.8 kg] from 23 source farms were randomly assigned to home pens, each comprised of three Familiar calves and three Unfamiliar calves. Cameras placed above the pens recorded video from which postural (standing and lying), social (agonistic and bunk displacements) and pain-related behaviors (wound checking and hind leg stamping) were quantified. Cattle were handled through a hydraulic squeeze chute once weekly over four consecutive weeks for data collection and standard processing procedures. On d 14 relative to arrival, calves were surgically castrated with multimodal pain mitigation. During all processing events, calves were marked with livestock paint for behavioral observations. Behavior was observed continuously for 15 min at five different time points (0 h, 1 h, 4 h, 24 h, 48 h) relative to when the last calf returned to the home pen after processing, and researchers were blind to treatment allocation. These time periods corresponded to expected periods when pain was absent and present based on duration of local anesthesia and systemic pain relief. Calf was the experimental unit. For the purpose of this abstract, data from the 48 h periods following d 7 and 14 were analyzed using the PROC GLIMMIX procedure of SAS; the model included treatment (Familiar, Unfamiliar) by week interaction. A P-value of ≤ 0.05 was considered significantly different. Regardless of treatment, preliminary analyses identified decreased lying (P &amp;lt; 0.02) and increased wound checking (P &amp;lt; 0.01) 48h following castration (d 14) when compared with the previous week (d 7). There were no observed differences for hindleg stamping (P = 0.2), agonistic behaviors (P &amp;gt; 0.06) or bunk displacement (P = 0.09). Based on preliminary analyses, we did not observe evidence of social buffering effects on castration stress during the immediate post-surgical period.

Assessment of Pain and Satisfaction After Orofacial Harmonization Procedures.

This long-term study assessed satisfaction and pain levels following facial aesthetic procedures. The study also aimed to correlate expectations, and psychological and social well-being immediately and after one month, describe perceived age, and assess differences in satisfaction between injectable fillers and other Orofacial Harmonization procedures such as hyaluronic acid treatments (for dark circles, nasolabial fold lips, malar, jaw), botulinum toxin injections, enzymatic lipolysis of the double chin, micro-needling, and PDO threads. Data were collected immediately after the procedures and then again 30days later. Among the participants, 159 (92.4%) were females and 13 (7.6%) were males, who completed FACE-Q questionnaires addressing perceived age, expectations, psychological and social well-being, satisfaction, and facial appearance, as well as the visual pain scale. The average age of the patients treated in the Dental Clinics in Brazil was 40.4years (SD± 12.7), with 48.8% of participants perceiving themselves as older immediately after the procedures, decreasing to 47.7% after 30days, and pain intensity was reported as low. The total number of Orofacial Harmonization procedures performed was 256. Satisfaction after 30days was high, especially among those who received fillers. The psychological and social function scales were positively correlated with satisfaction with the decision, result, and appearance scales. Fillers showed a significant improvement in perceived age appearance, with half of the patients feeling younger after 30days. The patients exhibited high satisfaction levels in one-month post-aesthetic orofacial harmonization procedures. Despite initially high expectations, patients reported enhanced psychological and social well-being, along with minimal pain during interventions CONCLUSION: Positive correlations were observed between satisfaction, decision-making, result perception, and appearance. Injectable fillers notably improved perceived aging, with a significant portion of patients initially perceiving themselves as older than their actual age, but later feeling younger post-procedure. Fillers also yielded superior satisfaction and pain relief compared to alternative interventions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

“I could 100% see myself getting hurt if I did it wrong”: a qualitative exploration of exercise perceptions in people with chronic low back pain

Purpose Traditionally, a specific “core” exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. Materials and methods Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. Results All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. “Core” exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. Conclusion People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts.

Effects of varying concentrations of ropivacaine on pain relief in ultrasound-guided brachial plexus block surgery in the intercostal space

Effects of varying concentrations of ropivacaine on pain relief in ultrasound-guided brachial plexus block surgery in the intercostal space

Conorphin-66 produces peripherally restricted antinociception via the kappa-opioid receptor with limited side effects

With the current unmet demand for effective pain relief, analgesics without major central adverse effects are highly appealing, such as peripherally restricted kappa-opioid receptor (KOR) agonists. In this study, Conorphin-66, an analog of the selective KOR peptide agonist Conorphin T, was pharmacologically characterized in a series of experiments, with CR845 serving as the reference compound. Firstly, in vitro functional assay indicated that Conorphin-66 selectively activates KOR and exhibits weak β-arrestin2 signaling bias (−1.54 versus −4.35 for CR845). Additionally, subcutaneous Conorphin-66 produced potent antinociception in mouse pain models with ED50 values ranged from 0.02 to 3.28 μmol/kg, including tail-flick test, post-operative pain, formalin pain, and acetic acid-induced visceral pain. Similarly, CR845 exert potent antinociception in mouse pain models ranged from 0.15 to 1.47 μmol/kg. Notably, antagonism studies revealed that the analgesic effects of Conorphin-66 were mainly mediated by the peripheral KOR. Furthermore, Conorphin-66 produced non-tolerance-forming antinociception over 8 days. Unlike CR845, subcutaneous Conorphin-66 did not promote the sedation, anxiogenic effects, depressive-like effects, but did exhibit diuretic activity. Further study showed that Conorphin-66 does not have apparent antipruritic effects in an acute itch model. Overall, Conorphin-66 emerges as a novel peripherally restricted KOR agonist that produced potent antinociception with reduced side effects.

Risk factors and a prediction model for pain recurrence after pancreatic stent removal in painful chronic pancreatitis.

Endoscopic pancreatic stenting (EPS) is an effective treatment modality for painful chronic pancreatitis. However, little is known about the factors that cause pain recurrence after stent removal, and there are no clear criteria for stent removal. We aimed to develop a prediction model for pain recurrence by identifying its risk factors. We retrospectively reviewed 95 patients who underwent EPS due to pain for the first time using a single plastic stent between January 2007 and July 2022 at our institute. Univariate and multivariate stepwise Cox proportional hazards models were used to identify the risk factors for pain recurrence, and a prediction model was developed based on the identified factors. Of the 95 enrolled patients, 89 (93.7%) achieved pain relief and 73 (76.8%) did stent removal. Of the 69 patients with a follow-up period ≥6 months after stent removal, 29 (42.0%) had pain recurrence during the median follow-up period of 59 months. Serum lipase level (p = 0.034) and pancreatic parenchymal thickness (p = 0.022) on computed tomography or magnetic resonance imaging were identified as independent risk factors for pain recurrence. The prediction model based on the identified factors had good discrimination ability, with a concordance index of 0.74, and could stratify pain recurrence rates. We identified the risk factors and developed a new prediction model for pain recurrence following stent removal. This model might be useful for decision-making in pancreatic stent management, such as deciding whether to remove a pancreatic stent, continue EPS, or convert to surgery.