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Osteoarthritis (OA) is a type of highly prevalent heterogeneous degenerative disease that leads to joint pain, deformity, the destruction of articular cartilage, and eventual disability. The current treatment strategies for OA often suffer from systemic side effects, poor anti-inflammatory efficacy, and persistent pain. To address these issues, we develop light-inducible nanomedicine that enables the co-delivery of anti-inflammatory drug (diacerein, DIA) and small interfering RNA (siRNA) targeting nerve growth factor (NGF) for pain relief to enhance the therapeutic efficacy of OA. The nanomedicine is based on poly(β -amino-ester)-coated gold nanocages (AuNCs), which is further incorporated with the phase-change material (lauric acid/stearic acid, LA/SA). Following intra-articular (IA) injection in vivo , the nanomedicine displays high degree of drug accumulation and retention in the joint lesion of OA mouse models. The photothermal effect, induced by AuNCs, not only promotes DIA and siRNA release, but also upregulates the expression of heat shock protein 70 (HSP-70) to resist the apoptosis of chondrocytes in the inflammatory condition. The internalization of both DIA and siRNA results in strong anti-inflammatory and pain-relieving effects, which greatly contribute to the joint repair of OA mice. This study offers a promising combination strategy for OA treatment. An AuNCs-based nanodrug system was developed for co-delivering anti-inflammatory drug DIA and pain-relieving siNGF to treat OA, enhancing chondrocyte protection and analgesia through photothermal effects and high siRNA transfection efficiency. [Display omitted] [ABSTRACT FROM AUTHOR]

This systematic review aims to determine the effectiveness of dorsal root ganglion stimulation (DRGS) in chronic pain management. In 2023, a comprehensive systematic review was undertaken utilizing various electronic databases, employing MeSH terms and free search terms tailored to the study's aims. This review included primary research such as cohorts, case-control studies, and clinical trials, all focusing on the efficacy of DRGS in treating various chronic pain conditions. Nonhuman or animal studies were omitted from the selection process. A review of study quality was conducted, followed by a meticulous analysis of the findings to synthesize the evidence. This review represents the most current research, with updates extending to 2024. A total of 400 articles were reviewed. Twenty-nine articles were included in our review after meticulous screening. Twenty-nine articles published in the last five years meeting selection criteria were identified, encompassing patients with various diagnoses warranting the use of DRGS beyond complex regional pain syndrome. Additionally, the analysis includes different outcome measurement tools, emphasizing improvements in pain management, functionality, and quality of life. Finally, common complications such as surgical site infections and issues with electrodes are highlighted. This systematic review affirms the effectiveness of DRGS therapy in managing diverse chronic pain conditions, highlighting improvements in quality of life, functionality, and mood states, making it a viable alternative for patients unresponsive to traditional treatments. [ABSTRACT FROM AUTHOR]

Pain management is crucial for improving patients' quality of care. Persistent pain has been linked to higher depression, anxiety, and work-related difficulties. This study aimed to enhance the time to pain relief in the emergency department through triage nurse-initiated analgesia. It evaluated the impact of nurse-led analgesia on patient satisfaction compared to standard pain management at Tikur Anbessa Specialized Hospital and Kidus Paulos Specialized Hospital. Additionally, it compared the time to analgesia between the two hospitals and assessed the effect of nurse-led analgesia on reducing the length of stay for patients with pain. Using a quasi-experimental design, the study included an intervention group and a control group. Data was collected using an open data kit, and after ensuring data completeness, it was exported to SPSS and Excel for analysis. To assess the effectiveness of the intervention, the time to analgesia was compared between the intervention and control groups using an independent samples t -test. This statistical test allowed for a comparison of the mean time to analgesia between the two groups. Patient satisfaction scores were also compared between the intervention and control groups using the Mann-Whitney U test. Kaplan-Meier curves were employed to compare the time to analgesia between the intervention and control groups within both settings. A point bi-serial correlation analysis was performed to examine the association between the length of stay and the intervention of nurse-led analgesia in both hospital settings. The study enrolled 179 participants, with a median age of 34 years (range: 9–80) and 67% female. The most common events leading to pain were medical conditions (21%), followed by trauma/quarrel/war, fall accidents, and underlying diseases (15%, 13%, and 13%, respectively). There was a significant correlation between the degree of pain on arrival and time to analgesia. Additionally, a significant correlation (p < 0.01) was found between time to analgesia and patient satisfaction. Implementing a nurse-led analgesia protocol in the emergency department is crucial for reducing time to analgesia and improving patient satisfaction. It is recommended to scale up this approach to other healthcare facilities by incorporating it into the nursing practice guidelines of the country. [ABSTRACT FROM AUTHOR]

Oral ulcerative mucositis (OUM) is common in patients with cancer, particularly in those undergoing chemoradiation therapy. The effective management of OUM is crucial for continuous cancer care and patient well-being. Recent studies have advanced our understanding of the causes, leading to clinical trials toward novel treatments. This review focuses on the contemporary therapeutic landscape, and provides the latest insights into the mechanisms of mucosal healing and pain. Management strategies for OUM in patients with cancer include maintaining good oral hygiene, reducing mucosal irritation against radiation, and using various topical analgesic treatments, including herbal medicines. However, the current management practices have limitations that necessitate the development of more efficacious and novel treatments. Molecular research on transient receptor potential (TRP) channels in the oral mucosa is crucial for understanding the mechanisms of wound healing and pain in patients with OUM. Targeting TRPV3 and TRPV4 can enhance wound healing through re-epithelialization. The suppression of TRPV1, TRPA1, and TRPV4 may be effective in alleviating OUM-induced pain. Research advancements have improved our understanding and potentially led to novel treatments that offer symptomatic relief. This progress highlights the importance of collaborations between clinical researchers and scientists in the development of innovative therapies. [ABSTRACT FROM AUTHOR]

• Exercise programs are effective in reducing low back pain for both nursing staff: nurses and nursing assistants. • Focusing on back and trunk exercises provide evidence based for low back pain relief for nurses and nursing assistants. • Exercise program for nurses and nursing assistants are more successful in those under 40 years old engaging in shorter exercise (20 sessions). Introduction : Nurses have a high prevalence of low back pain due to ergonomic hazards in healthcare workplaces. While exercise programs have been suggested as an intervention strategy, the effectiveness of low back pain programs has been inconsistent in the research literature. The purpose of study is to determine the effect of exercise programs to reduce low back pain among nursing staff. Methods : A systematic review and meta-analysis was conducted with five databases and systematically searched. Following the PRISMA guidelines, included studies evaluated low back pain relief among nurses or nursing assistants and described the exercise program. Two reviewers independently appraised, extracted, and synthesized all available studies. The study protocol was registered in PROSPERO (CRD42022359511). Results : A total of 296 articles with 1,355 nursing staff from nine countries were obtained. Nine randomized controlled trials with a moderate to low risk of bias quality were included. Exercise programs had a small but significant effect on low back pain of nursing staff (SMD = -0.48; 95% CI = -0.76 to −0.19; p = 0.03, I2 = 62%, p = 0.001). A subgroup analysis of nurses and nursing assistants showed moderate and small effects, respectively (I2 = 0% p < 0.0001, SMD −0.73 CI 95% [-0.97 to –0.48], p = 0.76, and I2 = 0% p = 0.002, SMD −0.23 CI 95% [-0.38 to −0.08], p < 0.88). Exercise for back and trunk exhibited a moderate effect on low back pain (SMD −0.56 CI 95% [-0.86 to −0.25], p = 0.01, I2 = 66%, p < 0.0004). A subgroup analysis comparing age, under 40 years old revealed a moderate effect size (SMD = -0.59; 95% CI = -0.83to −0.35; p = 0.06; I2 = 64%, p < 0.0001). Conclusions : Exercise programs are an effective treatment to reduce low back pain in nurses and nursing assistants, especially among younger staff. Practical application : Back and trunk exercise programs should be recommended for nursing staff with low back pain. [ABSTRACT FROM AUTHOR]

