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Pain radiating from the lower back to the lower limb below the knee is known as sciatica. The purpose of this research was to ascertain how patients with sciatica responded to multimodal rehabilitation therapy. Fifty-one patients with persistent sciatica receiving treatment at the Medical Rehabilitation Clinic of the Clinical Center of Vojvodina were included in the study. In addition to demographic information, we also collected scores from the Oswestry Disability Index, Central Sensitization Inventory, Fear Avoidance Component Scale, and Numerical Rating Scale. At the beginning and completion of the treatment, results were acquired. Thirty-four out of the patients, or 66.7%, were female. The stationary multimodal treatment for chronic pain took place for a period of 20.48 ± 5.89 days. After the treatment, the NRS assessed pain intensity had significantly decreased (6.49 ± 2.22 vs. 5.00 ± 2.22, t = 5.629, p < 0.001). Following the treatment, there was a substantial improvement in the average ODI score (48.75 ± 15.16 vs. 42.24 ± 14.13 (t = 4.246, p < 0.001) and FACS score (66.80 ± 14.13 vs. 62.47 ± 16.49, t = 2.086, p = 0.042). After the course of the treatment, the CSI score decreased, although this change was not statistically significant (t = 1.446, p = 0.155). Patients receiving stationary comprehensive rehabilitation treatment see improvements in their functional status, a decrease in their level of fear-induced activity avoidance, and a reduction in the severity of their pain. [ABSTRACT FROM AUTHOR]

An intensive care and reanimation unit (ICU) is a hospital ward that provides optimal care and treatment for critically ill patients. The reanimation unit is a very stressful environment for patients. Aims of the study were to evaluate and identify the pain experience of ICU patients and adequate assessment of pain. This study was conducted as a prospective, observational study involving 121 patients treated in the Reanimation Department, Emergency Center, Clinical Center of Vojvodina. All the examined patients over 18 years of age hospitalized in this Department who met inclusion criteria were interviewed at the bedside. Data were collected by using the questionnaire filled in by a doctor during their conversation with a patient. Thirty-two point two percent of patients were hospitalized from 3 to 7 days, the same percentage of patients were hospitalized for more than 7 days, while 21.5% were hospitalized 1-3 days and 14.1% for one day. Sixty-one point eight percent of the patients reported inability of speech, 14.5% of patients stated their inability of speech and not knowing who to refer to as a problem. Sixty-four point four six percent of patients received analgesic therapy soon after complaining of pain, while 4.13% of patients reported not having analgesics after complaining of pain. Eighty-four point one percent of patients received therapy intravenously. Fifty-six percent of patients answered positively and 3.5% of patients were not satisfied with prescribed analgesics. Fifty-five point three seven percent of patients had the strongest daytime pain. Many factors contributed to increased pain intensity: the extent of performed surgical treatment, surgical wound, injuries and fractures, numerous medical procedures, prolonged immobility in bed and back pain as a consequence. [ABSTRACT FROM AUTHOR]

The elderly are the fastest increasing population with multiple comorbidities and polypharmacy. They are especially prone to pain, both chronic and neuropathic, and treatement in the geriatric context should be based on balancing between benefits and risks. The process of aging includes multiple changines in the structure, neurochemistry and function of the nociceptive pathways, and also a significant reduction in the functioning of the endogenous inhibitory analgesic pathway. Because of the comorbidities, the elderly often use multiple drugs and in the context of changed physiology, especially pharmacokinetics, there is a big risk factor for side effects. Holistic geriatric assessment is a useful tool in the prevention of circulus vitiousus in the farmacotherapy of pain. Generally the conclusion is that analgetics which are used in the younger adult population are useful in the elderly as well, but the ratio between risks and benefit should be carefully evaluated. Recommendations for pharmacological treatement of pain in this vulnerable population are based on safety rather than efficacy. [ABSTRACT FROM AUTHOR]

