Pain Relief Research Articles

Comparative analysis of the effectiveness of quadratus lumborum and transversus abdominis muscle blocks for postoperative pain relief during laparoscopic robot-assisted total hysterectomy.

The purpose of this study was to compare and evaluate the analgesic effectiveness of quadratus lumborum block (QLB) and transversus abdominis plane bloc block (TAPB) after laparoscopic robot-assisted total hysterectomy. Materials and methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blocks were performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After surgery, pain was assessed using a 10-point digital visual analogue scale, and postoperative nausea and vomiting were assessed. (PONV) Average arterial pressure and heart rate were recorded. Additionally, the next morning, a survey was conducted to assess the well-being and satisfaction of patients. Results. There were no differences between the groups in terms of demographic characteristics, duration of surgery, and analgesic consumption during the intraoperative period. The severity of postoperative pain was higher (p<0.05) in the control group than in the blockade groups. Both block groups demonstrated lower pain scores at all time points assessed. The latest need for analgesics was in the QLB group. Mean arterial pressure (MAP) values differed only in the first 2 hours after surgery between the CON and TAPB groups (p<0.05). PONV one hour after surgery was more observed in the control group and less in the QLB group (p<0.05). According to the results of a survey conducted on the day after surgery, the number of patients satisfied with the anesthesia and assistance provided in the recovery room in the groups with blockade (TAPB, QLB) was 2.1-5.3% higher (p>0.05). More patients from the QLB group (p<0.05) noted very good and good health, and most patients (p<0.05) from the CON and TAPB group noted satisfactory health. Conclusion. The use of interfascial blocks for postoperative pain relief (TAPB, QLB) after laparoscopic robot-assisted hysterectomy improves the quality of pain relief and the well-being of patients. Benefits of QLB include better pain relief, reduced incidence of PONV, and greater patient satisfaction. TARP has shown equally good results, and this method is easier to perform.

Comparative Analysis of Ultrasound Guided Transversus Abdominis Plane Block with or without Buprenorphine Following Inguinal Hernia Repair

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Is the Use of a Buprenorphine Transdermal Patch More Effective Than Oral Medications for Postoperative Analgesia After Arthroscopic Rotator Cuff Repair? A Randomized Clinical Trial.

Appropriate analgesic protocols for patients following arthroscopic rotator cuff repair remain controversial. Although transdermal buprenorphine patches might potentially provide better pain control and fewer side effects, it is worth noting that there is limited evidence for this given a lack of direct comparisons with oral pain regimens. Among patients undergoing arthroscopic rotator cuff repair, and compared with an analgesic approach using oral tramadol plus celecoxib: (1) Does perioperative use of buprenorphine patches provide better pain relief by a clinically important margin? (2) Does perioperative use of buprenorphine patches improve shoulder joint function recovery? (3) Does perioperative use of buprenorphine patches have a lower frequency of adverse reactions? This was a prospective, single-center, randomized controlled trial. We included patients who underwent arthroscopic rotator cuff repair for partial- or full-thickness rotator cuff tears < 3 cm in size in the anterior to posterior direction as estimated by preoperative MRI and excluded those who had obesity, were pregnant, had opioid dependence, had history of cardiac bypass surgery or ipsilateral rotator cuff repair, had allergies to trial medications, were taking anticoagulants or antidepressants, were being treated with other postsurgical pain management methods, or had severe liver or kidney dysfunction. Based on these criteria, 64% (72 of 112) of patients were eligible. The patients were randomly assigned into either the control group (oral tramadol and celecoxib) or the experimental group (buprenorphine patches). The control group received 100 mg of tramadol and 200 mg of celecoxib every 12 hours for 2 weeks after surgery. The experimental group received buprenorphine patches about 48 hours before surgery without any oral medication. A medication journal was given to the patients to self-report their compliance in taking the drugs. The dosage regimen adhered strictly to protocol. After enrollment, 11% (4 of 36) of patients in the control group and 17% (6 of 36) of patients in the experimental group could not be fully analyzed because of loss to follow-up or missing data. The surveillance period was 3 months, and there was no crossover between groups. The groups did not differ at baseline in terms of demographic parameters and relevant clinical characteristics, including age, gender, BMI, American Society of Anesthesiologists classification, tear size, concomitant procedures, and number of anchors. The outcomes were (1) numeric rating scale (NRS) for pain score at rest or with movement, which ranges from 0 to 10, where 0 indicates no pain, and 10 indicates the worst pain; (2) the American Shoulder and Elbow Surgeons (ASES) score for joint function, which ranges from 0 to 100, with higher scores indicating better shoulder joint function; and (3) the incidence of postoperative adverse reactions. We defined the minimum clinically important difference on the NRS as 2 of 10 points and on the ASES score as 15 of 100 points, based on anchor-based approaches reported in other studies. We found no clinically important between-group differences in NRS pain scores at any time point, either at rest or with movement. Likewise, we found no clinically important between-group differences in ASES scores at any time point. Postoperative dizziness or drowsiness (20% [6 of 30 patients] versus 44% [14 of 32 patients]; p = 0.04) and nausea (10% [3 of 30 patients] versus 34% [11 of 32 patients]; p = 0.02) during the hospital stay were slightly lower in the experimental group compared with the control group. In this randomized trial, we found no clinically important advantages in pain or function to the use of buprenorphine patches after arthroscopic rotator cuff repair, and insufficient evidence exists to confirm whether the minor differences in transient side effects could justify the use of a new and largely untested analgesic approach in this context. That being so, we recommend against the routine use of buprenorphine patches for this indication. In general, we found that pain levels were low after the procedure in both groups. Future studies, therefore, should focus on the efficacy of buprenorphine patches for more invasive or more painful procedures. Level I, therapeutic study.

