Adverse childhood experiences (ACEs) increase the risk of developing chronic pain in adulthood. However, the impact of ACEs and specific ACEs subdomains on treatment response to cognitive behavioral interventions, which are among the frontline interventions for chronic pain, remains unexplored. This exploratory secondary analysis of a psychotherapy trial for chronic pain examined the associations among total ACEs and ACEs subdomains (household dysfunction and maltreatment) with pre-intervention level and treatment-related change in pain severity and interference. Trial participants (116 Veterans, Mage = 51.40; SD = 13.20) received one of two cognitive behavioral therapies for chronic pain that performed similarly in terms of pain outcomes. Participants completed self-report measures of ACEs at pre-treatment and measures of pain severity and interference at pre-treatment, weekly during treatment, post-treatment, and 3-month follow-up. There was a null association between ACEs (total and subdomains) and pain outcomes at pre-intervention. Higher total ACEs scores predicted significantly greater improvements in pain interference from pre-intervention to follow-up (p = .025). ACEs subdomains patterned differently with pain outcomes: higher maltreatment predicted significantly greater improvement in pain interference from pre-to-post-intervention (p = .049) and greater improvement from pre-intervention to follow-up, though above the threshold for statistical significance (p = .079). Further, higher household dysfunction predicted greater improvement in pain severity from pre-intervention to follow-up, though similarly above the threshold for statistical significance (p = .080). The present study yielded surprising and clinically informative results: cognitive behavioral interventions may be especially helpful for reducing pain interference in adults with higher ACEs. Furthermore, household dysfunction and maltreatment may be differentially associated with pain severity and interference. Future research is required to replicate the findings of this exploratory study.

Bharatanatyam, a venerable and highly structured classical dance form from India, requires significant physical strength, postural control, and precise movements. Dancers often begin to training during adolescence, a crucial period of musculoskeletal development. A key posture in Bharatanatyam, the Araimandi (half-sitting position), involves sustained hip and knee flexion with external rotation, which imposes considerable stress on the lumbopelvic complex. Repeatedly practicing this position may lead to compensatory changes, such as increased lumbar lordosis and anterior pelvic tilt, which potentially predispose the dancers to low back pain (LBP). This study aims to examine the relationship between sitting posture and the severity of low back pain in female Bharatanatyam dancers. A total of 100 female Bharatanatyam dancers aged 16-35years were selected through convenience sampling to evaluate their sitting posture using GaitON Software. Low back pain intensity and functional disability were measured using the Visual Analog Scale and the Roland-Morris Disability Questionnaire. Statistical analysis was conducted using R-Studio. Age and BMI showed a moderate positive correlation (r=0.53). Hip-knee alignment was negatively correlated with trunk-thigh angle (r=-0.66) and knee angle (r=-0.59). A weak positive correlation was found between knee angle and trunk-thigh angle (r=0.38). The Roland-Morris Disability Score showed no significant relationship with biomechanical or demographic characteristics. The results indicated no significant correlation between low back pain and sitting postural parameters. Despite the physical demands and sustained postures involved in Bharatanatyam practice, this study found no significant link between sitting postural parameters and low back pain. This suggests that discomfort in dancers may be more influenced by dynamic performance factors, repetitive loading, and training intensity than by static sitting posture alone. The results highlight the intricate characteristics of low back pain in dancers and the necessity of focusing on movement patterns and muscular endurance in effective rehabilitation approaches.