There is growing evidence that a number of genes play a critical role in determining pain sensitivity, pain reporting and susceptibility to developing chronic pain and their response to surgical outcomes, primarily the pain. Genomic variations influence basal pain sensitivity and the likelihood of developing chronic pain so it is logical that the future of medicine is to provide more focused treatment based on a person's genetic code. The completion of the human genome project in 2003 has provided a better understanding of why patients may experience pain syndromes. Pain has diverse etiologies, mechanisms, and characteristics, and causes variable responses that are interpreted differently among individuals. Genomic variations influencing basal pain sensitivity and the likelihood of developing chronic pain diseases have been noted and continue to be studied. Epigenetic mechanisms have also been implicated in the transition from acute to chronic pain, as well as its role in the development of chronic post-surgical neuropathic pain. Epigenetic, as well as genetic, mechanisms have been implicated in diverse pain conditions like "human bladder pain syndrome", as well as primary headaches, migraine and cluster headache. For the pain states, no robust genetic markers have been identified so far. Better understanding of pain-related genetic influences will provide important insights into the mechanisms of pain and may identify new targets for pharmacologic and other therapies. The selection of pain phenotype could substantially influence the nature and magnitude of any genetic association. It is inevitable that multiple genes, each with a small individual effect, interact among themselves and with a variety of environmental factors, to influence pain sensitivity and the expression of chronic pain conditions. Several studies have shown that polymorphisms in genes affecting the function of both catecholaminergic and serotonergic systems may be associated with chronic pain disorders Better understanding of pain-related genetic influences will provide important insights into pain mechanisms and may identify new targets for pharmacologic and other therapies. [ABSTRACT FROM AUTHOR]

Аfter lumbar microdiscectomy, different psychological factors can influence the postoperative back pain, including depression and pessimism. The aim of the study was to determine the correlation between pain intensity and functional disability in patients after lumbar microdiscectomy. The research was conducted on 198 patients at Clinical Centre of Vojvodina, Medical Rehabilitation Clinic Novi Sad, Serbia, with a permit from the Ethics Committee of Clinical Centre of Vojvodina. Four administered and validated questionnaires were utilised to obtain information about pain and its intensity and character, presence and degree of functional disability and depression, as well as personal expectations (pessimistic/optimistic) about the treatment results after microdiscectomy. These assessments were carried out after lumbar microdiscectomy in four time slots: just before rehabilitation treatment, and 1, 3 and 6 months after microdiscectomy. Patients with a high degree of current and general anxiety and with clinically pronounced depression had pain of greater intensity. Significantly lower pain intensity, if any pain was present at all, was in patients who were not anxious or depressed and who were optimistically oriented. The mentioned differences in pain intensities, in all periods of the examination, were statistically highly significant (p < 0.01). Pain and functional disability of the patients after lumbar microdiscectomy are notably related to gender, depression and pessimism. The sensation of the pain was higher in women, while men had a greater degree of functional disability. Intensity of pain and functional disability were significantly greater in patients with a higher degree of depression and pessimism and by registering mentioned factors it is possible to predict the postoperative results. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause long-term disability (prolonged COVID) with neurological manifestations even after mild infections. Reports of peripheral neuropathy and polyneuropathy include Guillain-Barré syndrome, mononeuritis multiplex, brachial plexitis, cranial neuropathies, and orthostatic intolerance. Various prolonged symptoms of COVID overlap with symptoms of small fiber polyneuropathy. Recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears to be exponential, with patients reporting a variety of long-term symptoms of COVID, including unexplained fatigue/exertion intolerance and dysautonomic and sensory problems. Indirect evidence links long-term COVID with incident polyneuropathy affecting small fiber (sensory/autonomic) axons. Cross-sectional and longitudinal data were analyzed from patients with long COVID, as defined by World Health Organization (WHO), without a previous history of neuropathy or a clinical presentation suggestive of peripheral neuropathy. Standardized symptoms were diagnosed, clinical examination, neurodiagnostic tests and outcomes were performed. Research and monitoring of symptoms lasted for a year. A prospective study examined 68 patients (mean age 43.5 years, 79% of females), 59% had ≥ 1 test results confirming neuropathy. This included 50% of autonomic function tests. Three patients were diagnosed with critical illness axonal neuropathy. While one patient was diagnosed with multifocal demyelinating neuropathy 3 weeks after mild COVID, ≥ 20 were diagnosed with small fiber neuropathy. Longitudinal improvement averaged 72%, although no one reported complete resolution. In 85% of patients, immunotherapy (corticosteroids and/or IV immunoglobulins) was administered. Among evaluated patients with long-term COVID-19 after mild SARS-CoV-2 infection, prolonged, often disabling small-fiber polyneuropathy was most common, starting as early as month after the onset of COVID-19 infection. [ABSTRACT FROM AUTHOR]