Use of Transverse Abdominis block for Post Operative pain management in Patients undergoing Emergency Cesarean Sections : a prospective study

INTRODUCTION Postoperative pain management is an essential aspect of perioperative care for patients undergoing emergency Cesarean sections. Adequate pain control not only improves patient comfort and satisfaction but also facilitates early mobilization, reduces the risk of complications, and shortens hospital stays. Transverse abdominis plane (TAP) block is a well-established technique for providing analgesia to the anterior abdominal wall, which can significantly reduce postoperative pain. In recent years, ultrasound guidance has been increasingly used to improve the accuracy and safety of TAP block. This research article aims to review the use of ultrasound-guided TAP block for postoperative analgesia in patients undergoing emergency Cesarean Sections. Methodology : A total of 60 patients who underwent Emergency Cesarean Sections were included in the study. All received bilateral US-guided TAP blocks with either ropivacaine 0.5% 20 ml on each side i. e. 40 ml total or saline. All participants received a spinal anaesthetic with bupivacaine, followed by postoperative acetaminophen, non-steroidal anti-inflammatory drugs, and patient-controlled i.v. tramadol . Each patient was assessed 24 h after delivery for PCA Tramadol usage, average pain score, nausea, vomiting, itch and duration of hospital stay. Results and Conclusion Out of the total 60 patients , 30 were in the study group and 30 in placebo group. Total PCA Tramadol use in 24 h was reduced in the study group compared with the placebo group ( P&lt;0.05). The active group reported improved satisfaction with their pain relief measured by visual analogue scale as compared with the placebo group ( P=0.008). There were no local complications attributable to the TAP block. Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 24h after cesarean section when used as adjunctive to standard analgesia.

Predictive Model of the Effects of Skin Phototype and Body Mass Index on Photobiomodulation Therapy for Orofacial Disorders

Monte Carlo techniques have been extensively used for planning laser-based clinical procedures such as photobiomodulation. However, the effects of several biological tissue characteristics regarding its morphological structure and physiological parameters have not been carefully addressed in many applications. Specifically, many questions remain concerning the effect of skin phototype and body mass index on the effectiveness of photobiomodulation for extraoral therapies. To address these questions, a Monte Carlo simulation model of the effects of body mass index-dependent skin structure on different Fitzpatrick skin types was developed, specifically tailored for the morphological characteristics of cheek tissue. The model describes the settings of a typical oral photobiomodulation treatment protocol for pain relief, namely the use of 660 nm and 808 nm laser wavelengths and a therapeutic dose of 2.0J/cm2 on the masseter muscle. The simulations were used to train a machine learning predictive model aimed at accelerating the treatment planning stage and assessing the importance of patient-specific parameters. A multiple-regression approach was adopted to predict muscle dose and treatment time for effective delivered dose. Body mass index had little effect on epidermal energy deposition, but an important impact on muscle dose parameters. Phototype also influenced muscle dose, but to a lesser extent than body mass index. The results of this study can be used to develop customized dosimetry phototherapy protocols to promote more effective and safe clinical outcomes.