A substantial proportion of patients report no pain after surgery, resulting in an excess of zero values that pose challenges for analysis using traditional statistical models. The current study was designed to test the hypothesis that a two-part model, commonly used in healthcare expenditures research, would demonstrate superior performance in predicting postsurgical pain when compared with traditional models and would secondarily better identify predictors of this clinically important outcome. This study analyzed a prospectively collected single-center data set (n = 3,925) of chronic postsurgical pain to compare a novel two-part modeling framework with logistic and linear regression. The two-part model first estimated the probability of experiencing postsurgical pain at 3 months (binary outcome), followed by the severity of pain among those affected (on a 1 to 10 numeric rating scale). To obtain an unbiased assessment of model performance, the data were randomly split into training (n = 3,000) and testing (n = 925) data sets. The models were trained on the training data set and evaluated on the testing set. This process was repeated 400 times to compute average performance estimates. As a secondary aim, the study assessed the associations of 15 baseline factors, including validated measures of patient-reported pain, functional and psychological measures, comorbidities, and surgical details, across the different modeling approaches. The two-part model demonstrated superior predictive performance compared with linear regression alone, with a higher mean R 2 value (0.075 vs . 0.050; P < 0.0001), lower root mean square error (1.466 vs . 1.485; P < 0.0001), and lower mean absolute error (1.020 vs . 1.030; P < 0.0001). Statistical comparison with logistic regression alone was not possible due to the shared binary component. The two-part model identified seven baseline preoperative covariates as independently associated with postsurgical pain that were missed by either logistic or linear models or both: self-reported race, education level, American Society of Anesthesiologists classification, overall body pain, widespread pain, symptom severity, and anxiety level. Significant baseline factors identified in all three models were patient sex, surgical type, and surgical site pain. A two-part model may offer a superior statistical approach to linear and logistic regression, better identifying patient- and clinical care-related risk factors of chronic postsurgical pain, primarily by distinguishing factors that drive the occurrence of chronic pain from those that are associated with pain severity.

Menstrual problems such as dysmenorrhea and premenstrual syndrome affect a significant proportion of women during their reproductive years and often cause problems in mood, productivity, and day-to-day activities. A safe and non-invasive alternative to pharmacological treatments, which may be associated with adverse effects, is exercise. This narrative review aimed to evaluate the effectiveness of different exercise interventions in reducing menstrual symptoms. This narrative review summarised studies published between January 2000 and December 2023 from the following databases: PubMed, Scopus, Cochrane CENTRAL, PEDro, CINAHL, SPORTDiscus and Google Scholar. A total of 86 studies were included with women aged 18-35years with dysmenorrhea or PMS. Studies that evaluated aerobic, resistance, stretching, yoga or multimodal exercise interventions for ≥4weeks were included. Non-English studies, case reports and studies that used a pharmacological intervention were excluded. Extracted data included study design, intervention, outcome and adherence. The narrative synthesis approach was followed. The risk of bias of the included studies was extracted using the ROBINS-I approach. Meta-analysis was not successful due to the variation in study methods and findings. The results indicate that yoga and aerobic therapy interventions demonstrated consistent improvements in overall health and a reduction in the severity of pain. Stretching and resistance training interventions also offer benefits, but the consequences are much less clear. Multimodal interventions have the potential to address both physical and psychological issues. There were no major adverse effects reported overall, and compliance was high. Exercise interventions appear to be effective, safe, and clinically applicable for managing menstrual discomfort, that is, aerobic and yoga interventions. More high-quality randomised controlled trials are needed to support clinical recommendations. This review uniquely provides a comparative synthesis across multiple therapeutic exercise modalities and highlights clinically relevant dose-response patterns.

Rebound pain, a sudden increase in pain intensity after resolution of regional anesthesia, remains a major challenge in postoperative patient care. Intravenous (IV) dexamethasone has been proposed as a preventive strategy, but whether its effectiveness varies across patient characteristics remains unclear. This retrospective study included patients who underwent upper extremity orthopedic surgery under brachial plexus block (BPB). Rebound pain was defined as the occurrence of both severe pain (numeric rating scale ≥ 7) and rescue analgesic administration between 4 and 24 hours after BPB. The association between IV dexamethasone and rebound pain was evaluated using multivariable logistic and generalized random forest (GRF) models. Among the 1,171 patients, 651 (55.6%) received IV dexamethasone. The dexamethasone group had a significantly lower incidence of rebound pain (7.1% vs. 16.9%, P < 0.001) with delayed onset (median 14 vs. 11 hours). IV dexamethasone was an independent protective factor (odds ratio, 0.42; 95% confidence interval [CI], 0.27 to 0.64; P < 0.001). GRF analysis estimated an average treatment effect of -0.09 (95% CI -0.13 to -0.05), corresponding to a 9% absolute risk reduction. Calibration testing demonstrated accurate model (GRF) estimation (mean coefficient, 0.98; P < 0.001) and no statistically detectable heterogeneity in treatment effect (differential coefficient, -0.30; P = 0.713). IV dexamethasone was associated with reduced rebound pain without evidence of meaningful heterogeneity in treatment effect in patients undergoing upper extremity surgery under BPB. These findings suggest a potential preventive role for dexamethasone as an adjunct to perioperative pain management in this population.