• Music therapy is a simple, non-invasive, non-pharmaceutical and effective practice for reducing patient anxiety suffering from chronic osteoarthritis. • Music therapy has proved its efficiency also by objective measurement, as the heart rate and respiratory. • Music therapy should be considered as a part of our daily practice, especially when handling patients with chronic pain. Music therapy seems to have a multitude of positive effects not only on mental health but also on organic pain. Some studies have showed its effectiveness on reducing pain for patients undergoing surgical procedures. However, data on its efficiency on patients' anxiety during rheumatology medical consultation for patients with chronic rheumatic diseases is lacking. The purpose of the present study was to describe the impact of music therapy on the mood of patients followed for chronic rheumatic diseases. We conducted a cross-sectional study including patients followed for chronic rheumatic diseases seen in the outpatient rheumatology department during a period of three weeks. Patients selected were randomly assigned into two groups. Patients seen while listening to music "The Mozart Sonata" formed theG1 (n = 40). Patients seen without listening to music formed the group G2 (n = 30). Participants' anxiety levels were assessedbefore and immediately after medical consultations by collecting vital signs (heart rate and respiratory rate) and by the Spielberger State Trait Anxiety inventory questionnaire (STAI). The mean age of 70 patients included was 54.36 ± 14.62 years. Females outnumbered males (62.9 %).The STAI scores were 38.44 (range, 25–60) and 34.51 (range, 22–52)respectively pre- and post-consultation. The medical consultation lasted for a mean of 24 ± 1.1 min in G1 and 20.63 ± 1.3 in G2. Sharp after the consultation, the mean Heart Ratewas significantly lower in the group with music therapy (64±1.5 in G1 versus 66.3 ± 1.3 in G2, p = 0.02) and the mean STAI decreased also significantly in tne G1 (34.72±1 in G1 versus 40.7 ± 5.2 in G2, p = 0.018). However, the decline of the mean Respiratory Ratewas not significant between both groups(16.1 ± 1 in G1 versus 16.96 ± 1.7 in G2, p = 0.42). Our study showed a significant lowering in anxiety level and heart rate in patients consulted while listening to music.This costless and available tool should be more used in our daily practice specially when treating patients with chronic painful diseases. [ABSTRACT FROM AUTHOR]

The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty. [ABSTRACT FROM AUTHOR]

To summarize the available evidence of acupuncture for pain relief in the patients with postherpetic neuralgia (PHN) using a scoping review. Seven electronic databases of the original studies of acupuncture on PHN were retrieved. The search time was from the inception to May 1, 2021. Two researchers screened the title, abstract and full text of each article independently. The original studies that was met the inclusion criteria were collected and analyzed, and finally presented with a qualitative description. A total of 216 original studies were eligible and all of them were randomized controlled trials. The acupuncture therapies with the highest use frequency included manual acupuncture, pricking and cupping and electroacupuncture. Acupuncture therapies were mostly combined with other interventions in studies. There were large differences in acupoint selection, time duration for single treatment and the total treatment times. It was believed in all of the included studies that acupuncture was effective of pain relief in PHN and 85.65% of the studies obtained the minimum clinical importance difference (MCID), suggesting the clinical effectiveness. The adverse reaction of acupuncture was low in its incidence, and mostly transient in occurrence. The study type of acupuncture for PHN is relatively simple. Most studies show the advantages of acupuncture in pain relief of PHN. The quality of study needs to be improved. [ABSTRACT FROM AUTHOR]

Generic medicines have been associated with less efficacy compared to originator products. Educational videos explaining generic medicines can have a positive effect on perceptions of generic drugs and their pain-relieving effect. The central aim of the current study was to examine whether trust in the governmental approval process of medicines mediates the effect of educational video interventions on the pain-relieving effect induced by a generic medicine and whether trust can be built by improving individuals' understanding of generic medication. This is a secondary analysis of a randomized controlled trial where participants with frequent tension headaches were randomly assigned to either watching a video explaining generic drugs (n = 69) or a video informing about headaches (control group: n = 34). After watching the video, participants took an originator and a generic pain analgesic in a randomized order to treat their next two consecutive headaches. Pain severity was measured before and 1 h after taking the medicine. A multiple serial mediator model showed that improving individuals' understanding of generic medicines is associated with increased trust in medicines. Both factors together, understanding and trust, significantly mediated the effect of the video education about generic drugs on the generic's pain-relieving effect (total indirect effect: coefficient: 0.20, 95% CI: 0.42, −0.0001). Results of this study show that improving individuals' understanding of generic medication and trust in the process of approving medicines should be considered as important mechanisms of future educational interventions about generic medicines. • Educational videos on generic drugs can increase individuals' trust in medicines. • Educational videos can improve individuals' understanding of generic medicines. • Individuals' understanding of medicines and trust in medicines are associated. • Understanding of and trust in generics are mechanisms educational videos' effects. [ABSTRACT FROM AUTHOR]

To compare nifedipine, naproxen, or placebo for pain relief during diagnostic hysteroscopy. Double-blind, randomized controlled pilot study. University hospital. Women scheduled for office diagnostic hysteroscopy (n = 60). Women received nifedipine (2 tablets of 10 mg), naproxen (2 tablets of 250 mg), or placebo (2 tablets of 500 mg lactose) 30 to 60 minutes prior to hysteroscopy. Sixty patients were enrolled in the study (21 in the nifedipine group, 19 in the naproxen group, and 20 in the placebo group). The median pain scores during hysteroscope insertion, measured on a Visual Analog Scale (VAS), were 1 (interquartile range (IQR) 0–0), 2 (0–4) and 1 (0–1) in the nifedipine, naproxen and placebo group, respectively (P,14). The median VAS scores during hysteroscopy were 5 (IQR 2–7), 5 (4–8) and 5 (3–7) in the nifedipine, naproxen and placebo group, respectively (P,73). The median VAS scores immediately after hysteroscopy were 2 (IQR 0–4), 3 (0–6) and 3 (1–5) in the nifedipine, naproxen and placebo group, respectively (P,40). The median VAS scores 30 minutes after hysteroscopy were 1 (IQR 0–2), 1 (0–1) and 1 (0–2) in the nifedipine, naproxen and placebo group, respectively (P,63). Hysteroscope insertion failed in 1 case (naproxen group) because of cervica'l stenosis (P,32). Flushes, fatigue and vertigo, 30 minutes after the procedure, were significantly more prevalent in the nifedipine group compared to the naproxen (p <.001, p,03, p,03, respectively) and the placebo group (p <.001, p,01, p,01, respectively). Palpitations occurred only in the nifedipine group (p <.001). The day after the procedure, the headache was most prevalent in the nifedipine group compared to the naproxen group (p,001) and the placebo group (p,001). In our pilot study, pain relief and success rates for office diagnostic hysteroscopy were not significantly different between nifedipine, naproxen, and placebo. Nifedipine was associated with more, albeit tolerable, side-effects. [ABSTRACT FROM AUTHOR]

Spinal anesthesia is a commonly performed regional anesthesia technique by most anesthesiologists worldwide. This technique is learned early during training and is relatively easy to master. Despite being an old technique, spinal anesthesia has evolved and developed in various aspects. This review attempts to highlight the current indications of this technique. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient-specific techniques and interventions. [ABSTRACT FROM AUTHOR]

Labor pain is among the most severe types of physical pain that women may experience during their lifetime. Thus, pain relief is an essential part of medical care during childbirth. Epidural analgesia is considered to be the most efficient method of pain relief during labor. Nevertheless, patient preferences, contraindications, limited availability, and technical failure may require the use of alternative pain reliving methods during labor including systemic pharmacologic agents, and nonpharmacologic methods. Nonpharmacologic methods for pain alleviation during vaginal birth have become popular over the years, either as a complement to pharmacologic agents or at times as the principal therapy. Methods such as relaxation techniques (ie, yoga, hypnosis, and music), manual techniques (ie, massage, reflexology, and shiatsu), acupuncture, birthing ball, and transcutaneous electrical nerve stimulation are considered safe, although the evidence supporting their effectiveness for pain relief is not as robust as it is for pharmacologic agents. Systemic pharmacologic agents are mostly administered by inhalation (nitrous oxide) or through the parenteral route. These agents include opioids such as meperidine, nalbuphine, tramadol, butorphanol, morphine, and remifentanil, and non-opioid agents such as parenteral acetaminophen and nonsteroidal anti-inflammatory drugs. Systemic pharmacologic agents suggest a diverse armamentarium of medication for pain management during labor. Their efficacy in treating pain associated with labor varies, and some continue to be used even though they have not been proven effective for pain relief. In addition, the maternal and perinatal side effects differ markedly among these agents. There is a relative abundance of data regarding the effectiveness of analgesic drugs compared with epidural, but the data regarding comparisons among the different types of alternative analgesic agents are scarce, and there is no consistency regarding the drug of choice for women who do not receive epidural pain management. This review aims to present the available data regarding the effectiveness of the different methods of relieving pain during labor other than epidural. The data presented are mainly based on recent level I evidence regarding pharmacologic and nonpharmacologic methods for pain relief during labor. [ABSTRACT FROM AUTHOR]

The objective of the study is to evaluate the best available evidence on the effectiveness of DN in the management of tendinopathy. Seven randomized control trials were selected following an electronic search in PubMed, Web of Science, Scopus, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants, which investigated the effect of the DN technique on the management of tendinopathies. Only studies in the English language published in peer-reviewed journals between 1999 and 2020 were included. The methodological quality of the studies was assessed using the PEDro scale. The PEDro score of the studies ranged from 5 to 9 with a mean score of 6.7 ± 1.2 (mean ± SD). A total of 357 participants were enrolled in the seven included studies, which were on greater trochanteric pain syndrome, lateral epicondylitis, supraspinatus tendinopathy and Achilles tendinopathy. DN was compared with various interventions, including platelet-rich plasma injection, autologous blood injection and non-steroidal anti-inflammatory medication. All the selected studies reported a significant positive effect of DN on pain intensity and other outcome measures, such as patient-specific functional score, disability index, range of motion and health-related quality of life. The results indicate that DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months. DN can be considered among the many options available for the management of tendinopathy. [ABSTRACT FROM AUTHOR]