The efficacy and safety of ketorolac for postoperative pain management in lumbar spine surgery: a meta-analysis of randomized controlled trials.

Ketorolac is widely utilized for postoperative pain management, including back pain after lumbar spinal surgery. Several trials have assessed the efficacy of Ketorolac alone and in combination with other analgesics such as bupivacaine, morphine, epinephrine, paracetamol, and pregabalin. However, the effects and safety profile of ketorolac in these contexts remain controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of Ketorolac administration, both as a monotherapy and in combination with other analgesics, for managing postoperative pain in adults undergoing lumbar spinal surgery. We searched PubMed, EMbase, Web of Science, EBSCO, CNKI, WanFang, VIP, and Cochrane library databases through July 2024 for randomized controlled trials (RCTs) assessing the analgesic efficacy of Ketorolac administration for postoperative pain of lumbar surgery. The meta-analysis was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statements. Data were extracted and analyzed using open-source meta-analysis software OpenMeta-Analyst, focusing on outcomes such as VAS pain scores, postoperative morphine requirements (PMR), length of hospital stay (LOS), and adverse effects, such as nausea, vomiting, pruritus, and constipation. The quality of evidence was assessed using the Jada scale. Thirteen RCTs comprising a total of 938 patients were included. The methodological quality of the studies was high, with three studies scoring 5, six studies scoring 4, and four studies scoring 3 on the Jadad scale. Ketorolac significantly reduced pain compared to controls at 0-6h, with a mean difference (MD) of - 1.42 (95% CI: - 2.03 to - 0.80; P < 0.0001), exceeding the Minimal Clinically Important Difference (MCID) of 1.2 to 2.0 points on the Visual Analog Scale (VAS), indicating clinically meaningful pain relief. During the 6-12-h period, the pain reduction was significant (MD = - 0.58; 95% CI: - 0.80 to - 0.35; P < 0.0001), though below the MCID threshold. In the 12-24-h period, Ketorolac continued to show significant pain reduction (MD = - 0.48; 95% CI: - 0.68 to - 0.28; P < 0.0001), but this reduction was also below the MCID. Heterogeneity was low in the 12-24-h period (I2 = 13%), indicating consistent results across studies. There was a significant reduction in PMR (SMD = - 1.83; 95% CI = - 3.42 to - 0.23; P < 0.0001), although with considerable heterogeneity among the studies (I2 = 93%, heterogeneity P < 0.01). Ketorolac administration also significantly reduced the LOS compared to controls (MD = - 0.45days; 95% CI = - 0.74 to - 0.16; P = 0.0001), though this reduction, which is less than a full day (0.45days), may have limited clinical significance. The findings suggest that Ketorolac effectively reduces pain and opioid use postoperatively, supporting its role in multimodal analgesia for lumbar spinal surgery. The significant reduction in PMR indicates a beneficial opioid-sparing effect, crucial in the context of reducing opioid-related complications. The observed reduction in LOS, while statistically significant, may not translate into substantial clinical benefit due to its limited magnitude. No significant increase in common adverse effects was noted, indicating Ketorolac's safety profile. Ketorolac administration, either alone or in combination with other analgesics, effectively reduces postoperative pain and opioid consumption in adults following lumbar spinal surgery. And Ketorolac did not significantly increase the incidence of postoperative nausea and vomiting relative to other analgesics or placebos. While it also decreases LOS, the clinical relevance of this reduction is modest. However, the variability in study designs, dosages, and combination therapies contribute to significant heterogeneity in outcomes. Future research should focus on standardizing protocols and exploring optimal dosing strategies. Additionally, long-term safety and effectiveness studies are needed to better understand Ketorolac's role in postoperative pain management.

Inhibition of Phosphodiesterase 10A Alleviates Pain-like Behavior in Mice.