Minimally invasive total thoracoscopic fixation versus open fixation for multiple Rib fractures: Systematic review and meta-analysis of clinical outcomes.

Construct validity, reliability, and sensitivity of proxy-reported pain interference in individuals with cerebral palsy.

Autonomic dysfunction in fibromyalgia syndrome: the role of small fiber damage.

Knee osteoarthritis (OA) is a chronic disease characterized by persistent pain. Kinesiophobia and pain catastrophizing are cognitive-behavioral factors that have been associated with functional limitations and pain severity. Although previous studies have highlighted potential relationships between these factors and movement patterns, their association with specific functional tasks remains unclear. This study aimed to investigate the relationship between kinesiophobia, pain catastrophizing, and kinematics during functional activities in women with knee OA. Thirty-five women (67.00 ± 8.43) with a medical diagnosis of knee OA participated in the study. Anamnesis was conducted, followed by the application of the Brief Fear of Movement, Pain Catastrophizing Scale and Western Ontario and McMaster Universities (WOMAC). Kinematic evaluation during the step-down test and sit-to-stand tasks was performed. Joint angles for trunk inclination, pelvic tilt, hip flexion, knee flexion, knee valgus and ankle dorsiflexion were calculated. For statistical analysis, Pearson's correlation test was used, with a significance level set at p < 0.05. A strong correlation was observed between knee flexion during the sit-to-stand task and the Brief scale (r = -0.776, p = 0.005) and between the WOMAC Function domain and the Brief scale (r = 0.412, p = 0.042). A moderate correlation was found between knee flexion angle during step-down task and the Brief scale (r = -0.459, p = 0.012). Higher levels of kinesiophobia and pain catastrophizing are associated with specific kinematic adaptations during daily functional tasks in women with knee OA.

Network and cluster analyses reveal the central role of disability and the presence of nociplastic pain features in cervical radiculopathy.

Leptin-driven microglial activation in fibromyalgia: mechanistic insights and therapeutic implications.

Obesity has been associated with increased migraine frequency and disability, and bariatric surgery may reduce migraine burden. However, the relationship between postoperative weight loss magnitude and migraine improvement remains incompletely defined. In this prospective single-arm before-after study, 52 adults with severe obesity and clinically established migraine underwent Roux-en-Y gastric bypass (RYGB). Migraine-related outcomes were assessed preoperatively and at 3 months postoperatively using the Migraine Disability Assessment (MIDAS), the Migraine-Specific Quality of Life Questionnaire (MSQ; raw summed score), migraine frequency, and pain severity measured by visual analog scale (VAS). Paired t-tests were used to compare pre- and postoperative outcomes. Associations between age, weight reduction, and changes in migraine outcomes were evaluated using Pearson correlation coefficients. At 3 months, significant reductions were observed in body weight (- 28.9kg; p < 0.001) and BMI (- 10.9kg/m²; p < 0.001). Migraine frequency decreased from 15.4 ± 7.0 to 5.0 ± 5.6 episodes (p < 0.001), and pain severity decreased from 7.2 ± 1.4 to 3.7 ± 2.8 (p < 0.001). MIDAS scores declined from 94.0 ± 24.5 to 34.9 ± 35.9 (p < 0.001), with a marked shift toward lower disability grades. MSQ impairment scores decreased from 52.6 ± 9.1 to 31.2 ± 10.9 (p < 0.001), indicating improved migraine-related quality of life. Effect sizes were large across outcomes. Changes in migraine-related outcomes were strongly intercorrelated but were not significantly associated with age or the magnitude of weight loss. Roux-en-Y gastric bypass was associated with substantial short-term reductions in migraine frequency, severity, disability, and quality-of-life impairment in adults with severe obesity. Improvements were not correlated with weight loss magnitude or age. These findings suggest that migraine burden may improve following metabolic surgery performed for standard obesity indications, while highlighting the need for controlled studies with longer follow-up.

