Specific Pain Research Articles

Fatigue can influence the development of late-onset pain in post-COVID-19 syndrome: An observational study.

Late-onset pain is frequent following COVID-19, and many pathogenetic mechanisms have been proposed. Identifying the main features of patients may help in designing tailored rehabilitative interventions. We enrolled post-COVID-19 patients with an increase in pain intensity of two points on the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) at 52 weeks compared to the pre-COVID-19 condition. All subjects were retrospectively monitored at 12, 26, and 52 weeks. A specific pain assessment was performed to determine the characteristics and mechanisms of pain. Catastrophizing, kinesiophobia, and other psychological symptoms were evaluated. The pressure pain threshold (PPT) and temporal summation (TS) were measured and compared in age- and sex-matched healthy controls to analyse pain characteristics. A total of 67 patients were recruited, with 20 of them presenting an increase in pain at 52 weeks. Subjects of the two subgroups were similar in demographic and clinical characteristics at baseline; significant differences in fatigue, anxiety, mobility, ability to perform daily activities, and general health perception were recorded at 26 weeks. Fatigue significantly predicted pain onset (β = 0.54, p = 0.002). Sixteen different body regions were identified as painful, with a pain intensity of 6.0 ± 1.9. Most of the samples did not show neuropathic or nociplastic mechanisms. No differences in PPT and TS were recorded between patients and healthy controls. Almost one out of three patients hospitalized for COVID-19 developed pain 1 year later, and fatigue seems responsible for chronicity. An overlapping of conditions may explain late-onset post-COVID-19 pain, and a comprehensive approach must be considered for patient management. Late-onset pain is frequent in post-COVID-19 syndrome and an overlapping of different mechanisms seems to be responsible for its development. Among many predisposing factors, fatigue in the months before seems to be one of the primary causes of pain one year following infection and its management may help to identify new strategies for prevention and treatment of late-onset pain.

Chronic Pain Management in The Basque Health Service: Starting from The Strategy

Introduction: Pain is defined by the International Association for the Study of Pain (IASP) as an "unpleasant, unpleasant, and unpleasant sensory and emotional experience of pain. (IASP) as an "unpleasant sensory and emotional experience, associated with or similar to that associated with actual or potential tissue damage". In Spain, it is estimated that 1 in 6 Spaniards (17%) suffers from chronic pain and that this disease represents the second cause of consultation in primary care (PC) and more than 50% of these interventions are related to it. Of the 10 most prevalent pathologies, half of them are related to pain, with a notably higher impact on women.
 Aims And Objectives:
 - To know the approach to pain, with special emphasis on chronic pain, in the Basque public health system.
 - To carry out an analysis of the results obtained in the survey and in the interviews with key clinical and management professionals.
 - Design and implement a pain strategy in Osakidetza.
 Material And Method: Design of an online survey with the different key areas of a strategy for pain management in a healthcare organization. 31 questions in 8 blocks.
 1.Pain management strategy or plan
 2.Resources allocated by the organization
 3.Assessment tools
 4.Pain management
 5.Training activities for professionals
 6.Information/sensitization and empowerment of the patients and families
 7.Coordination and continuity of care
 8.Evaluation indicators
 Results:
 All organizations have strategies or plans.
 67% of the Integrated care Organisation (ICO) have a Pain commission
 100% of the ICO has a Pain Unit.
 25% have specific resources for primary care.
 100% has medical protocols for referrals and 75% in infirmary.
 100% of ICO use the analog visual scale (AVS), among others.
 83% of the ICOs have drug management reconciliation activities and safety criteria in drug management, and 75% refer to non-pharmacological approach methodologies, mainly related to the neurosciences.
 58% of the OSIs consider that there are activities such as specific courses on pain and in 75% of them encourage an interdisciplinary approach with specific pain care plans such as musculoskeletal pain.
 67% believe that it promotes empowerment interventions, such as community interventions, patient empowerment, group approaches, and health education for both patients and caregivers.
 regarding continuity of care 75% have face-to-face activities and 100% have non-face-to-face activities.
 Realted to evaluation 60% uses AVS instrument and there is a high use of opioids
 Conclussion: Although there are a multitude of interventions and many agents involved in pain management, the truth is that there is great heterogeneity in the availability of the same resources in the different ICO. Pprimary care still has a residual role in the management of these patients as well as non-pharmacological treatments. the lack of psychological care for these patients is striking. Also noteworthy is the almost non-existent difference in care according to the patient's gender.
 Implications For Applicability And Limitations: A strategic plan is therefore necessary for the corporation

The role of walking exercise on axonal regrowth and neuropathic pain markers in dorsal root ganglion after sciatic nerve injury.