Emerging evidence indicates that cyclic nucleotide phosphodiesterases exert distinct functions in pain processing and that targeting phosphodiesterases might be a novel strategy for pain relief. This study hypothesized that the phosphodiesterase isoform PDE10A might be a target for analgesic therapy. In situ hybridization, immunostaining, cyclic nucleotide enzyme immunoassays, real-time cyclic guanosine monophosphate imaging, and real-time quantitative reverse transcription polymerase chain reaction were performed to investigate the expression and activity of PDE10A in the dorsal root ganglia and spinal cord. Mice of both sexes were assessed in multiple pain models after the administration of specific PDE10A inhibitors. PDE10A is distinctly expressed in nociceptive neurons in the dorsal root ganglia and spinal cord of mice. Incubation of cultured sensory neurons with the PDE10A inhibitor, TAK-063 (150 nM), increased cyclic guanosine monophosphate levels in enzyme immunoassays and real-time imaging at the single-cell level. Strikingly, treatment with TAK-063 (0.3 mg/kg intraperitoneal) ameliorated the pain-like behavior of female and male mice in models of acute nociceptive pain after intraplantar injection of capsaicin (mean ± SD; 8.87 ± 8.78 s [TAK-063] vs. 51.24 ± 36.36 s [vehicle], P = 0.020) or allyl isothiocyanate (2.46 ± 3.43 s [TAK-063] vs. 10.36 ± 4.87 s [vehicle]; P = 0.018). Furthermore, TAK-063 (0.3 mg/kg intraperitoneal) reduced established pain-like behavior in models of inflammatory pain induced by intraplantar injection of zymosan (Two-way ANOVA, group, F(1, 18) = 48.51, TAK-063 vs. vehicle; P ≤ 0.0001) or complete Freund's adjuvant (F(1, 14) = 46.10, TAK-063 vs. vehicle; P ≤ 0.0001), without the development of antinociceptive tolerance. The antinociceptive effects were recapitulated using the PDE10A inhibitor PF-2545920. Collectively, our data support the idea that PDE10A is a suitable target for the development of efficacious analgesic drugs.

High Preoperative Expectations may not Need to be Feared.

Retrospective. Evaluate correlations between preoperative expectations for pain improvement and 12-month functional outcomes and satisfaction following 1-2 level primary anterior cervical surgery. Limited data exists evaluating correlations between patients' preoperative expectations for pain relief and subsequent functional and satisfaction outcomes following primary anterior cervical surgery. Understanding correlations between expectations and outcomes may help identify patients most likely to benefit from surgery. Patients who underwent 1-2 level primary ACDF or CDA for degenerative disease between 2016-2021 were included. All patients had 12-month NDI data. Preoperative expectations for pain relief were collected at the initial clinic visit using 5-point Likert scales. Preoperative and 12-month postoperative satisfaction were recorded using 7-point Likert scales. Covariates including age, gender, procedure type, smoking status, opioid use, worker's compensation/litigation, BMI, and indication (radiculopathy versus myelopathy). Linear regression models were constructed to assess 12-month NDI change score versus pain relief expectations. Additional regression models assessed expectations versus achievement of MCID at 3- and 12-months and satisfaction at 12-months. 198 ACDF (56.1% female, median age 57) and 52 CDR patients (55.8% female, median age 51) were included. Regression models found no significant correlations between pain relief expectations and degree of NDI score improvement at the 12-month postoperative timepoint or MCID achievement at the 3- and 12-month postoperative timepoints. There was no association between preoperative expectations and 12-month satisfaction. However, greater preoperative dissatisfaction was significantly associated with greater 12-month improvement in NDI score. Preoperative pain relief expectations were not associated with functional outcomes or satisfaction following 1-2 level primary ACDF or CDR at 12-month follow-up. Patients' dissatisfaction with their preoperative spinal condition was significantly associated with greater 12-month NDI improvement. Assessing preoperative satisfaction may help identify those most likely to benefit from surgery.

Effect of Lingual Nerve Block and Localised Somatosensory Abnormalities in Patients With Burning Mouth Syndrome-A Randomised Crossover Double-Blind Trial.