In photodynamic therapy (PDT), reactive oxygen species (ROS) are key products that induce cell death, and increasing amount of ROS is a crucial way to enhance PDT efficacy. However, the generated ROS stimulates the transient receptor potential vanilloid 1 channel (TRPV1), which can be activated in the pain pathway and then exacerbate pain. Herein, we utilized arginine−glycine−aspartate (RGD) peptide-modified liposomes for encapsulation Chlorin e6 (Ce6) and capsazepine (Cz), a receptor antagonist of TRPV1, to prepare drug-loaded liposomes, RLCC. Soluble hyaluronic acid microneedle arrays (MNs), which possess sufficient skin penetration capability and excellent biosafety, was applied for in situ delivery of RLCC. With the aid of RGD peptides, the efficiency of intracellular liposomal uptake and the dispersion of drugs in tumor after delivery by MNs were significantly enhanced, showcasing tremendous potential for improving the PDT efficacy. Besides, through the analysis of sciatic nerve signals in mice during PDT, RLCC demonstrated remarkable effectiveness in alleviating pain by significantly reducing nerve impulses. Hence, RLCC demonstrated outstanding effectiveness in PDT and effectively alleviated the associated pain. Overall, this research highlights the potential of utilizing MNs for the in situ delivery of RLCC, facilitating effective PDT while addressing the issue of pain during the treatment. • Soluble hyaluronic acid MNs have excellent biosafety and drug delivery efficiency. • RLCC increases the production of ROS by photosensitizers. • MNs mediated RLCC administration enhances drug distribution in tumor sites. • RLCC effectively alleviates pain during PDT [ABSTRACT FROM AUTHOR]

Pain in photodynamic therapy (PDT), resulting from the stimulation of reactive oxygen species (ROS) and local acute inflammation, is a primary side effect of PDT that often leads to treatment interruption or termination, significantly compromising the efficacy of PDT and posing an enduring challenge for clinical practice. Herein, a ROS-responsive nanomicelle, poly(ethylene glycol)-b-poly(propylene sulphide) (PEG-PPS) encapsulated Ce6 and Lidocaine (LC), (ESCL) was used to address these problems. The tumor preferentially accumulated micelles could realize enhanced PDT effect, as well as in situ quickly release LC due to its ROS generation ability after light irradiation, which owes to the ROS-responsive property of PSS. In addition, PSS can suppress inflammatory pain which is one of the mechanisms of PDT induced pain. High LC-loaded efficiency (94.56 %) owing to the presence of the thioether bond of the PPS made an additional pain relief by inhibiting excessive inflammation besides blocking voltage-gated sodium channels (VGSC). Moreover, the anti-angiogenic effect of LC offers further therapeutic effects of PDT. The in vitro and in vivo anti-tumor results revealed significant PDT efficacy. The signals of the sciatic nerve in mice were measured by electrophysiological study to evaluate the pain relief, results showed that the relative integral area of neural signals in ESCL-treated mice decreased by 49.90 % compared to the micelles without loaded LC. Therefore, our study not only develops a very simple but effective tumor treatment PDT and in situ pain relief strategy during PDT, but also provides a quantitative pain evaluation method. [Display omitted] • ESCL demonstrates excellent drug encapsulation capacity for lidocaine. • The sciatic nerve signal can reflect pain during photodynamic therapy. • ESCL effectively relieves pain during photodynamic therapy. • ESCL enhances the efficacy of photodynamic therapy [ABSTRACT FROM AUTHOR]

Primary dysmenorrhoea (PD) is a common problem among women in their reproductive years that can negatively impact their quality of life. The present systematic review aimed to summarise the reported experimental and semi-experimental studies on the effects of different methods of oral and topical ginger to treat PD. A literature search was performed using various databases with no language restrictions; and without any time limitation, until May 2023. The inclusion criteria of the articles included all clinical trials and semi-experimental studies conducted on humans in which ginger was used alone or in combination with other methods for pain relief of dysmenorrhoea. The review of 60 eligible articles showed that ginger is more effective than placebo in relieving pain, and there was no significant difference between ginger and nonsteroidal anti-inflammatory drugs. Most studies showed that the effects of oral ginger in the treatment of PD are greater than other herbal medicines. Most of the studies that compared oral ginger with exercise and micronutrients (including vitamin E, vitamin D, and zinc sulphate) showed a similar or superior effect of ginger. All studies conducted on topical ginger demonstrated the greater effect of its use compared to other methods. There is a promising paradigm of the effect of oral and topical ginger as a potentially effective treatment for pain relief in PD. However, due to the many shortcomings in the existing studies, the findings should be interpreted with caution and more high-quality studies seem to be necessary. [Display omitted] • Some studies demonstrated a decrease in prostaglandin F2α after using oral ginger. • Ginger was more effective than a placebo for pain relief. • There was no significant difference between ginger and non-steroidal anti-inflammatory drugs. • Ginger can be an alternative to relieve dysmenorrhea without the side effects of chemical drugs. • Ginger is recommended for primary dysmenorrhea management and improving women's quality of life. [ABSTRACT FROM AUTHOR]

Photobiomodulation (PBM) has been studied since the 1960s as a clinical tool. More recently, PBM has been observed to reduce compound action potential components and hypersensitivities associated with neuropathic pains. However, no definitive description of efficacious light parameters has been determined. Some reasons may be that previous meta-analyses and reviews have focused on emitter output rather than the light at the target tissue and have included data sets that are large but with notable variability (e.g., combining data from various disease etiologies, and data from PBM at various wavelengths). This fact has made it difficult to successfully define the range of effective parameters. In this study, photon propagation software was used to estimate irradiance at a target nerve using several published data sets chosen for their narrow criteria to minimize variability. Utilizing these estimates, effective and ineffective light irradiances at the nerve of interest for wavelengths of 633 nm or 808–830 nm were examined and estimated. These estimates are focused on the amount of light required to achieve a reduction in pain or a surrogate measure via a hypothesized nerve block mechanism. Accounting for irradiance at the target nerve yielded a clear separation of PBM doses that achieved small-fiber nerve block from those that did not. For both the 633 nm group and the 808–830 group, the irradiance separation threshold followed a nonlinear path with respect to PBM application duration, where shorter durations required higher irradiances, and longer durations required lower irradiances. Using the same modeling methods, irradiance was estimated as a function of depth from a transcutaneous source (distance from skin surface) for emitter output power using small or large emitter sizes. Taken together, the results of this study can be used to estimate effective PBM dosing schemes to achieve small-fiber inhibition for various anatomical scenarios. • Photobiomodulation can be used to reduce hypersensitivities. • Strategies analyzing dosing strategies have focused on emitter properties. • Photon propagation modeling can estimate light properties at neural targets. • Irradiances at the neural target distinguish effective and ineffective treatments. • Using these modeling methods, near nerve light application doses can be determined. [ABSTRACT FROM AUTHOR]

Patients undergoing major vascular surgery are high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Endovascular procedures are less invasive, yet not devoid of potentially serious complications. Reduction of myocardial oxygen demand is key, as is stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia. Continuation of preoperative risk-reduction strategies including aspirin, beta-blockers and statin therapies are critical, and should be continued in the postoperative period. Maintaining a high index of suspicion for procedure-specific complications is essential in order to reduce morbidity and mortality in these patients. [ABSTRACT FROM AUTHOR]