Complementary medicine methods have been used increasingly to treat painful conditions such as neck and back pain, joint pain, headaches, and myofascial pain. The methods are used both in acute and chronic conditions. Pharmacological approaches may be unavailable for individual patients because of the adverse effects or precautions due to interactions with drugs used to treat comorbid conditions. Recent research also shows the possibility of complementary medicine methods acting on the hyperexcitability of different nervous system structures. The most important feature of these methods is safety in use. In this regard, the professional public's interest in integrative strategies for treating pain has grown in recent years. An electronic search of PubMed, The Cochrane Library, EMBASE, Google Scholar, and Science Citation Index Expanded databases was conducted with the following keywords: pain, alternative medicine, and complementary medicine. The methods used are relaxation, yoga, tai chi, manipulative techniques, and acupuncture. The literature review indicates a varying degree of effectiveness of the methods and methodological shortcomings of research in this area. Generally speaking, positive evidence for applying yoga, relaxation methods, tai chi, and manipulative techniques is still weak. However, the results from a systematic review of the literature indicates significant evidence for using acupuncture to treat painful conditions. Research also suggests that the degree of recommendation by the professional public for the application of complementary medicine is still weak, despite the appearance of recommendations in the specific guides for the treatment of painful conditions. There is also a noticeable trend of multimodal application of complementary medicine methods in treating pain. [ABSTRACT FROM AUTHOR]

Pain remains one of the most common medical problems in rehabilitation, and it is one of the most clinically challenging complications that occurs after a stroke. Post-Stroke Pain (PSP) often decreases patients’ functional status and it can negatively affect the rehabilitation outcome. To quantify and characterize pain in a sample of post-stroke patients undergoing rehabilitation and to investigate the impact of pain on patient’ functional status. This single center cross-sectional study icluded 56 inpatients with subacute and chronic stroke who were treated at Medical rehabilitation department, Clinical Centre of Vojvodina from 01.01.2021. to 31.12.2021. Pain intensity was measured with the Numerical Rating Scale (NRS). Furthermore, pain characteristics were assessed with the Douleur Neuropathique en 4 Questions (DN4), and Neuropathic Pain Symptom Inventory (NPSI) questionnaires. Functional outcome was measured with Barthel index (BI). A clinical assessment on pain occurrence, impact, and management was administered by the physician in charge of the patients. About half of the patients (49.2%) reported pain occurrence after the stroke. Most of them had moderate to severe pain (NRS ≥ 3) – 76.3%. It was found that in 48.3% of patients the pain had neuropathic components (DN4 ≥ 4). Significantly higher neuropathic pain scores were found in patients with hypoesthesia than in patients with a normal sensory function. Regarding functional outcome, we found that patients with higher neuropathic pain had lower functional outcome measures compared to the patients with no pain detected. The results from the study show that neuropathic pain can negatively influence the functional outcome after a stroke. Pain in post-stroke patients should be carefully evaluated both in regards to intensity and its neuropathic components. Individually designed pharmacological and physical therapy for treatment and prevention of pain might improve patients’ functional outcome and add quality to the rehabilitation process. [ABSTRACT FROM AUTHOR]

Pain perception is a complicated process and depends both on ascending pathways that convey nociceptive information to the central nervous system and descending pathways through which nociceptive information can be modulated. There are two ways of nociceptive input modulation: inhibition and facilitation. One inhibitory system is diffuse noxious inhibitory control and conditioned pain modulation (CPM) is the new term for this paradigm in humans. CPM tests are based on the theory that "pain inhibits pain". One painful stimulus (conditioning stimulus) can modulate another painful stimulus (test stimulus). CPM effects can be evaluated by measuring the difference between pain induced by a test stimulus (TS) before, and pain during or after the administration of a painful conditioning stimulus (CS) in the remote body region. Efficient CPM represents inhibition of pain induced by the TS as a response to the CS. In certain chronic painful conditions (e.g. fibromyalgia, low back pain, temporomandibular disorders, irritable bowel syndrome, etc.) deranged CPM is frequently seen. In addition, it has been shown that efficacy of the descending pain inhibition could be a significant factor in the advancement of acute to chronic pain. Therefore, the interest in protocols that investigate CPM in a clinical setting is rising. Various TS and CS are used in existing CPM protocols. Mechanical, thermal, and electrical stimuli are the most frequently used modalities as a TS, while cold pressure test, contact heat and cuff pressure are the most frequently used as a CS. However, the gold standard for the CPM testing has not been reached yet. Although development of the clinically useful test for evaluation of the CPM is challenging, designing of such a test would be valuable for determination of the individual pain modulation profile and for designing the most efficient pain treatment. [ABSTRACT FROM AUTHOR]