To investigate the effect of a lingual nerve block on spontaneous pain in patients with burning mouth syndrome (BMS) and to estimate associated somatosensory abnormalities by quantitative sensory testing (QST). A standardised QST battery including cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) was performed at the oral mucosa of the most painful site and intraoral control site in 20 BMS patients, and at the tongue and cheek mucosa in 22 age- and gender-matched healthy controls. The effect of a lingual nerve block on spontaneous burning pain reported by the BMS patients on a 0-10 cm visual analogue scale (VAS) was investigated in a randomised double-blind crossover design using (1 mL) lidocaine (lido) or saline (sal) with an interval of 1 week. The BMS patients were grouped into 'central' and 'peripheral' mechanisms based on the effect of the lingual nerve injections. For each BMS patient, Z-scores and Loss/Gain scores were computed. Differences among groups and sites were analysed using a two-way ANOVA. Differences within group were assessed by paired t-test. The 20 BMS patients were characterised on the basis of VAS changes (ΔLido-ΔSal) as a peripheral BMS subgroup (n = 9) with pain relief more than 1 cm on the VAS and a central BMS subgroup (n = 11) with pain relief less than 1 cm. BMS patients (n = 20) had lower sensitivity to thermal stimuli (i.e., CDT, WDT, TSL, CPT, HPT and PPT) and higher sensitivity to mechanical stimuli (i.e., PPT) compared with controls (p ≤ 0.007). Based on Loss/Gain coding, L1G0 (loss of thermal somatosensory function with no somatosensory gain, 55.0%) was the most frequent coding in the BMS group, which was higher than 11.4% in the control group (p < 0.001). Surprisingly, there was no significant difference between the peripheral and central BMS subgroups with regard to the Z-scores of any of the nine QST parameters (p > 0.097). The results of the lingual nerve blocks demonstrated two distinct phenotypes with either peripheral or central mechanisms but no direct impact on somatosensory function. Overall, somatosensory function in BMS patients seems abnormal in the painful areas compared to matched controls with a conspicuous loss of thermosensory function.

Conditioned Pain Modulation Differences in Central and Peripheral Burning Mouth Syndrome (BMS) Patients.

To evaluate conditioned pain modulation (CPM) in burning mouth syndrome (BMS) patients with different pain mechanisms. Twenty BMS patients (52.0 ± 6.8 years, 17 women and 3 men) and age- and gender-matched 22 healthy controls were enrolled in this randomised controlled trial. The patients received an active lingual nerve block (lidocaine) and a placebo injection (saline) randomly with an interval of 1 week in a double-blinded manner. Patients evaluated their pain intensity on a 0- to 10-cm visual analogue scale (VAS) before and after each injection, with or without CPM. Based on the anaesthesia effect, BMS patients were divided into two groups with presumed different pain mechanisms; a 'central subgroup (n = 11)' with pain relief less than 1 cm and 'peripheral subgroup (n = 9)' with pain relief more than 1 cm on the VAS. Mechanical pain threshold (MPT) and wind-up ratio (WUR) were investigated at two oral mucosa regions: the region with most intense symptoms and a control region for the patient group; tongue and buccal region for the control group. CPM was induced by immersing the left hand into cold water. A moderate level of pain (around five on the VAS) was obtained by adjusting the water temperature. MPT and WUR were measured twice for all the participants with and without CPM, which was analysed and presented as relative change in MPT and WUR. Differences between groups were analysed using two-way ANOVA. Differences within group between tests were assessed by paired t-test. At baseline, there were no significant group differences for MPT or WUR between BMS patients and healthy controls (p ≥ 0.156). The mean bath temperature to evoke moderate pain for the BMS group was significantly lower than that for the healthy control group (8.9°C vs. 11.9°C, p = 0.003). The CPM evoked an inhibitory modulation in 18.2%-44.4% of BMS patients, while for the healthy group, the ratio was 68.2%-81.8%. Central BMS patients had smaller CPM effects than healthy participants at the painful site and control site, which indicated a decreased CPM function (p ≤ 0.034). Peripheral BMS patients had lower CPM effects than healthy participants only at the painful site (p = 0.037). The present findings documented impairment of central nociceptive inhibition processing in BMS patients which was more extensive in central BMS than peripheral BMS. These findings add to the suggestion that BMS may a heterogeneous pain condition with at least two different phenotypes.

Kratom (Mitragyna speciosa) use for self-management of pain: Insights from cross-sectional and ecological momentary assessment data