Objective: To review the available literature on the effect of cannabis-based products on the female reproductive system and establish whether there is any evidence that they benefit or harm patients with endometriosis and, therefore, whether there is sufficient evidence to recommend them.Data Sources: An electronic-based search was performed in PubMed, Embase, and the Cochrane Database. Reference lists of articles retrieved were reviewed, and a gray literature search was also performed.Methods Of Study Selection: The original database search yielded 264 articles from PubMed, Embase, and the Cochrane Database, of which 41 were included. One hundred sixty-one studies relating to gynecologic malignancy, conditions unrelated to endometriosis, or therapies unrelated to cannabis-based products were excluded. Twelve articles were included from a gray literature search and review of references.Tabulation, Integration, and Results: Most available evidence is from laboratory studies aiming to simulate the effects of cannabis-based products on preclinical endometriosis models. Some show evidence of benefit with cannabis-based products. However, results are conflicting, and the impact in humans cannot necessarily be extrapolated from these data. Few studies exist looking at the effect of cannabis or its derived products in women with endometriosis; the majority are in the form of surveys and are affected by bias. National guidance was also reviewed: at present, this dictates that cannabis-based products can only be prescribed for conditions in which there is clear published evidence of benefit and only when all other treatment options have been exhausted.Conclusion: Current treatment options for endometriosis often affect fertility and/or have undesirable side effects that impede long-term management. Cannabis-based products have been suggested as a novel therapeutic option that may circumvent these issues. However, there is a paucity of well-designed, robust studies and randomized controlled trials looking at their use in the treatment of endometriosis. In addition, cannabis use has a potential for harm in the long term, with a possible association with "cannabis use disorder," psychosis, and mood disturbances. At present, national guidance cannot recommend cannabis-based products to patients in the UK owing to lack of clear evidence of benefit. More comprehensive research into the impact of endocannabinoids in the context of endometriosis is required before their use can be recommended or prescribed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical benefit of simultaneous percutaneous microwave ablation (PMA) and percutaneous cementoplasty (PC) for patients with painful osteolytic bone metastases under flat-detector C-arm computed tomography (CACT).Methods and Materials: Thirty patients (17 men and 13 women) with 42 osteolytic metastatic tumors were prospectively treated with PMA and PC simultaneously under CACT guidance. Technical success, major complications, local tumor control status, and daily morphine consumption were recorded. Visual analog scale, Oswestry disability index, and the short-form 36 questionnaire (SF-36, 8 domains) were used to evaluate pain, functional status, and quality of life (QoL), respectively.Results: The technical success rate was 100% without major complications, and local tumor control rates were 100% and 75% for lesion diameter ≤3 cm and >3 cm, respectively. Daily morphine consumption, visual analog scale, and Oswestry disability index improved significantly from the respective pretreatment values of 75 mg, 7.4, and 59.2 to 17.3 mg, 1.7, and 22.9 at 1 week; 8.5 mg, 1.4, and 6.7 at 4 weeks; and 5.3 mg, 1.3, and 9.2 at 12 weeks, respectively (p< 0.01). The QoL assessments at 4 weeks showed significant improvements in physical function, role physical, bodily pain, general health and vitality (p < 0.05).Conclusion: Simultaneous PMA and PC under CACT guidance is effective to control pain and improve QoL in selective patients with painful osteolytic bone metastases. [ABSTRACT FROM AUTHOR]

Background: Generic medicines have been associated with less perceived efficacy and more side effects compared to brand name drugs. Educational interventions to improve individuals' negative perceptions of generic medicines show contradictory effects.Objective: This study investigated whether an interventional video that informs about the approval process of releasing medicines has better effects on outcomes related to perceptions and effectiveness of generic medicines in participants with headaches, in comparison with another interventional video that addresses bioequivalence between brand name and generic drugs or a control video.Methods: Participants with frequent tension headaches were randomized to one of three groups (one of two interventional videos or the control video). One of the interventional videos explained the process of approval of generic medicines (n = 34), the other one explained the bioequivalence between brand name and generic drugs (n = 35). The control video informed participants about the epidemiology and etiology of headaches (n = 34). After watching the video, participants treated their next two consecutive episodes of headache with a brand name and a generic analgesic in randomized order.Main Outcome Measures: Self-report measures of understanding and perceptions of and preference for medicines, pain severity and side effects.Results: Linear mixed models showed that both interventional videos improved participants' understanding of generic medicines. The generic drug approval process video enhanced the perceived effectiveness, safety and quality of generic drugs. The bioequivalence video positively influenced the preference for generic drugs. The brand name and generic drug were equally effective in relieving pain in participants who watched either the generic drug approval process or the bioequivalence video.Conclusions: Information about both, approving a switch from brand name medicines to generic counterparts and bioequivalence, can be important and should be addressed in future educational interventions. [ABSTRACT FROM AUTHOR]

This « Magnum Opus » emphasizes that serendipity is a corner stone in research. The paths of discovery and innovation often result from the interdisciplinarity of scientific areas that are a priori disconnected from each other. In the 1970s, fundamental discoveries in cell biology led to unexpected advances in galenic pharmacy with the emergence of nanotechnologies for the intracellular delivery of non diffusing molecules. As well, fluorescein-loaded polyacrylamide nanocapsules were shown to deliver this fluorescent agent precisely into cellular lysosomes which represented a seminal observation. However, due to the lack of biodegradability of this carrier polymer, this approach was still far from therapeutic application. The use of cyanoacrylates as surgical glue inspired us to use this material in the design of the first biodegradable nanoparticles for human use. Capable of transporting compounds with anti-tumor activity, these polyalkylcyanoacrylate nanoparticles demonstrated the unexpected property of overcoming multi-drug resistance. This discovery led to the development of a nanomedicine that has completed phase III clinical trials for the treatment of resistant hepatocarcinoma. Going beyond the state-of-the art, a step ahead in the nanomedicine field was the drug « squalenoylation » technology, which represents a shift from the « physical » to the « chemical » encapsulation paradigm. The bioconjugation of anticancer and other drugs to squalene, a natural and biocompatible lipid, enabled a dramatic increase in drug payload, and eliminated the so-called « burst release » of drug: Two major drawbacks commonly associated with drug nanoencapsulation. The drug « squalenoylation » approach resulted in a generic nanomedicine platform with broad pharmacological applications. [Display omitted] [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a common chronic functional bowel disorder for which patients take significant risks to ameliorate symptoms. Unfortunately, there is no cure for IBS. We assessed the willingness of patients with IBS to take medication risks and the costs they would pay to improve symptoms. We mailed a survey on medication risk to patients with IBS who met the Rome IV criteria. The survey collected data on patient demographics, symptoms, medication use, prior medication-averse events, and pain catastrophization. A standard gamble evaluated respondents' willingness to take medication risks, and a willingness-to-pay set of questions quantified maximal spending on a hypothetical medication to treat IBS. Among respondents (n = 215; 81.8% female; mean age, 57 y) the average duration of IBS symptoms was 17.7 years. Patients whose predominant symptom was severe diarrhea (diarrhea-predominant IBS) reported accepting a mean 10.2% ± 15.7% risk of sudden death for a 99% chance of cure. Pain catastrophizing scale scores were not associated with an increased likelihood of taking medication risks. Patients with IBS would be willing to pay an average amount of $73 per month (if annual income was <$75,000) and $197 per month (if annual income was >$75,000) for a medication that would resolve their pain. In a survey of 215 patients with IBS, we found that patients with diarrhea-predominant IBS are willing to take extraordinary risks to improve their symptoms, whereas patients with IBS and pain catastrophization are not. Clinician understanding of patients' willingness to take medication risks might help them guide their patients through complex therapeutic options. [ABSTRACT FROM AUTHOR]

• Some of piriformis syndrome intractable with conservative treatment. • Surgery was indicated for intractable piriformis syndrome. • Piriformis resection can be a feasible option for intractable piriformis syndrome. • Piriformis resection decrease visual analog scale in intractable piriformis syndrome. Piriformis syndrome (PS) is an uncommon neuromuscular condition characterized by buttock pain radiating to the leg. Although the goal of PS treatment is symptom relief, it is difficult in some patients using conservative treatment alone. A 72-year-old male underwent piriformis resection after failed sequential steroid injection of the piriformis. The patient ultimately underwent surgery for resection of the piriformis muscle and experienced satisfactory pain relief (pain reduction > 75% according to visual analog scale for at least 12 months) following surgery and in the 3-year follow-up period. Conservative treatment is first-choice treatment for managing PS. Surgery was indicated when the patient did not achieve satisfactory pain relief with conservative treatment. Surgical resection of the piriformis muscle has been shown to be effective and feasible. Piriformis resection is effective and can be a feasible option for the treatment of PS following failure of appropriate conservative treatment(s). [ABSTRACT FROM AUTHOR]

Although spinal decompression surgery is an effective treatment for myelopathy-induced upper limb pain, some postoperative patients suffer from residual pain in spite of adequate decompression. However, the neural mechanism underlying the poor outcome of pain relief is still unclear. The goal of this study was to explore the brain mechanisms involved in the poor recovery of upper limb pain after the spinal decompression surgery by using functional connectivity (FC) analysis. In this cross-sectional study, 17 patients who underwent cervical spinal decompression surgery were included. Functional MRI (fMRI) during a tactile stimulus for each hand was performed at 1 day before and 7 days after the surgery. In total, 34 fMRI scans (17 left and right upper limbs, respectively) were obtained before and after the surgery, respectively. The patients were divided into poor-recovery and good-recovery groups, and then we searched for the FC that was related to poor-recovery. The poor-recovery group (n = 15) showed significantly stronger connectivity between the postcentral gyrus (postCG) and dorsolateral prefrontal cortex (DLPFC) than the good-recovery group (n = 12) preoperatively. When the cutoff value of the preoperative FC between the left postCG and right middle frontal gyrus included in DLPFC was >0.17, the sensitivity and specificity for poor recovery were 73% and 75%, respectively. Our study showed that FC between the postCG and DLPFC may be a predictor of pain relief. This result suggested that assessing FC can lead to more informed surgical interventions for cervical spondylotic myelopathy. [ABSTRACT FROM AUTHOR]