The aim of this study was to determine whether walking exercise can regulate the expression level of neuropathic pain- and inflammatory response markers in the ipsilateral lumbar 4 to 6 dorsal root ganglion neurons after sciatic nerve injury (SNI). The experimental rats were randomly divided into seven groups: the normal control group, sedentary groups for 3, 7, and, 14 days postinjury (dpi), and walking exercise groups for 3, 7, and 14 dpi. Western blot techniques were used to evaluate specific neuropathic pain- and cytokine markers and mechanical allodynia was confirmed by paw withdrawal test. Mechanical allodynia was significantly improved in the walking exercise group compared to the sedentary group at all 7, 10, and 14 dpi. Furthermore, growth associated protein 43 and brain-derived neurotrophic factor levels were significantly increased in the walking exercise groups compared to the sedentary group at all 3, 7, and 14 dpi. Conversely, nuclear factor kappa-light-chain-enhancer of activated B cells, interleukin-6, tumor necrosis factor α, calcitonin gene-related peptide, and c-Fos expression levels were significantly decreased in the walking exercise groups compared to the sedentary group at all 3, 7, and 14 dpi. These findings suggest meaningful information that aggressive rehabilitation walking exercise applied early after SNI might be improve mechanical allodynia, neuropathic pain and inflammatory response markers following SNI.

A System for Identifying Deficiency Elements in Apple Leaf Disease Based on Deep Learning

Background: Plant diseases and pests were natural disasters that seriously threaten agricultural production. Leaf diseases posed a significant threat to the overall productivity and quality of apple orchards. Currently, the diagnosis of plant diseases in apple orchards mainly relied on manual labor, which was both time-consuming and costly. It took a considerable amount of time to train an expert capable of accurately identifying apple diseases and pests, and different crop diseases vary. However, with the use of AI technology, training could be completed in just a few hours to a day, transforming computers into experts in disease and pest identification. Although China became a major apple cultivation nation, the development data from 2021 revealed that traditional advantageous production areas were undergoing dynamic adjustments due to optimization of industrial structure, leading to a decrease in cultivated land. Conversely, the demand for apples in the Chinese market continued to rise, even as the country's population structure gradually trended towards an aging population. This situation underscored the urgent need to replace the laborious and high-cost task of identifying apple foliar diseases in the cultivation process with intelligent agricultural technological solutions. Taking into account the aforementioned factors of the natural environment and socio-cultural considerations and addressing the issue of reduced apple yields due to the high impact of foliar diseases, we initiated study on disease prevention and control during the cultivation process. Methods: To overcome the objective impact of environmental factors, the system extracted images and performed operations such as enhancement and segmentation. Subsequently, a convolutional neural network was employed to process the enhanced images, extracting features such as color, shape, and texture of apple foliar lesions, which were then summarized into histograms using mathematical methods. These histograms served as the primary reference for distinguishing various diseases. Python was chosen as the programming language for the system, and the recognition system was operated by integrating frontend technologies, backend database design, and other relevant techniques. Results: Based on a substantial number of experimental results, the apple leaf disease and nutrient deficiency recognition system could accurately and with extremely high precision identifying major diseases commonly occurring in apple plants, including apple scab, leaf spot disease, rust disease, gray mold disease, and brown spot disease. Moreover, the system was capable of proposing remedies tailored to the specific pain points of each disease. It not only detected apple leaf diseases but also performs nutrient deficiency detection. This holds significant importance in enhancing both the yield and quality of apples. Conclusion: For the commonly occurring foliar diseases in cultivation, the system exhibited the capability to autonomously recognize and provide decision feedback. In contrast to the less efficient and more costly traditional approach of consulting experts, the more accessible apple foliar disease recognition system was poised to replace it as a primary tool for prevention and control assistance. This system will serve as a guiding companion, safeguarding the robust growth of apple plants.