Kratom (Mitragyna speciosa) is increasingly used in the US for self-management of pain, despite limited research on its efficacy and safety. To better understand how and why people use kratom for pain self-management, we analyzed baseline survey data (N = 395) and 15-day ecological momentary assessment (EMA) data (N = 357) from kratom consumers across the US. Although we recruited participants based on their kratom use, not on whether they used it for pain management, nearly half (49.1 %) met criteria for chronic pain, with many reporting substantial pain relief and high effectiveness of kratom in managing pain. A majority (69.2 %) reported difficulties in obtaining adequate pain treatment, and most indicated that these challenges impacted their decision to try kratom. Most participants did not report concerns about overuse or significant side effects. EMA data showed that, regardless of chronic-pain status, pain relief was the most frequently endorsed primary motivation for daily kratom use. There were no significant association between daily pain levels and kratom use frequency, and no difference in the daily kratom use between those with vs. without chronic pain. Recent kratom use was associated with lower current pain levels. Stronger subjective effects of kratom were associated with lower pain levels. This effect was significantly moderated by chronic-pain status: those with chronic pain showed a stronger link between subjective kratom effects and pain reduction. These findings underscore the urgent need for systematic, rigorous research on long-term implications, efficacy, and safety of kratom in pain management to guide informed clinical practices and regulatory policies. PerspectiveThis study reveals that chronic pain is common among kratom consumers, who frequently use it for pain self-management and report significant relief, as shown by ecological momentary assessment. There is an urgent need for research into kratom's safety, efficacy, and mechanisms to guide clinical practice and inform policies.

Early Pain Relief in Malignant Psoas Syndrome with Radiation Therapy: A Case Report

Early Pain Relief in Malignant Psoas Syndrome with Radiation Therapy: A Case Report

Aggressive bone tumours: What a radiologist can offer to the surgeon?

The complexity of aggressive bone tumours necessitates a comprehensive approach that combines radiological assessments with clinical and pathological findings. Radiologists offer valuable insights to surgeons throughout the diagnostic and therapeutic journey, enhancing the precision and efficacy of surgical interventions. Radiologists contribute to definitive diagnosis in the majority of benign and certain aggressive tumours, although the complexity of aggressive bone tumours often requires histopathological confirmation. They assist in characterizing tumours and evaluating their extension, providing critical information for treatment planning. Radiologists guide biopsy procedures, ensuring representative tissue samples while minimizing morbidity and the risk of tumour spread. In preoperative planning, radiologists construct detailed 3D reconstructions of tumours, aiding surgeons in strategizing surgical approaches and anticipating challenges. During surgery, radiologists offer intraoperative guidance through techniques like image fusion and intraoperative MRI, enhancing surgical precision. Post-surgical surveillance for tumour recurrence heavily relies on radiological imaging, with functional MR sequences providing valuable insights. Radiologists also play a significant role in image-guided therapeutic interventions for aggressive bone tumours, offering procedures like osteoplasty and ablation techniques for pain relief and tumour control. In conclusion, radiologists are indispensable members of the multidisciplinary team and offer expertise in diagnosis, biopsy guidance, preoperative planning, intraoperative guidance, post-surgical surveillance, and interventional therapy. Their collaborative efforts significantly optimize patient's outcome and quality of life.

Intra-Articular Physiological Saline in Temporomandibular Disorders May Be a Treatment, Not a Placebo: A Hypothesis, Systematic Review, and Meta-Analysis

Background: Intra-articular injections reduce pain in patients with temporomandibular joint (TMJ) disorders who are unresponsive to conservative treatment. Hyaluronic acid, blood products, and medications provide rapid relief when administered this way, although their mechanisms of action remain unclear. In control groups, which are intended to be untreated, 0.9% NaCl is typically delivered. The hypothesis that “normal saline injections in TMJ cavities produce a therapeutic effect” is proposed, with an exploration of its potential verification, alongside a systematic review and meta-analysis of studies on intra-TMJ 0.9% NaCl. Methods: Randomized controlled trials (RCTs) on patients with TMJ internal derangement, arthritis, or degeneration were selected under PRISMA 2020 and assessed with RoB2. Results: Seven RCTs with 359 patients were included. Weekly follow-ups revealed a decrease in articular pain by 23.72% (SE: 0.84%; 95% CI: 24.38–21.06%; p &lt; 0.01), and monthly follow-ups indicated a decrease of 34.01% (SE: 1.09%; 95% CI: 36.16–31.86%; p &lt; 0.01) compared to the baseline values. These findings were grounded in low-risk-of-bias evidence on 267 patients in five RCTs and 222 patients in four RCTs, respectively. Conclusions: The hypothesis warrants further testing to determine whether, in addition to the known biological activity of typical injectables, the mechanical action also contributes to pain relief.