Is fentanyl and midazolam non-inferior to pethidine and diazepam in pain relief during oocyte retrieval under conscious sedation? A randomized double-blinded non-inferiority trial of 170 infertile women undergoing oocyte retrieval under conscious sedation in an assisted reproduction centre. The women were randomized to receive intravenously either 0.1 mg fentanyl and 5 mg midazolam or 25 mg pethidine and 5 mg diazepam, plus paracervical block with 10 ml 1% lignocaine. The primary outcome was abdominal pain level during retrieval assessed by linear visual analogue scale from 0–10. Secondary outcomes included vaginal pain levels during and after retrieval and postoperative abdominal pain levels and side-effects, satisfaction level, clinical pregnancy and ongoing pregnancy rates. A pre-defined non-inferiority margin of 1 for the difference in pain levels between two groups was set. Vaginal and abdominal pain levels during retrieval were significantly lower in the fentanyl and midazolam group compared with the pethidine and diazepam group (per-protocol analysis, vaginal pain: 1.6 versus 4.3; mean difference: –2.7, 95% CI –3.7, –1.8; P < 0.001; abdominal pain: 2.9 versus 5.2; mean difference: –2.3, 95% CI –3.3 to –1.3; P < 0.001 for non-inferiority). No differences were observed in these pain levels after retrieval. Most women experienced no postoperative side-effects. The fentanyl and midazolam group had better sedation level, satisfaction level on pain relief and satisfaction on the overall retrieval procedure than the pethidine and diazepam group. No significant differences were found in clinical pregnancy and ongoing pregnancy rates between the two groups. The fentanyl and midazolam group had significantly lower vaginal and abdominal pain levels during oocyte retrieval than the pethidine and diazepam group. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate the efficacy of vaginal dinoprostone in reducing pain perception during diagnostic office hysteroscopy (OH) in postmenopausal women.Design: Randomized, double-blind controlled trial.Setting: Tertiary university hospital.Participants: Postmenopausal patients scheduled for OH.Interventions: Eligible participants were randomized in a 1:1 ratio to the dinoprostone and placebo groups. The severity of pain was assessed with a visual analog scale (VAS) ranging from 0, no pain to 10, worst pain during OH and 30 minutes after OH.Measurements and Main Results: The difference in the intensity of pain using the VAS score during the procedure. One hundred women (50 in each arm) were included in the study. The mean VAS score during OH was significantly lower in the dinoprostone group compared with the placebo group (3.9 ± 0.8 vs 5.6 ± 0.7; p <.001). The passage of the hysteroscope through the cervical canal was easier in the dinoprostone group (62.4 ± 9.5 vs 42.8 ± 10.8; p <.001). The 2 groups were comparable in terms of the duration of the procedure (p = .91) and the rate of adverse effects.Conclusion: Vaginal dinoprostone is effective in relieving pain during diagnostic OH in postmenopausal women with few adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the acute effects of isometric versus dynamic resistance exercise on pain during a pain-provoking activity, and exercise-induced hypoalgesia in participants with patellar tendinopathy.Design: This study was a pre-registered randomised crossover study. Participants were blinded to the study hypothesis.Methods: Participants (N = 21) performed a single session of high load isometric resistance exercise or dynamic resistance exercise, in a randomised order separated by a 7-day washout period. Outcomes were assessed before, immediately after, and 45 min post-exercise. The primary outcome was pain intensity scored on a numeric pain rating scale (NRS; 0-10) during a pain-provoking single leg decline squat (SLDS). Secondary outcomes were pressure pain thresholds (PPTs) locally, distally and remotely, as well as tendon thickness.Results: There was a significant decrease in pain NRS scores (mean reduction 0.9, NRS 95%CI 0.1-1.7; p = 0.028), and increase in PPTs at the tibialis anterior muscle (mean increase 34 kPa 95%CI 9.5-58.5; p = 0.009) immediately post-exercise. These were not sustained 45 min post-exercise for pain (NRS) or PPTs (p > 0.05). There were no differences between exercise on any outcome.Conclusions: While patients with patellar tendinopathy decreased pain during SLDS in response to resistance training, but the magnitude was small. Contraction mode may not be the most important factor in determining the magnitude of pain relieving effects. Similarly, there were only small increases in PPTs at the tibialis anterior which were not superior for isometric exercise. [ABSTRACT FROM AUTHOR]

Newborns commonly experience pain due to a variety of reasons. Non-nutritive sucking (NNS) is thought to be an effective non-pharmacological method of pain-relief. However, the significant heterogeneity in some systematic reviews limited the certainty of the findings about NNS. Hence, this study was aimed at evaluating the analgesic effect and safety of NNS in healthy term neonates during the heel prick test, using the Neonatal Pain Agitation and Sedation Scale (N-PASS). In this randomized controlled trial, 42 term infants were included: 22 infants in the intervention group (receiving NNS) and 20 infants in the control group (not receiving NNS). In the intervention group, neonates were given a silicone pacifier 120 s before, during, and 120 s after the heel puncture, while neonates in the control group received routine care. Pain-related outcomes were assessed using the N-PASS at 30s, 60s, 90s, and 120s after the heel prick. Any adverse events during the procedure were noted. The Spearman correlation coefficients between the pain scores on the N-PASS and two other scales (NFCS and NIPS) were calculated at all four moments of evaluation. The mean N-PASS pain scores at 30s, 60s, 90s, and 120s after heel prick were significantly lower in the NNS group than in the control group: 4.73 ± 2.78 vs. 7.90 ± 1.52 (p = 0.0002); 3.64 ± 3.06 vs. 5.55 ± 2.95 (p = 0.052); 2.59 ± 3.08 vs. 5.25 ± 3.51 (p = 0.011); and 2.05 ± 2.94 vs. 4.90 ± 3.99 (p = 0.013), respectively. No adverse events were detected in either group. Our findings revealed a strong positive correlation between the pain scores on the N-PASS and two other scales (NFCS and NIPS), which was statistically significant (p < 0.01). NNS is considered a safe and effective pain-relief method during the heel prick procedure in term neonates, demonstrated using the N-PASS. These findings were correlated with the pain evaluation by NFCS and NIPS. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effectiveness of cupping therapy on low back pain (LBP). Medline, Embase, Scopus and WANFANG databases were searched for relevant cupping RCTs on low back pain articles up to 2023. A complementary search was manually made on 27 September for update screening. Full-text English and Chinese articles on all ethnic adults with LBP of cupping management were included in this study. Studies looking at acute low back pain only were excluded. Two independent reviewers screened and extracted data, with any disagreement resolved through consensus by a third reviewer. The methodological quality of the included studies was evaluated independently by two reviewers using an adapted tool. Change-from-baseline outcomes were treated as continuous variables and calculated according to the Cochrane Handbook. Data were extracted and pooled into the meta-analysis by Review Manager software (version 5.4, Nordic Cochrane Centre). Eleven trials involving 921 participants were included. Five studies were assessed as being at low risk of bias, and six studies were of acceptable quality. High-quality evidence demonstrated cupping significantly improves pain at 2–8 weeks endpoint intervention (d=1.09, 95% CI: [0.35–1.83], p = 0.004). There was no continuous pain improvement observed at one month (d=0.11, 95% CI: [−1.02–1.23], p = 0.85) and 3–6 months (d=0.39, 95% CI: [−0.09–0.87], p = 0.11). Dry cupping did not improve pain (d=1.06, 95% CI: [−0.34, 2.45], p = 0.14) compared with wet cupping (d=1.5, 95% CI: [0.39–2.6], p = 0.008) at the endpoint intervention. There was no evidence indicating the association between pain reduction and different types of cupping (p = 0.2). Moderate- to low-quality evidence showed that cupping did not reduce chronic low back pain (d=0.74, 95% CI: [−0.67–2.15], p = 0.30) and non-specific chronic low back pain (d=0.27, 95% CI: [−1.69–2.24], p = 0.78) at the endpoint intervention. Cupping on acupoints showed a significant improvement in pain (d=1.29, 95% CI: [0.63–1.94], p < 0.01) compared with the lower back area (d=0.35, 95% CI: [−0.29–0.99], p = 0.29). A potential association between pain reduction and different cupping locations (p = 0.05) was found. Meta-analysis showed a significant effect on pain improvement compared to medication therapy (n = 8; d=1.8 [95% CI: 1.22 – 2.39], p < 0.001) and usual care (n = 5; d=1.07 [95% CI: 0.21- 1.93], p = 0.01). Two studies demonstrated that cupping significantly mediated sensory and emotional pain immediately, after 24 h, and 2 weeks post-intervention (d= 5.49, 95% CI [4.13–6.84], p < 0.001). Moderate evidence suggested that cupping improved disability at the 1–6 months follow-up (d=0.67, 95% CI: [0.06–1.28], p = 0.03). There was no immediate effect observed at the 2–8 weeks endpoint (d=0.40, 95% CI: [−0.51–1.30], p = 0.39). A high degree of heterogeneity was noted in the subgroup analysis (I2 >50%). High- to moderate-quality evidence indicates that cupping significantly improves pain and disability. The effectiveness of cupping for LBP varies based on treatment durations, cupping types, treatment locations, and LBP classifications. Cupping demonstrated a superior and sustained effect on pain reduction compared with medication and usual care. The notable heterogeneity among studies raises concerns about the certainty of these findings. Further research should be designed with a standardized cupping manipulation that specifies treatment sessions, frequency, cupping types, and treatment locations. The actual therapeutic effects of cupping could be confirmed by using objective pain assessments. Studies with at least six- to twelve-month follow-ups are needed to investigate the long-term efficacy of cupping in managing LBP. This systematic review was initially registered on PROSPERO with registration code: CRD42021271245 on 08 September 2021. • This study comprehensively assesses both eligible English and Chinese studies, providing up-to-date evidence on the effectiveness of cupping for LBP. • Eleven studies were included, providing high- to moderate-quality evidence that cupping significantly improves pain and disability in LBP management. • Diverse impacts on pain and disability are observed based on cupping manipulations (wet vs. dry, acupoints vs. lower back area), LBP classification, and intervention duration. • Cupping shows superior and sustainable effects in pain reduction compared to medication and usual care. • Cupping improves sensory and emotional pain immediately, after 24 hours, and 2 weeks post-intervention. [ABSTRACT FROM AUTHOR]