Comparison of Treatment Outcome of the Effectiveness of Isometric Exercises as Compared to General Exercises with Cervical Spine Mobilization in The Management of Chronic Non Specific Neck Pain

The purpose of this study was to evaluate the “effectiveness of isometric exercises as compared to general exercises along with cervical spinal mobilization to reduce pain, disability and to increase range of motion in chronic non-specific neck pain”For this randomized controlled experiment total 32 patients (16 in each group) with chronic non-specific neck pain were recruited from physiotherapy Ward Mayo Hospital Lahore, Department of Physiotherapy King Edward Medical University Lahore between October, 2019 and March, 2020. Simple randomization method was used to assign participants into isometric exercise group and general exercise with cervical spine mobilization group. The isometric exercise group performed exercises for neck muscle groups with a rubber band and general exercises with cervical mobilization group performed active range of movement exercises for all neck movements. Patients in both groups received 4 supervised treatment sessions per week for 6 weeks. Visual Analogue Scale (VAS), Neck disability index Questionnaire and goniometer were used to assess pain, disability and neck range of movements at baseline and after 6 weeks.Both interventions showed statistically significant improvements in pain, function and range of movement p = 0.001for isometric exercise group, p = 0.05 for general exercises group and p= <0.001 for range of movement. However, mean improvements in post intervention VAS score and Neck disability index Questionnaire score was better in isometric exercises group as compared to general exercise group. In conclusion, both interventions are effective in the treatment of chronic non- specific neck pain however; isometric exercises are clinically more effective than general exercises with cervical spine mobilization.

TO STUDY PALLIATION OF SYMPTOMS BY A HYPOFRACTIONATED RADIOTHERAPY SCHEDULE IN ADVANCED INOPERABLE SQUAMOUS CELL CARCINOMAS OF THE ORAL CAVITY

Introduction: Decisions regarding optimal integration of surgery, radiation, and chemotherapy should be made on a case to case basis in a multidisciplinary tumor board setting. Treatment planning of advanced oral cavity cancers is derived from trials that included a heterogeneous group of patients which included all head and neck sites and observational data from the oral cavity cancer patient series. Aim: The aim of the study was to study palliation of symptoms and improvements in quality of life (QoL) in inoperable squamous cell cancers of the oral cavity with a hypofractionated radiotherapy schedule. Methods: It is a prospective and observational study in patients with locally advanced squamous cell cancers of the oral cavity attending the outpatient clinic who have been deemed inoperable after discussion in a multidisciplinary team were considered. The data was tested using Friedman’s test for the significance in QoL. Results: All of the functional scales were found significant in this study with physical functioning, emotional functioning and cognitive functioning (CF) being significant at 1% alpha level while role functioning (RF) and social functioning (SF) are significant at 5% alpha level. RF was assessed based on the capabilities of the patient to finish daily activities. The median score remained at 33 but the interquartile range (IQR) was showing an increasing trend. Both pain and head-and-neck specific pain had significantly reduced over time. Fatigue had shown a constant reduction during radiation and during the first follow-up as well. The increase in nausea, vomiting, and constipation during radiation can be attributed to the use of morphine during radiation for pain control and as an effect of radiation itself. There was weight loss during radiation which improved during subsequent follow-up visits. Conclusions: In patients diagnosed with inoperable oral cavity cancer, hypofractionated radiotherapy delivering 50 Gy in 20 fractions over 4 weeks is a well-tolerated and safe regimen. In our study, statistically significant QoL improvement in global health score, SF, and CF lasting for a minimum of 6 weeks was attained after completion of treatment with this regimen.

Associations between the Use of Pain Management Strategies and Self-Reported Emotional and Behavioral Functioning of Adolescent and Young Adults with Sickle Cell Disease