Bilateral slipped capital femoral epiphysis in a cerebral palsy patient: a Case Report

BackgroundSlipped capital femoral epiphysis (SCFE) is usually seen in patients with high body mass index (BMI) and endocrine diseases. SCFE is exceedingly rare among Cerebral palsy (CP) patients due to spasticity present in those patients. Percutaneous in situ fixation is the treatment option for SCFE patients. According to the literature, there’s no single case report with SCFE in a spastic CP patient with no prior history of trauma, seizure episodes, or endocrine disease.Case presentationWe report a case of an 11-year-old spastic cerebral palsy (CP) patient with a physical status of level 5 motor function on the gross motor function classification system. He was brought by his mother to the clinic complaining of bilateral hip pain. The mother denied any history of trauma or any seizure episodes. The pain had started spontaneously. Physical examination showed severe spasticity and bilateral hip abduction with external rotation. Drehmann’s sign was positive. Bilateral hip radiographs revealed bilateral partial open femoral capital physis with evidence of SCFE bilaterally. Also, the Southwick angle was measured, and it was severe. The patient was taken to the operating room and treated with closed reduction and percutaneous in situ fixation. He was seen multiple times following surgical intervention, reporting pain relief, and showing complete wound healing.ConclusionThis report concludes that paraplegic spastic CP patients may present with SCFE spontaneously without trauma, seizures, or an underlying endocrine disease. Also, severe spasticity might potentially be a risk factor for SCFE, although further investigations would be necessary to establish a conclusive link.

New ways to repurpose salmeterol in an animal model of fibromyalgia.

Fibromyalgia (FM) is a syndrome of pervasive chronic pain accompanied by low mood, sleep disorders, and cognitive decline. The dysfunction of central pain processing systems along with neurotransmitter disturbances are possible contributing mechanisms. Genetic polymorphism of the 𝛽2 adrenergic receptors is reported in FM patients. It is reported that chronic β2 agonists administration is effective for neuropathic pain alleviation. No current information, however, exists on their potential to alleviate nociplastic pain, such as FM. Therefore, the purpose of the current study is to examine salmeterol's potential antiallodynic effects in experimentally produced FM and explore some of the possible contributing mechanisms. Thirty rats are allocated into three groups (n = 10): a normal group, a reserpine group that received reserpine (1 mg/kg; s.c.) for 3 days, and a reserpine + salmeterol group that received salmeterol (1 mg/kg; i.p.) for 21 consecutive days following last reserpine injection. Reserpine administration resulted in behavioral and biochemical changes consistent with FM, including thermal and mechanical hyperalgesia, depressive behavior, and motor incoordination. This is coupled with disturbed spinal monoamine levels, depressed cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signaling, disturbed mitochondrial function/dynamics, and compromised blood-nerve barrier integrity. Treatment with salmeterol conceivably reversed these effects. β2 receptor agonists such as salmeterol could be regarded as a promising strategy for the management of FM.

Could a robot feel pain?

AbstractQuestions about robots feeling pain are important because the experience of pain implies sentience and the ability to suffer. Pain is not the same as nociception, a reflex response to an aversive stimulus. The experience of pain in others has to be inferred. Danaher’s (Sci Eng Ethics 26(4):2023–2049, 2020. https://doi.org/10.1007/s11948-019-00119-x) ‘ethical behaviourist’ account claims that if a robot behaves in the same way as an animal that is recognised to have moral status, then its moral status should also be assumed. Similarly, under a precautionary approach (Sebo in Harvard Rev Philos 25:51–70, 2018. https://doi.org/10.5840/harvardreview20185913), entities from foetuses to plants and robots are given the benefit of the doubt and assumed to be sentient. However, there is a growing consensus about the scientific criteria used to indicate pain and the ability to suffer in animals (Birch in Anim Sentience, 2017. https://doi.org/10.51291/2377-7478.1200; Sneddon et al. in Anim Behav 97:201–212, 2014. https://doi.org/10.1016/j.anbehav.2014.09.007). These include the presence of a central nervous system, changed behaviour in response to pain, and the effects of analgesic pain relief. Few of these criteria are met by robots, and there are risks to assuming that they are sentient and capable of suffering pain. Since robots lack nervous systems and living bodies there is little reason to believe that future robots capable of feeling pain could (or should) be developed.