To evaluate the response rate, pain relief duration, and time it took for pain to decline or resolve after radiation therapy (RT) with or without fever-range Whole Body Hyperthermia (WBH) in bony metastatic patients with mainly primary tumor of prostate and breast cancer leading to bone pain. Bony metastatic patients with pain score ≥4 on the Brief Pain Inventory (BPI) underwent RT of 30 Gy in 10 fractions in combination with WBH with nursing care under medical supervision versus RT-alone. WBH application time was 3-4 h in three fractions with at least 48-h intervals. All patients were stratified primary site, breast or prostate cancer vs others, BPI score, and exclusion criteria. The primary endpoint was complete response (CR) (BPI equal to zero with no increase of analgesics) within two months of follow-up. Based on this study, the RT-alone group showed the worst pain. The study was terminated after the enrollment of a total of 61 patients, 5 years after the first enrollment (April 2016 to February 2021). Finally, the CR rate in RT + WBH revealed the most significant difference with RT-alone, 47.4% versus 5.3% respectively within 2 months post-treatment (P-value <0.05). The time of complete pain relief was 10 days for RT + WBH, while the endpoint was not reached during the RT-alone arm. Pain progression or stable disease was observed in half of the patients in RT-alone group within 4 weeks after treatment. However, this score was near zero in RT + WBHT patients in two months post-treatment. WBH plus RT showed significant increases in pain relief and shorter response time in comparison with RT-alone for patients with bone metastatic lesions. • The mean percentage of CR, and PR rate were 47.4%, and 47.43% for RT + WBH and 5.3%, 31.6% for RT group respectively at week 8. • The time to reach the treatment response in RT + WBH group was much quicker than RTalone group. • The maximum CR rate in RT + WBH was seen at week 8, while in RT alone it was equal to5.3% at week 8 after the treatment. [ABSTRACT FROM AUTHOR]

Post-surgical chronic pain with a neuropathic component is usually more severe and leads to worse quality of life. We conducted this systematic review to examine the evidence of topical lidocaine for post-surgical neuropathic pain. Systematic review with meta-analysis. Published randomized controlled trials (RCTs) comparing topical lidocaine with placebo or no topical lidocaine for post-surgical neuropathic pain. Seven RCTs including 585 patients. We systematically searched databases for randomized controlled trials (RCTs) investigating the effect and safety outcomes of topical lidocaine compared with placebo or no intervention. We conducted meta-analyses to evaluate the effect of topical lidocaine on pain intensity, adverse events, and quality of life. Standardized mean difference (SMD) and relative risk (RR) with 95% CIs were effect measures for continuous and dichotomous outcomes, respectively. We assessed the risk of bias of included trials and the certainty of evidence for each outcome. Our review included 7 studies with 585 participants. There is moderate certainty evidence that topical lidocaine may increase the likelihood of global pain relief, with a relative risk (RR) of 1.98 (95% confidence interval (CI): 1.04, 3.76; I2 = 70%, P = 0.04). Low certainty evidence suggested topical lidocaine may lead to more reduction in pain intensity (SMD: −0.70; 95% confidence interval: −1.46, 0.06; I2 = 93%, P = 0.07). High certainty evidence showed that topical lidocaine did not increase the adverse event risk (RR: 1.04; 95% CI: 0.93, 1.16; I2 = 0%, P = 0.51). Topical lidocaine may lead to pain relief and is safe to use for patient with post-surgical pain, though its impact on quality of life is unclear. This review supports the use of topical lidocaine for patients with post-surgical pain, and reveals the evidence gap in topical lidocaine use. (Registration: PROSPERO CRD42021294100). • Topical lidocaine may lead to pain relief, but does not increase the risk of adverse events. • Topical lidocaine could be used for patients with post-surgical neuropathic pain. • There is evidence gap in difference between different formula of topical lidocaine, and optimal preparation of topical lidocaine. [ABSTRACT FROM AUTHOR]

Introduction: Although acute musculoskeletal pain has a wide range of causes from tendinitis, muscle spasm, to bone and joint injuries, it is a frequent occurrence in emergency services. Paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are common used in the treatment of musculoskeletal pain. This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief.Methods: This prospective, randomized, double blind, controlled study was carried out in a university emergency room. The participating patients were randomized into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 ml of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins.Results: 200 patients were included in the study, excluding 7342 of them. The mean age of the patients was calculated as 32,6. Paracetamol and dexketoprofen intervention decreases NRS pain scores over time. When compared to all pain locations, the NRS pain score of the patients was found to be statistically more effective in dexketoprofen than in paracetamol (p = 0.001). Paracetamol and dexketoprofen intervention reduces pain VAS scores over time. When the VAS pain score of the patients was compared to all pain locations, dexketoprofen was found to be statistically more effective than paracetamol (p = 0.001).Conclusion: Intravenous dexketoprofen seemed to achieve superior analgesia to intravenous paracetamol when compared with all pain locations in patients with non-traumatic musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Radiofrequency rhizotomy (RFR) is a commonly used, effective procedure for trigeminal neuralgia (TN), but a subset of patients experiences pain recurrence and requires subsequent surgeries. Currently, the rhizotomy temperature and duration of application are empirically determined, and there is no consensus on what settings are most beneficial. In this study, we analyzed patients who underwent trigeminal RFR and had subsequent surgeries to identify whether rhizotomy parameters were associated with the duration of pain relief. Single-center, retrospective analysis of patients undergoing RFR for TN from 1995 to 2016. The primary endpoint was subsequent procedure. Associations with rhizotomy parameters and covariates were assessed using Cox regression analysis. The study included 338 patients, average age 65 years; 61% were women. Temperature was significantly associated with both the degree of immediate postoperative pain relief and the duration of pain relief, and in subgroup analyses by multiple sclerosis status and RFR procedural count. Ablation duration was also independently significant, though not when analyzed alongside age, sex, and race. Duration of pain relief was generally shorter in patients with multiple sclerosis and in repeated RFR. Higher temperatures may be necessary to achieve pain relief in some patients, given the progressive nature of the facial pain, but they are not associated with longer duration of pain relief in patients who have recurrent pain. Modulation of the ablation duration does not seem to affect the short-term or long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic lumbar back pain (CLBP) often present with an altered gait profile, which is a crucial element of good functioning in everyday life. In patients with multisegmental spinal pathologies and incongruity between radiologic imaging and clinical presentation, inpatient gradual diagnostics (IGD) is performed to determine the precise origin of the disabling pain. The underlying principle of IGD is the assumption that by locally administering an analgesic and anti-inflammatory agent to possible surgical target areas, the surgical effect can be temporarily simulated. The conclusions drawn from IGD are, however, mostly based on the patients' subjective feedback about pain relief.Research Question: The aim of this study was to evaluate whether reported pain relief during IGD can be objectified by gait analysis. We hypothesized that patients with greater pain relief during IGD would show greater improvement in their pathologic gait and stance.Methods: Treadmill gait and stance analyses were prospectively performed on CLBP patients before and after a one-week IGD. Self-report measures included the numeric pain rating scale (NRS) and the Oswestry Disability Index (ODI).Results and Significance: Compared with a reference group (n = 28), IGD patients (n = 57) at admission showed reduced velocity, cadence, step length, and swing phase (p < .01 each). Their stance phase was increased by 5% of the gait cycle, and a more asymmetrical total load distribution during stance was observed. No difference was seen in stride width or foot rotation. While many patients reported good pain relief during IGD, no correlation was observed between subjective improvement and treadmill measures. We can thus confirm a pathologic gait profile in patients with CLBP. Based on our findings, gait analysis would not yet seem suitable to objectify IGD results. The short time interval between admission and discharge may not suffice to change a pathological gait that has developed over years. [ABSTRACT FROM AUTHOR]