Pain in inflammatory rheumatic diseases is caused by chronic destructive synovitis and the existence of multisystemic dysfunction.The sensitivity threshold is hereditary and is linked to GCH-1, a gene on chromosome 7. About one quarter of people in the world have a special type of this gene, which is responsible for protection against pain. Unlike acute nociceptive pain in inflammatory rheumatic diseases, which is short-lived and has a protective role, chronic pain lasts longer than 3 months, is accompanied by physical and psycho-social changes, reduces the quality of life and represents a separate clinical entity. Pain therapy in inflammatory rheumatic diseases is complex and requires a clear idea of the cause of pain and the mechanisms of its occurrence. Nociceptive inflammatory pain is most often treated with DMARDs, anti-inflammatory drugs and analgesics. Chronic pain, however, is much more difficult to treat and often requires a multidisciplinary approach. The treatment usually starts with medication (csDMARDs, bDMARDs, tsDMARDs, anti-inflammatory drugs, analgesics, coanalgesics), but those are not a long-term effective solution, due to the numerous side effects. Recently, the influence of the multifunctional protein regulator of G protein signaling 4 (RGS4) on the maintenance and modulation of chronic pain in the brain has been discovered. The role of RGS4 helps to relieve pain and sensory symptoms, and these findings open the possibility of exploring new therapeutic modalities. The use of drugs in the treatment of pain in rheumatic patients is long-term, but it can also be uncritical with numerous adverse reactions. A multimodal approach to treatment can achieve an analgesic effect and minimize unwanted consequences. The importance of physical agents (laser therapy, magnetotherapy, transcutaneous electrostimulation, diadynamic currents, interference currents, galvanic current, electrophoresis, ultrasound, sonophoresis) in the treatment of chronic pain is great because it reduces the need to take drugs, and there are no unwanted side effects. Various alternative methods are available that can also be helpful: tai chi exercise, yoga, acupuncture, music and art therapy, pet therapy, psychotherapy. massage, meditation... In addition to nociceptive, inflammatory pain therapy, early discovery of neuropathic pain (using PainDetect and DN4 questionnaire) is very important for a successful treatment outcome. Effective drugs for this type of pain are drugs that stabilize or modulate CNS functions, tricyclic antidepressants (TCAs) or anticonvulsants. The most commonly used drugs in this group are pregabalin, carbamazepine, phenytoin, valproic acid, clonazepam and gabapentin. After using TCAs and anticonvulsants, local anesthetics are given in the third line. Multimodal treatment includes a pharmacological approach, regular exercise, physical therapy, adequate nutrition, psychotherapy, functional neurosurgery, and various surgical techniques. In addition to treating the underlying disease, pain in inflammatory rheumatic diseases requires an individual approach. Physical pain is related to emotional pain, so mastering emotional skills can affect stress, which is related to the health condition. Pain in inflammatory rheumatic diseases requires an individual approach. Physical pain is related to emotional pain, so mastering emotional skills can affect stress, which is related to a health condition. [ABSTRACT FROM AUTHOR]