Effect of perioperative single dose intravenous vitamin C on pain after total hip arthroplasty

IntroductionVitamin c can relieve the pain after other diseases, but there are no studies on whether vitamin C can relieve the pain after hip replacement. The purpose of this paper is to study whether vitamin C can relieve the pain after total hip replacement.PurposeIn this prospective, double-blind, placebo-controlled, randomized trial, 100 patients receiving THA at our hospital were randomly assigned to vitamin c or control groups. During the operation, the vitamin C group will receive intravenous injection of 3 g vitamin C, and the control group will receive 3 g placebo. If the patient has postoperative pain, 10 ml subcutaneous injection of morphine will be required as a rescue analgesic. The primary outcome was the amount of postoperative injection of morphine as a rescue analgesic and expression of inflammatory factors, and the secondary outcome was postoperative pain and hip recovery as assessed by visual analog scale (VAS).ResultsThe dosage of subcutaneous injection of morphine was significantly reduced in vitamin C group. VAS pain scores at rest and exercise were lower in the vitamin C group 24 h after surgery, and hip motion was better 24 h after surgery, but there was no significant difference between the two groups 24 h after surgery.Nonetheless, the overall changes in morphine usage and VAS scores did not surpass the established minimal clinically important differences (10 mg for morphine consumption; 1.5 at rest and 1.8 during movement for VAS scores).ConclusionAdding intravenous vitamin c to multimodal analgesia significantly improved morphine consumption, VAS pain score, and functional recovery. However, it is recommended that single intravenous administration of vitamin C during the perioperative period may achieve better pain relief for patients after THA.

Pain in palliative cancer patients – Analysis of the German National Palliative Care Registry

Palliative care aims to improve the quality of life in patients with progressive diseases such as cancer. Effective cancer pain management is a major challenge of palliative treatment. Empirical data on the prevalence of cancer pain, the efficiency of pain treatment and influencing factors are scarce. Here, we investigated pain in cancer patients treated on inpatient palliative care wards in Germany. N = 4779 data sets provided by the German Palliative Care Registry from yearly evaluation periods between 2015 and 2020 were included. Pain ratings were assessed by professionals through a checklist of symptoms and problems (HOPE-SP-CL). More than half of the included patients suffered from moderate/severe pain at the beginning of inpatient palliative care and in 71% of these patients, pain relief was achieved at the end of inpatient treatment. Pain intensity, depression and ECOG performance status at admission were weak predictors of later pain relief. The highest pain intensity at the beginning and least pain relief were found in patients with bone and cartilage cancer. The highest percentage of adequate pain control (81%) was seen in 2020. Data from the German Palliative Care Registry confirmed that although increasingly better addressed over the years, insufficiently controlled cancer pain remains a challenge for palliative care units. Patient-specific (e.g. psychological comorbidity) and cancer-related (e.g. bone or cartilage cancer) risk factors for poor pain treatment underline the need for individualized multimodal pain management including psychological support.

Short-Term Clinical Results of Middle Trapezius Tendon Transfer with Achilles Tendon Allograft for Irreparable Supraspinatus Tears

BackgroundAmong emerging options, Middle Trapezius Tendon (MTT) transfer has shown promise, particularly in isolated supraspinatus irreparable rotator cuff tears (ISIRCTs) and nonarthritic shoulders unsuitable for reverse total shoulder arthroplasty. This study aims to assess clinical and radiological results of MTT transfer utilizing an Achilles tendon allograft for ISIRCTs. MethodsWe retrospectively reviewed patients who received MTT transfer using Achilles tendon allograft for ISIRCTs between May 2020 and August 2021. Clinical assessments using pain VAS, Constant, ASES, UCLA, and SANE score were assessed pre- and postoperatively. Active Range of Motion (aROM) were obtained, and radiologic assessments included AHD, Hamada grade, and MTT integrity. Results18 patients were involved with mean age of 63.8 ± 7.1, followed for an average of 25.4 ± 4.4 months. Significant improvements were observed in pain relief (VAS:4.7±1.5 to 1.6±0.9, P<.001), shoulder function (Constant: 53.1±11.1 to 70.0±15.1, ASES: 57.7±13.5 to 78.2±17.0, UCLA: 13.6±4.5 to 22.0±6.4; all P<.001), and patient satisfaction (SANE: 51.3±14.1 to 73.7±15.0, P<.001). Active range of motion significantly improved in Forward elevation (FE) and abduction (ABD). Radiologic assessments showed no significant change in AHD and Hamada grade, with p-values of 0.503 and 0.260, respectively. ConclusionMTT transfer using Achilles tendon allograft showed improvement in pain relief, clinical scores, and active FE and ABD in patients with ISIRCTs. However, the validation of its effectiveness necessitates multicenter and long-term studies.