Background: Colposcopy is an office gynecological procedure used for cervical evaluation in patients with abnormal cervical cytology. It is considered an important tool for early detection of cases of cervical cancer. Objective: To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy of local anesthetics in pain relief during colposcopic-guided biopsy. Data sources: Several electronic databases included MEDLINE, EMBASE, Cochrane Library, ISI and Scopus were searched using the relevant MeSH terms. Methods of study selection: All RCTs assessing the effect of local anesthetics in relieving pain during colposcopy were considered for this meta-analysis. There were 1339 studies identified of which 11 studies deemed eligible for this review. We performed quality and risk of bias assessment for all included studies. Data extraction: Three researchers independently extracted the data from the individual articles and entered it into RevMan software. The extracted outcomes included pain scores and the duration of the procedure. Results: Eleven RCTs were included. Local anesthesia (LA) was associated with higher pain at speculum insertion than control (SMD = 0.23, 95% CI [0.03, 0.43]). While, LA significantly reduced biopsy pain than control (SMD= -0.57, 95% CI [-0.94, -0.20]). The overall pooled estimate showed no significant difference between LA and control regarding postprocedural pain, pain on endocervical curettage, pain expectancy, and overall pain scores. Conclusions: This meta-analysis suggests that local anesthetics are effective in pain relief during a colposcopic-guided biopsy; however there is no strong evidence to recommend its use in current practice. [ABSTRACT FROM AUTHOR]

Patients undergoing major vascular surgery are high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Endovascular procedures are less invasive, yet not devoid of potentially serious complications. Reduction of myocardial oxygen demand is key: stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia. Continuation of preoperative risk-reduction strategies including aspirin, beta-blockers and statin therapies are critical, and should be continued in the postoperative period. Maintaining a high index of suspicion for procedure-specific complications is essential in order to reduce morbidity and mortality in these patients. [ABSTRACT FROM AUTHOR]

Study Objective: To compare the efficacy of oral diclofenac potassium versus hyoscine-N-butyl bromide (HBB) in reducing pain perception in patients undergoing diagnostic office hysteroscopy (OH).Design: A randomized double-blind placebo-controlled trial (Canadian Task Force classification I).Setting: A university hospital.Interventions: One-hundred twenty-nine patients were divided randomly into 3 groups (n = 43 in each group); group 1 received 50mg diclofenac potassium, group 2 received 20mg HBB, and group 3 received placebo tablets. All tablets were taken orally 1hour before OH. The primary outcome was the participant's self-rated pain perception using the 10-point visual analog scale during the procedure. The secondary outcomes included the visual analog scale score 30 minutes after OH, ease of OH assessment using a 10-cm scale, duration of OH, and adverse effects of the study medications.Measurements and Main Results: Both the diclofenac and HBB groups showed significant pain score reduction compared with the placebo group (p = .001). The mean pain score in the diclofenac group was significantly lower than the HBB group (2.12 ± 1.03vs 3.02 ± 1.55, respectively; p = .002). The pain scores in the diclofenac and HBB groups immediately after OH were significantly lower than the placebo group (p = .001), and the mean pain score in the diclofenac group was significantly lower than the HBB group (1.23 ± 0.57vs 1.56 ± 0.73, respectively; p = .024). The ease of procedure score was significantly lower in the diclofenac and HBB groups than the placebo group (p = .003 and p = .005, respectively). The mean duration of the procedure was significantly less in the diclofenac group (p = .01). Fourteen women (32.6%) in the HBB group experienced dizziness and 2 women (4.6%) had nausea, whereas only 4 women (9.3%) in the diclofenac group had dizziness and 2 women (4.6%) had vomiting.Conclusion: Oral diclofenac potassium administration 1hour before diagnostic OH reduces the procedure pain with subsequent easier and shorter OH duration. Oral HBB is less effective than diclofenac potassium with more adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH).Design: Systematic review and meta-analysis of randomized controlled trials.Setting: Not applicable.Patient(s): Patients undergoing diagnostic OH received tramadol versus those who were administered placebo.Intervention(s): Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic).Main Outcome Measure(s): Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure.Result(s): One hundred thirteen studies were identified of which four randomized clinical trials were deemed eligible for this review (tramadol: n = 209; placebo: n = 209). The pooled estimate showed that tramadol significantly reduced VAS during procedure than placebo (weighted mean difference [WMD] = -1.33; 95% confidence interval [CI] -1.78 to -0.88, I2 = 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = -1.05; 95% CI -1.49 to -0.61, I2= 0, P = .84) and 30 minutes after (WMD = -0.98; 95% CI -1.30 to -0.65, I2 = 0, P = .88).Conclusion(s): This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH. [ABSTRACT FROM AUTHOR]

Highlights • Nurses prepares, mentally, practically, and theoretically for child encounters. • Nurses uses different methods to develop trusting relationships with children. • Needs for education about children in specialist courses and at the workplace. • Nurses administrates low doses of analgesics and risk insufficient pain relief. • It is essential to evaluate the administration of adequate pain relief to children. Abstract Background Pain relief in children is a complex issue, partly an ethical dilemma and due to a lack of nursing competence. There are few studies regarding prehospital care encounters with children in pain. Aim The aim of this study was to describe nurses' experiences in prehospital care encounters with children in pain and the specific related challenges. Method This study has a qualitative design. Eighteen Swedish nurses participated in three focus group interviews analysed using qualitative content analysis. Findings The findings consist of a theme, "A challenge to shift focus and adjust to the child", and three categories describing prehospital care encounters with children in pain: "Being receptive and focusing on care," "Developing a trusting relationship," and "Providing professional nursing care." Caring for children in pain was stressful for the nurses. The nurses described how they had to shift focus and used different methods to build trust, such as playfulness, making eye contact, attracting curiosity, and using the parents to create trust. The also had to adjust to the child regarding dosages and materials. Conclusion Nurses has to be practically, mentally, and theoretically prepared to care for children with prehospital pain. It is essential to evaluate the administration of adequate pain relief to children, and more evidence-based knowledge is necessary concerning the different modes of administering pain-relieving drugs to prehospital children. [ABSTRACT FROM AUTHOR]

Abstract Downloadable open access UK guidelines for managing complex regional pain syndrome (CRPS) have been available since 2012. Care is interdisciplinary and readers involved in the care of patients with CRPS are strongly recommended to read these guidelines. Since 2012 there have been several larger randomized controlled trials (RCTs) which have helped to clarify the role of some treatments in CRPS management, although the results of some subsequent meta-analyses have been conflicting. Early data from an RCT with 152 patients suggest superiority of dorsal root ganglion stimulation over conventional spinal cord stimulation in patients with lower extremity CRPS. An RCT involving 111 patients investigating the role of low-dose intravenous immunoglobulin treatment in long-standing CRPS failed to show benefit from this treatment. Despite the lack of direct evidence that nociceptive and neuropathic pain drugs can relieve pain from CRPS, it is reasonable for orthopaedic surgeons to follow relevant guidelines and initiate treatment with these drugs and to request GP colleagues to monitor and titrate these drugs as appropriate. As per the UK CRPS guidelines, the non-surgical approach to the management of CRPS centres on the following four pillars of care: education, physical rehabilitation, pain relief and psychological intervention where appropriate. [ABSTRACT FROM AUTHOR]

Abstract Background The use of sterile water injections (SWI) for the relief of pain in labour is popular amongst midwives in countries such as Sweden and Australia. Anecdotal reports suggest the procedure is used less commonly in the United Kingdom (UK) and that a number of barriers to introducing the practice may exist. Objective The objective of this study was to explore the awareness and use of SWI amongst midwives in the UK. Design A cross-sectional study using an internet-based questionnaire. Participants Midwives with Nursing and Midwifery Council Registration and currently practicing. Setting The questionnaire was distributed via the Royal College of Midwives Facebook page and Twitter account. Invitations to participate were also sent to Heads of Midwifery to distribute to staff. Findings Three hundred and ninety-eight midwives completed the survey. Eighty-two percent of midwives did not use SWI in practice although 69% would consider learning the procedure. There was considerable variation in techniques amongst midwives that did provide SWI. The lack of available practice guidelines and the advice from the National Institute for Health and Care Excellence to not use SWI were cited as the main barriers. Key conclusions SWI use is uncommon in the UK although midwives are interested in incorporating the procedure into practice. Implications for practice National guidance on SWI and the lack of information and training is restricting the use of the procedure in practice, despite SWI being widely used in other countries and being effective in the treatment of pain in labour. [ABSTRACT FROM AUTHOR]