Chronic pain is associated with memory deficits clinically and in animal models. Similarly, interstitial cystitis/bladder pain syndrome (IC/BPS) afflicts patients with severe chronic pelvic pain and urinary dysfunction as well as cognitive effects, including anxiety/depression and patient-reported memory deficits. In a genetic model of IC/BPS, mice deficient for the lipase acyloxyacyl hydrolase (AOAH) mimic key symptoms, including rodent correlates of chronic pelvic pain and anxiety/depression. Recently, we observed that pelvic pain of female AOAH-deficient mice is associated with microglial activation in the prefrontal cortex and paraventricular nucleus, and pain is dependent upon microglia. Because chronic pain is associated with memory deficits and microglia support learning and memory, we hypothesized that chronic pelvic pain is associated with memory deficits in IC/BPS models. In the hippocampus, we observed microglia in the dentate gyrus of AOAH-deficient females that exhibited a hyper-ramified morphology with increased branching, number of endpoints, and process length. In contrast, dentate gyrus microglia of AOAH-deficient males had an amoeboid morphology. Using specific memory tests, female AOAH-deficient mice exhibited deficits in both spatial and recognition memory relative to wild-type controls, whereas males had a modest phenotype. Depleting microglia pharmacologically with an antagonist of colony-stimulating factor-1 receptor resolved the deficit in recognition memory but did not improve spatial memory in females and had no significant effect in males. Overall, these data suggest a role for microglial modulation of cognitive function in pelvic pain that is sex-specific and thus identify a potential target for treating cognitive symptoms in female patients.NEW & NOTEWORTHY Interstitial cystitis/bladder pain syndrome (IC/BPS) afflicts patients with debilitating pelvic pain, voiding dysfunction, and cognitive deficits, but effective therapies are lacking. Using acyloxyacyl hydrolase-deficient mice as a genetic model of IC/BPS, we previously showed that microglia mediate pelvic pain and now show that microglia mediate sex-specific memory deficits. These findings identify microglia as potential therapeutic targets for pain and cognitive dysfunction in IC/BPS.

AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Inflammatory Bowel Disease: Expert Review.

Vertebral hemangiomas are typically benign and asymptomatic, but a small subset, known as aggressive vertebral hemangiomas, may present with neurological deficits due to extraosseous extension and spinal cord compression. These cases require timely diagnosis and a multidisciplinary management approach. A 42-year-old man presented with acute-onset severe mid-back pain for 2 months. Neurological examination revealed exaggerated reflexes without motor or sensory deficits. Magnetic resonance imaging showed expansile lesions at T7, T9, and T10, with additional angiomatous lesions at T3 and T4. T7 and T10 lesions caused spinal cord compression. Preoperative embolization of T7 and T10 was performed using polidocanol. The patient subsequently underwent vertebroplasty at T7, T9, and T10 levels, pedicle screw fixation from T4 to T11, posterior decompression at T6 to T7 and T9 to T10. Intraoperative biopsies revealed a cavernous hemangioma at T7 and a capillary hemangioma at T9. No malignancy was found. Postoperative recovery was uneventful, with early mobilization and significant functional improvement. At 2-year follow-up, the patient had no pain or neurological symptoms, and radiographs showed stable fixation with no recurrence. Aggressive vertebral hemangiomas, though rare, should be considered in patients with progressive neurological symptoms. Early diagnosis, embolization, surgical decompression, and stabilization can yield excellent outcomes.