Background: Sickle Cell Disease (SCD) often causes significant pain that may require the use of various pain management strategies. These strategies are typically categorized into two broad groups, pharmacological and nonpharmacological, but a need exists to understand how specific strategies may impact an individual's functioning. This understanding is especially critical when considering adolescents and young adults (AYA) with SCD, as this age range may experience increased pain and other SCD complications that coincide with the transition from pediatric to adult care. Methods: Adolescent and young adult patients with SCD completed the Behavioral Assessment System for Children, Third Edition (BASC-3), a measure of emotional and behavioral functioning, and a questionnaire about their pain management strategy use. These strategies were categorized as: Over the Counter Medication (acetaminophen, ibuprofen, naproxen), Prescription Medication (codeine, short-acting morphine, long-acting morphine, oxycodone, hydrocodone, hydromorphone, gabapentin, amitriptyline), Psychological Strategies (deep breathing, imagery, distraction, talking with friends/family, prayer/meditation), and Behavioral Strategies (hydrate, apply heat, apply cold, massage, smoking, rest/sleep). Analyses included Spearman rank correlations to determine the relationship between categories of pain management strategies and self-reported BASC scores. Based on correlation results, independent sample t-tests were conducted to further examine the relationship between the use of specific pain management strategies and self-reported BASC scores. Results: Participants included 94 AYA patients with SCD (Mean age = 18.1 ± 1.5 years; 51.1% female; 52.1% HbSS). Of the pain management categories, Prescription Medication and Behavioral Strategies had significant correlations with self-reported BASC scores. Within the Prescription Medication category, participants that reported use of hydrocodone (40.9%) self-reported higher scores on the Social Stress (p = 0.01) and Somatization (p = 0.001) scales of the BASC-3 as well as lower scores on the Interpersonal Relations (p = 0.048) scale compared to participants that did not use hydrocodone. Those using oxycodone (25%) self-reported higher scores on the Somatization (p = 0.002) scale and lower scores on the Interpersonal Relations (p = 0.036) scale compared to those that did not use oxycodone. Participants that reported use of gabapentin (6.8%) self-reported higher scores on the Social Stress (p = 0.006) and Somatization (p = 0.009) scales compared to those that did not use of gabapentin. Compared to participants that did not use amitriptyline, those that reported use (3.4%) self-reported higher scores on the Somatization (p = 0.017) scale. Within the Behavioral Strategies category, adolescents and young adults that reported the use of smoking to manage pain (7.3%) self-reported higher scores on the Somatization (p < 0.001) and Attention Problems (p < 0.001) scales than those that did not smoke. Additionally, participants that reported the application of cold temperature to manage pain (15.9%) self-reported higher scores on the Attitude to School (p = 0.03) and Attention Problems (p = 0.006) scales compared to those that did not use this strategy. Conclusions: Results indicate that specific pain management strategies may be associated with different social, emotional, and behavioral functioning. Further exploration to understand the mechanisms between specific pain management strategies and patient functioning during the AYA period is warranted. Given the unique challenges of adolescents and young adults with SCD, future work should also investigate how specific pain management strategies may improve the experience of those transitioning from pediatric to adult care.

A Review on Effects of Exercises Therapy for Office Workers with Chronic No Specific Low Back Pain

Study Design: A literature review was conducted in order to provide an overview of the effect of exercise therapy for office workers with chronic Non-specific low back pain. Review provides a summary of large bodies of evidence and reviews help to explain differences among studies. Objectives: The aim of this study is to review exercises therapy for office workers with chronic nonspecific low back pain treatment. Background: Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. Exercise therapy is widely used as an intervention in low back pain. Low back pain is defined as discomfort that develops above the posterior glutelines and below the costal edge of the final ribs, with or without lower limb pain(1).Between 60 and 85% of people experience it at some point throughout their lives(2). Methods: Search strategy: Relevant articles were identified by engines such as SCIENCE DIRECT, PUBMED, GOOGLESCHOLAR, and COCHRANE DATA BASE OF SYSTEMATIC REVIEW (www.cochrane.org), and CINALE.Website like physiopedia (www.physiopedia.com) was searched and published texts were `also reviewed in these studies.

Non-Invasive Screening for Sickle Cell Disease Using Only a Smartphone Application