The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or an experience described in the context of such damage". Nociceptors (pain receptors) are free nerve endings (A-δ (thick myelinated) and C (thin unmyelinated) nerve fibers). The mechanism of the formation of the sensation of pain arises from the integration of four physiological processes: transduction, transmission, perception and modulation. Transduction is the process of converting mechanical, thermal or chemical stimuli into an electrical stimulus. That is, algogenic substances change the permeability of the membrane of nociceptive endings for ions, there is a depolarization of the membrane and the formation of a receptor and later an action potential. Pain transmission is the process of transmitting painful impulses, i.e. generated action potentials from nociceptors to the spinal cord and brain. Transmission refers to the transmission of pain from irritated nociceptors to the primary and secondary somatosensory fields in the cerebral cortex and limbic system. Pain perception is the subjective experience of pain. The primary and secondary somatosensory cortex are responsible for the conscious perception and characteristics of pain in the form of its localization, intensity and duration of pain. The limbic system is involved in the emotional-affective component of pain perception. The perception of pain is actually the result of the neural activity of different centers in the brain that participate in the localization, processing and interpretation of painful sensations. Through perception, pain becomes a conscious experience and acquires an affective-motivational, emotional and behavioral component. In this process, the degree of attention, anxiety, fear, previous experience of the individual and expectations play a significant role. Threshold of pain receptor stimulation and pain tolerance are important for pain perception. Pain modulation is an activity that controls the process of pain signal transmission. Pain modulation refers to the inhibitory effect of descending pathways of pain control on neurons of the posterior horns of the spinal cord. The endogenous analgesia system modulates pain, which consequently affects the perception of pain. [ABSTRACT FROM AUTHOR]

Nociplastic pain was introduced as a new term for describing nociceptive pain and neuropathic pain. Persistent nociceptive pain is a risk factor for nociplastic pain, which can often occur in isolation or in combination with other types of pain, most often in patients with chronic rheumatic diseases (osteoarthritis, lumbar and cervical syndrome, fibromyalgia, rheumatoidarthritis, complex regional pain syndrome, tendinopathy and similar). Nociplastic pain arises from altered nociception with central sensitization mechanism. It is manifested through an increased sensitivity outside the primary area of tissue injury or damage, or beyond the innervation territory of lesioned or diseased nervous structures (fibromyalgia, osteoarthritis, Ehlers-Danlos syndrome, and rheumatoid arthritis). Often, there are discrepancies between the degree of inflammation and structural damage and pain in patients suffering from rheumatic disease. Different underlying pathophysiological mechanisms in different patients can manifest asthe same central sensitization phenotype. Nearly half of the patients with rheumatoid arthritis have moderate to high amounts of pain, fatigue, pain catastrophizing, and sleep disturbance, but with minimal signs of peripheral inflammation, thereby indicative of the widespread pain syndrome, whereas a third of patients also fulfill the fibromyalgia syndrome criteria. Patients with rheumatoid arthritis without other painful comorbidities had hyperalgesia and abnormal cerebral nociceptive processing during noxious stimulation of inflamed joints, but not during the stimulation of healthy tissues, thereby indicating peripheral or spinal sensitization. Some of the pain conditions with features of central sensitization are characterized by peripheral inflammation (eg, rheumatoid arthritis and osteoarthritis). Neuroinflammation in the CNS is a potential contributor to the pain and other symptoms in rheumatological diseases. Aberrant glial activation, shown in patients with chronic non-specific low back pain and fibromyalgia can explain the establishment, maintenance, or both, of central sensitization in at least a subset of patients. Although central sensitization can predict poor treatment outcomes in some patient groups, there are both pharmacological and non-pharmacological treatments available that show the capacity to attenuate central sensitization. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the incidence of pain in patients at various stages of inoperable cervical cancer, establish clinical phenotype of pain, as well as the degree of impact of pain on quality of life and its indicators. The study included 102 patients with a pathohistological finding of inoperable cervical cancer. A numerical scale (NRS) was used to determine the severity of the pain. The following parameters of quality of life were observed: appetite, sleep, mood, social interaction and general activity. Patients assessed the degree of pain on a scale from zero to ten for each of these parameters. By adding these values, the score (0-50) defining the quality of life was obtained. The impact of pain on the quality of life was determined before specific oncological treatment and three months after therapy. Before therapy, scores of pain effects on appetite, sleep, mood, social interaction, general activity, as well as quality of life were significantly higher in patients with severe and the worst possible pain than in patients with mild (ANOVA and Tukey test: p < 0.001) and moderate pain (p < 0.01). The score of impact of pain on the quality of life after therapy was significantly higher in patients with the worst possible pain (48.57 ± 1.81) than in patients with mild (4.50 ± 10.79; p < 0.001), moderate (15.56 ± 17.34; p < 0.001) and severe pain (17.61 ± 21.88; p < 0.01). Cancer pain reduces the motive for treatment, affects basic parameters such as appetite, sleep, mood, social interaction and general activity. All this significantly reduces the quality of life and performance status, both before and after the application of adequate therapeutic procedures. [ABSTRACT FROM AUTHOR]