Luteinizing hormone-releasing hormone agonists, used in advanced prostate cancer, can cause an initial testosterone surge and may inadequately suppress follicle-stimulating hormone, potentially promoting tumor growth. Injectable gonadotropin-releasing hormone (GnRH) antagonists avoid this surge but have drawbacks like injection-site reactions and monthly dosing. Relugolix, an oral GnRH antagonist, offers rapid testosterone suppression without flare and reduced cardiovascular risks. We report a 72-year-old man with suspected metastatic prostate cancer, presenting with severe neuritic pain and lower limb weakness. Relugolix, started before biopsy along with zoledronic acid and steroids, led to symptom relief within 24 h. This case supports Relugolix's utility in urgent hormone-sensitive metastatic prostate cancer care.

Considering biological sex is essential for assessing perioperative risk and tailoring anesthetic care, yet this issue remains under-addressed. Preoperative risk scores rarely incorporate sex, despite growing evidence of sex-based differences across the perioperative continuum. Sex influences both anesthetic pharmacokinetics and pharmacodynamics. Women exhibit reduced sensitivity to propofol, experience more rapid emergence from general anesthesia, but demonstrate increased sensitivity to opioids and neuromuscular blockers like rocuronium. Postoperatively, women experience more severe and chronic pain, yet exhibit lower mortality rates. Complication profiles also vary by sex and type of surgery. This narrative review aims to summarize current evidence on sex-related differences in anesthesia and highlights key gaps in the literature according to recent considerations. While emerging data suggest meaningful sex-based variations, further research is needed to elucidate underlying mechanisms and promote a more personalized approach to perioperative management.

In 2020, an estimated 14.9 million herpes zoster (HZ) cases occurred worldwide among adults aged ≥ 50 years; this number is projected to rise to 19.1 million by 2030. Postherpetic neuralgia (PHN), the most common complication of HZ, develops in 5% to > 30% of patients with HZ. Poorly managed PHN may cause persistent pain, functional impairment, psychological distress, and, in severe cases, suicide. This review summarizes the current evidence on PHN and proposes a tiered management framework. PubMed and Web of Science were searched for PHN-related articles published from January 2011 to December 2025, with reference-list screening. Studies were selected by clinical relevance and design. Management strategies were tiered by guideline support, regulatory approval, and PHN-specific efficacy and safety evidence. Pathogenesis involves viral reactivation, peripheral and central sensitization, and genetic modulation. Major risk factors include older age, severe acute pain, extensive rash, craniofacial/thoracic involvement, immunocompromise, comorbidities, and treatment delay. Management of PHN is tiered: Tier 1 treatments include gabapentinoids, the 5% lidocaine patch, tricyclic antidepressants, duloxetine, and the 8% capsaicin patch; Tier 2 treatments include botulinum toxin type A injections, pulsed radiofrequency, and temporary spinal cord stimulation (tSCS); and Tier 3 options include opioids and neuromodulation. PHN remains the most common and therapeutically challenging complication of HZ. Although a stratified framework for PHN management has been proposed, it still requires validation in clinical practice and further refinement to support more effective individualized treatment.

Dexamethasone as an adjuvant to erector spinae plane block is associated with improved neuromonitoring parameters and analgesia in pediatric spine surgery.

Crohn's disease (CD) is a chronic autoimmune inflammatory bowel disease (IBD) with significant diagnostic and therapeutic challenges. We reported a case of a 20-year-old Bangladeshi male with an 8-month history of severe upper abdominal pain, bowel discomfort, and intermittent low-grade fever. Initial investigations showed mild anemia and elevated inflammatory markers. Magnetic resonance enterography revealed distal small bowel thickening, suggestive of IBD. Colonoscopy and biopsy confirmed chronic ileitis without granulomas and an ulcer at the terminal ileum. Despite the absence of granulomas, clinical symptoms, elevated fecal calprotectin, and high C-reactive protein (CRP)led to a diagnosis of CD. The disease later progressed to a perianal abscess, a fistulizing complication. The patient received three doses of infliximab but subsequently discontinued therapy. He remained untreated for 3-years and subsequently developed an intestinal perforation requiring right hemicolectomy with ileostomy. Following ileostomy reversal, adalimumab was advised. This case highlighted the diagnostic and therapeutic challenges of CD in Bangladesh.