Introduction Pediatric mortality due to Sickle Cell Disease (SCD) remains high and often occurs prior to diagnosis in most black and brown low- and middle-income countries (LMICs), due to the high prevalence of SCD and limited resources in these countries.To that end, we developed a low-cost non-invasive screening tool that can be widely available at the point of need. Our screening tool utilizes the power of both image analysis and predictive algorithms as a novel approach to SCD screening and diagnostics. In this new app, we have combined the quantitative analysis of fingernail pallor, an adaptation of our previously described smartphone app for estimating blood hemoglobin levels using smartphone images of the nail beds, with qualitative symptom and medical history data to compute an SCD Likelihood Score (SLS) that provides an individual's pre-diagnostic test potential for disease, a key metric in the disease screening and diagnostic process. Methods 417 subjects ages 0.5-20 years old were enrolled from Children's Healthcare of Atlanta (CHOA) hematology/oncology clinic; of these patients, 219 patients had SCD, and 198 did not. Pediatric patients were screened because they best simulated the target populations aimed for the app's use. Our analysis was restricted to the presence of specific pain, past stroke history and/or symptoms, splenic crises, neurodevelopment disorder, family history of SCD, due to their specificity to SCD and their ability to be answered without the need for resource-intensive diagnostics. The SLS was calculated by determining the presence of these medical history items and the patient's anemia status informed by the patient's most recent CBC. For each symptom a weighted score was generated by finding the difference between the percentage of subjects with SCD and those without SCD, who experienced the symptom. The presence of symptoms was binarized with 1 indicating the presence of a symptom and 0 indicating the absence of a symptom. The binary value of the symptom was then multiplied by the symptom's respective weighted value. These values were totaled and normalized to give the overall clinical profile-weighted score with the same weight as the anemia status. A receiver operating characteristic analysis was conducted to select a threshold for the SLS that provided the most accurate diagnosis in our training dataset. We incorporated this SLS model into our lab's previously described smartphone app predictive algorithm . Results A clinical assessment of the screening app was conducted at CHOA and enrolled 68 participants from both in-patient and out-patient settings. Patient hemoglobin measurements were obtained using our previously described hemoglobin screening app and patients (and their parents for those needing their assistance) were asked to provide responses to the symptom survey. Of the five medical history items queried, family history and a history of splenic crisis when present was found to contribute to 30% and 41%, respectively, of the overall clinical profile score. Whereas the presence of a history of pain, stroke history, and learning difficulties made up smaller portions of this portion of the SLS. The app performed with a sensitivity of 100% and a specificity of 75% in screening for SCD in patients <5 years of age, the target demographic for early screening. Conclusion This SCD screening application has the potential to expand and improve SCD outcomes in LMICs where access to the gold standard or any accurate diagnostic tools is limited. The app's non-invasive and easy-to-use nature and the ubiquity of smartphones globally make this screening tool a practical and feasible mode of screening. Early disease screening is paramount to survival for children with SCD and if this tool proves to be accurate in these settings, can be lifesaving for the hundreds of thousands of infants with SCD born in LMICs per year. Non-invasive modalities such as our SCD screening application can enable resource allocation and cost reduction by identifying those patients who do and do not have a high likelihood of disease, thus reserving tests for those who are high risk.

LmNaTx15, a novel scorpion toxin, enhances the activity of Nav channels and induces pain in mice

Polypeptide toxins are major bioactive components found in venomous animals. Many polypeptide toxins can specifically act on targets, such as ion channels and voltage-gated sodium (Nav) channels, in the nervous, muscle, and cardiovascular systems of the recipient to increase defense and predation efficiency. In this study, a novel polypeptide toxin, LmNaTx15, was isolated from the venom of the scorpion Lychas mucronatus, and its activity was analyzed. LmNaTx15 slowed the fast inactivation of Nav1.2, Nav1.3, Nav1.4, Nav1.5, and Nav1.7 and inhibited the peak current of Nav1.5, but it did not affect Nav1.8. In addition, LmNaTx15 altered the voltage-dependent activation and inactivation of these Nav channel subtypes. Furthermore, like site 3 neurotoxins, LmNaTx15 induced pain in mice. These results show a novel scorpion toxin with a modulatory effect on specific Nav channel subtypes and pain induction in mice. Therefore, LmNaTx15 may be a key bioactive component for scorpion defense and predation. Besides, this study provides a basis for analyzing structure-function relationships of the scorpion toxins affecting Nav channel activity.

General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis.

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. Methods: A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1 st, 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials(RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. Results: General anesthesia resulted in fewer Clavien-Dindo grade II (OR: 0.68; 95% CI: 0.49 - 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 - 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 - 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 - -5.41; p<0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 - -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 - 0.20; p<0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 - 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Conclusions: Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.

Acupressure for Pain of Osteoarthritis : A Systematic Review

Background: Osteoarthritis can be defined as a disorder of movable joints characterized by deterioration of articular cartilage; osteophyte formation and bone remodeling; changes in periarticular tissues; and a low-grade, nonpurulent inflammation of variable degree. Acupressure is a traditional non-pharmacological intervention that promotes blood circulation and muscle activity. Purpose: This review aimed to investigate the efficacy of acupressure as a complementary therapy method for the pain of osteoarthritis. Methods: Four electronic databases were searched from PubMed, ProQuest, Scopus, and The Cochrane Library use PICO strategy. In studies comparing acupressure with sham acupuncture, no intervention, or conventional intervention was eligible for inclusion. Article study is published on 2012-2022, using English and design RCT and Quasi-experiment. Prisma analysis was used in selection process. The risk of bias in the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tools for Quasi-Experimental Studies and Randomized Controlled Trials. Results: There were 12 reports selected for review with the homogeny of knee Osteoarthritis. Outcomes were either objectively- or subjectively assessed improvements in specific pain parameters and safety for clinical use. Results showed more clinical trials with proper methodology are needed to confirm the effectiveness of acupressure for the pain of Osteoarthritis. The results of the review showed a positive effect in reducing pain level with acupressure intervention as either the main or complementary therapy. Conclusion: This systematic review shows that acupressure as a single or complementary intervention provides significant benefits in the management of Osteoarthritis. Further trials with a more rigorous design are needed to further validate and address the limitations of the current evidence.

Nitrous oxide for the treatment of complex regional pain syndrome: a randomized blinded trial

IntroductionComplex Regional Pain Syndrome (CRPS) is a debilitating neuropathic condition often refractory to conventional treatments. N-methyl-D-aspartate (NMDA) receptor antagonists have a well-established role in the development and modulation of chronic...

Loss of PKCδ/Prkcd prevents cartilage degeneration in joints but exacerbates hyperalgesia in an experimental osteoarthritis mouse model

Pain is the prime symptom of osteoarthritis (OA) that directly affects the quality of life. Protein kinase Cδ (PKCδ/Prkcd) plays a critical role in OA pathogenesis; however, its significance in OA-related pain is not entirely understood. The present study investigated the functional role of PKCδ in OA pain sensation. OA was surgically induced in control (Prkcdfl/fl), global- (Prkcdfl/fl; ROSACreERT2), and sensory neuron-specific conditional knockout (cKO) mice (Prkcdfl/fl; NaV1.8/Scn10aCreERT2) followed by comprehensive analysis of longitudinal behavioral pain, histopathology and immunofluorescence studies. GlobalPrkcd cKO mice prevented cartilage deterioration by inhibiting matrix metalloproteinase-13 (MMP13) in joint tissues but significantly increased OA pain. Sensory neuron-specificdeletion of Prkcd in mice did not protect cartilage from degeneration but worsened OA-associated pain. Exacerbated pain sensitivity observed in global- and sensory neuron-specific cKO of Prkcd was corroborated with markedly increased specific pain mediators in knee synovium and dorsal root ganglia (DRG). These specific pain markers include nerve growth factor (NGF) and vascular endothelial growth factor (VEGF), and their cognate receptors, including tropomyosin receptor kinase A (TrkA) and vascular endothelial growth factor receptor-1 (VEGFR1). The increased levels of NGF/TrkA and VEGF/VEGFR1 were comparable in both global- and sensory neuron-specific cKO groups. These data suggest that the absence of Prkcd gene expression in the sensory neurons is strongly associated with OA hyperalgesia independent of cartilage protection. Thus, inhibition of PKCδ may be beneficial for cartilage homeostasis but could aggravate OA-related pain symptoms.

Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features.

Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.

Peripheral Mechanism of Cancer-Induced Bone Pain.

Cancer-induced bone pain (CIBP) is a type of ongoing or breakthrough pain caused by a primary bone tumor or bone metastasis. CIBP constitutes a specific pain state with distinct characteristics; however, it shares similarities with inflammatory and neuropathic pain. At present, although various therapies have been developed for this condition, complete relief from CIBP in patients with cancer is yet to be achieved. Hence, it is urgent to study the mechanism underlying CIBP to develop efficient analgesic drugs. Herein, we focused on the peripheral mechanism associated with the initiation of CIBP, which involves tissue injury in the bone and changes in the tumor microenvironment (TME) and dorsal root ganglion. The nerve-cancer and cancer-immunocyte cross-talk in the TME creates circumstances that promote tumor growth and metastasis, ultimately leading to CIBP. The peripheral mechanism of CIBP and current treatments as well as potential therapeutic targets are discussed in this review.

Revisiting the factor structure of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2): Evidence for a bifactor model in individuals with Chiari malformation.

The Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2; Dworkin et al., 2009) is intended to measure the multidimensional qualities of pain (i.e., continuous, intermittent, neuropathic, and affective) as well as total pain. Using structural equation modeling, we evaluated the fit of four competing measurement models of the SF-MPQ-2-an oblique 4-factor model, a 1-factor model, a higher-order model, and a bifactor model-in 552 adults diagnosed with Chiari malformation, a chronic health condition whose primary symptoms include head and neck pain. Results revealed the strongest support for the bifactor model, suggesting that SF-MPQ-2 item responses are due to both a general pain factor and a specific pain factor that is orthogonal to the general pain factor. Additional bifactor analyses of the SF-MPQ-2's model-based reliability and dimensionality revealed that most of the SF-MPQ-2's reliable variance is explained by a general pain factor, and that the instrument can be modeled unidimensionally and scored as a general pain measure. Results also indicated that the general and affective pain factors in the bifactor model uniquely predicted pain-related external criteria (e.g., depression, anxiety, and stress); however, the continuous, intermittent, and neuropathic factors did not.

Analyzing facial action units in children to differentiate genuine and fake pain during inferior alveolar nerve block: a cross-sectional study

This study aimed to investigate the association between facial action units and pain levels in Syrian children, focusing on both genuine and fake pain expressions. A total of 300 Syrian children aged 6–9 years participated in the study. Pain levels were assessed using the validated Face, Legs, Activity, Cry, Consolability scale, and facial expressions were analyzed using the Facial Action Coding System. The children were asked to mimic their feelings after receiving a dental injection to elicit fake pain expressions. Statistical analysis, including multinomial logistic regression and chi-square tests, was conducted to determine the Action Units (AUs) associated with each pain level and to compare the differences between real and fake pain expressions. The results revealed significant associations between specific AUs and pain levels. For real pain expressions, the most activated AUs across different pain levels with positive coefficient values of correlation (P-value < 0.01) were analyzed. In contrast, for fake pain expressions, AU12 and AU38 were consistently observed to be the most activated. These findings suggest that certain AUs are uniquely associated with fake pain expressions, distinct from those observed in real pain expressions. Furthermore, there were no significant differences between boys and girls in terms of their genuine and fake pain expressions, indicating a similar pattern of AU activation (P-value > 0.05). It was concluded that AUs 4, 6, 41, and 46 were associated with mild pain, and AUs 4, 6, 41, 46, and 11 were associated with moderate pain cases. In severe pain, AUs 4, 6, 7, 9, 11, and 43 were associated. In fake pain feelings, AU43, AU38, and AU12 were the most activated with no difference between boys and girls.

Sleep Disorders and Chronic Pain Syndromes in the Pediatric Population

Sleep problems are widespread in children and adolescents suffering from chronic pain disorders. Sleep loss intensifies the experience of pain and is detrimental to the budding self-efficacy of a young individual with limitless horizons. Addressing sleep disorders may prevent the chronification of pain and prevent adverse health outcomes, such as functional impairment, psychiatric comorbidities and overall poor quality of life. This review will explore the cyclical nature between sleep, pain and mood, as well as the functional impact of this relationship on children and adolescents. There will be a discussion about sleep assessment and diagnostic testing, followed by a description of sleep disturbances found in specific pain conditions, ranging from headache, musculoskeletal/abdominal pain, to rheumatologic disorders. Finally, there will be a brief review of pharmacologic and behavioral interventions designed to improve sleep quality, and when possible, to alleviate pain.

Treatment of Pain Revisited ‐ The argument against too rapid resort to narcotic analgesics in Emergency Departments in Australia

Introduction: Pain is a common neurological complaint with many patients already taking narcotic analgesics at presentation to the neurologist. This paper examines an approach to pain management aimed to avoid narcotic analgesics. Clinical Practice: Pain is subjective and may be considered as either acute or chronic pain, differentiated between pain provoking avoidance or pain without benefit. Pain management is determined by the underlying diagnosis and clinical status. Use of Narcotic Analgesics: Narcotic analgesics have the potential for abuse and pose public health risks. Abuse has increased among street and recreational drug users. The Australian Government restricted access to combination codeine containing medications, requiring a prescription and medical supervision. Discussion: While there exist specific pain syndromes, the use of narcotic analgesics should be judicious. Their use should be restricted to refractory pain but should not exclude their legitimate use, once alternative remediation has been exhausted and entails medical supervision. Conclusion: Narcotic analgesics should not be the first line treatment for pain, with initial approach directed towards diagnosis and treating the underlying cause. Once refractory chronic pain has been established, narcotic analgesics should be available under medical supervision, acknowledging the risk of overuse and addiction.