Abstract Background About 30% of women in labour suffer from lower back pain. Studies of sterile water injections for management of low back pain have consistently shown this approach to be effective. The objective of this evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower back pain in labouring women. Methods To identify relevant publications our search strategy was based on computerised literature searches in scientific databases. The methodological quality of each study was assessed using the modified version of the Jadad scale, 12 studies were included. Findings Recommendations regarding the clinical use of sterile water injections for pain relief in labour are reported in terms of the location of injection administration, various injection techniques, number of injections used, amount of sterile water in each injection and adverse effects. Discussion Both injection techniques provide good pain relief for lower back pain during labour. The subcutaneous injection technique is possibly less painful than the intracutaneous technique administered, but we are unsure if this impacts on effectiveness. The effect seems to be related to the number of injections and the amount of sterile water in each injection. Conclusion The recommendation at present, based on the current state of knowledge, is to give four injections. Notwithstanding the differences in injection technique and number of injections the method appears to provide significant levels of pain relief and can be repeated as often as required with no adverse effect (apart from the administration pain) on the woman or her foetus. [ABSTRACT FROM AUTHOR]

Highlights • Psychoneurophysiological processes as mechanistic approach for chronic pain. • Importance of motivation, reward/pain relief in the context of chronic pain. • Importance of fear learning in the context of chronic pain. • Mechanistic approach important for the transition from acute to chronic pain. Abstract In the understanding of chronic pain, hypotheses derived from psychological theories, together with insights from physiological assessments and brain imaging, highlight the importance of mechanistically driven approaches. Physical system changes, for example following injury, can result in alterations of psychological processes and are accompanied by changes in corticolimbic circuits, which have been shown to be essential in emotional learning and memory, as well as reward processing and related behavior. In the present review, we thus highlight the importance of motivational, reward/pain relief, and fear learning processes in the context of chronic pain and discuss the potential of a mechanistic understanding of chronic pain within a clinical perspective, for example for the development of therapeutic strategies. We argue that changes in these mechanisms are not only characteristic for chronic pain, reflecting consequences of the disorder, but are also critically involved in the transition from acute to chronic pain states. [ABSTRACT FROM AUTHOR]

Objective In the Netherlands, the place of birth, birthing position, and pain relief are subject to preference-sensitive decisions of women, after counseling by their midwife. Dutch midwives are responsible for providing information and advice to guide pregnant women in such decisions. In this study we investigate how midwifery students, who are simultaneously committed to midwifery values and influenced by media culture, approach such preference-oriented communication in midwifery care . Design and setting In-depth interviews and a focus group with seventeen Dutch midwifery students were conducted and analyzed applying a grounded theory approach. Findings Student midwives are confronted with women who prefer a medical (“safe”) and pain-free (“comfortable”) birth. Such preferences reveal culturally induced priorities that form a threat to the bond of trust between midwives and women throughout the childbirth continuum. This development is felt personally by midwifery students, as an impact on each individual physiological birth, as well as professionally, as a threat to the midwifery values they acquire in their education. The interviews revealed that students have adopted distinctive communicative strategies to respond to media-driven values in childbearing women: Take Time and Listen; Counsel Neutral Information; and Safeguard from Negative Impact. Key conclusions and implications Non-confrontational communication strategies allow midwifery students to build a trusting relationship with women, but the strategies are in part contradictory. Students experience inner tension due to decision outcomes that conflict with their midwifery values. Consequences for midwifery education are discussed. [ABSTRACT FROM AUTHOR]

Aim This study aims to analyze and describe the effects of music listening in the management of pain in adult patients, as reported in systematic reviews and meta-analysis. Methods A search of articles published between 2004 and 2017 was conducted on Pubmed, ScienceDirect, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE and LILACS. Search, quality assessment, and data extraction was done independently by two researchers. Results Most of reviews found a significant effect of music on pain. All analyses had a high heterogeneity, and only acute pain and music delivered under general anesthesia had moderate heterogeneity. No differences were found when music was chosen by the patient. Music type and its characteristics are scantly described and in terms that lack validity. Conclusions More focused trials and reviews, objective language for music, and trials with music chosen by its characteristics are required. [ABSTRACT FROM AUTHOR]

Cautery disbudding of goat kids is painful, but may be alleviated with pain mitigation. We therefore evaluated the effect of administering general anesthesia (isoflurane) or a nonsteroidal anti-inflammatory drug (meloxicam) on goat kid behavior and physiology following cautery disbudding. Trial 1 (n = 12/treatment) evaluated behavioral responses in 72 female Saanen dairy goat kids (mean ± standard error of the mean; 3.9 ± 0.15 d old) and trial 2 (n = 10/treatment) evaluated physiological responses in 60 female Saanen dairy goat kids (4.3 ± 0.14 d old). Goat kids were randomly assigned to 1 of 6 treatment groups that were either (1) sham-handled only (simulated disbudding; SHAM) or disbudded with (2) no pain relief (CAUT), (3) isoflurane gas (ISO), (4) isoflurane and s.c. meloxicam combined (ISO+MEL), (5) meloxicam s.c. (0.5 mg/kg of body weight; I-MEL), or (6) oral meloxicam (0.2 mg/kg of body weight; O-MEL). Head shaking, head scratching, self-grooming, feeding, and body shaking were continuously video recorded for 24 h pre- and post-treatment. Lying behavior was recorded continuously for 24 h pre- and post-treatment using accelerometers. Plasma cortisol, glucose, and lactate concentrations were measured from blood samples collected immediately before treatment (baseline) and at 15, 60, and 120 min post-treatment. Body temperature was measured immediately after blood sampling at all blood sampling time points. Head shaking and body shaking frequencies were 50% higher in CAUT than SHAM kids 5 min post-treatment; ISO+MEL and ISO kids performed 25% less body shakes than CAUT kids. Head scratching durations 1 h post-treatment were higher in CAUT than SHAM kids, whereas O-MEL were similar to SHAM kids from 2 h post-treatment. Self-grooming, feeding, and lying did not differ between groups. Cortisol concentrations were higher in CAUT than SHAM kids (156.4 ± 26.41 and 104.1 ± 26.41 nmol/L, respectively), whereas ISO+MEL and ISO kids (88.3 ± 26.41 and 113.2 ± 26.41 nmol/L, respectively) had lower cortisol concentrations than CAUT kids over the 2-h sampling period. Moreover, O-MEL and I-MEL kids (163.0 ± 26.41 and 130.9 ± 26.41 nmol/L, respectively) had similar cortisol concentrations to CAUT kids. We found no evidence that plasma glucose and lactate concentrations or body temperature were affected by treatment. The administration of isoflurane, with or without meloxicam, appeared to reduce pain associated with cautery disbudding. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les métastases osseuses sont source de douleurs et altèrent la qualité de vie des patients. La radiothérapie est un des traitements antalgiques de référence. L’objectif de cette étude était de comparer les pratiques courantes d’un service de radiothérapie français pour le traitement des métastases osseuses non compliquées avec les données de la littérature dans le but d’améliorer et d’optimiser la prise en charge des patients. Matériel et méthodes Une étude rétrospective monocentrique des patients ayant bénéficié d’une irradiation palliative de métastases osseuses non compliquées a été menée. Résultats Quatre-vingt-onze patients ont bénéficié de 116 radiothérapies de métastases osseuses non compliquées sur la période étudiée, dont 44 hommes (48 %) et 47 femmes (52 %), âgés en moyenne de 63 ans (25–88 ans). Les tumeurs primitives les plus fréquemment retrouvées étaient mammaires (35 %), pulmonaires (16 %) et prostatiques (12 %). Les schémas thérapeutiques utilisés étaient dans 29 % des cas 30 Gy en dix fractions, dans 21 % des cas 20 Gy en cinq fractions, dans 22 % des cas 8 Gy en une séance et dans 28 % des cas 23,31 Gy en trois fractions en conditions stéréotaxiques. L’état général du patient (indice de performance selon l’Organisation mondiale de la santé et indice de Karnofsky) ( p < 0,001), le score de la douleur et la consommation d’antalgiques ( p < 0,001), son profil oligométastatique ( p = 0,003) et l’expérience du praticien ( p < 0,001) étaient des facteurs influençant le choix du schéma d’irradiation. L’âge ( p = 0,46), le sexe ( p = 0,14), les traitements anticancéreux en cours ( p = 0,56), l’hospitalisation concomitante ( p = 0,14) et la distance entre le centre de radiothérapie et le domicile ( p = 0,87) n’influençaient pas la décision significativement. En tout, trois cas de compression médullaire et un de fracture post-thérapeutique ont été observés, survenant respectivement entre un et 128 jours et 577 jours après l’irradiation. Huit pour cent de l’ensemble des métastases irradiées ont été ré-irradiées entre 13 et 434 jours. Le taux de ré-irradiation était significativement plus important après un traitement par 8 Gy ( p = 0,02). Le taux de décès était significativement moins important ( p < 0,001) et la probabilité de survie globale significativement plus importante après radiothérapie stéréotaxique ( p < 0,001). Conclusion Cette étude a montré que la population des patients analysée était comparable aux populations de différentes études. Des facteurs prédictifs de choix du schéma thérapeutique ont été identifiés. Le traitement non fractionné était sous-utilisé, alors que le traitement en conditions stéréotaxiques était de plus en plus prescrit, ce qui montre une évolution dans la prise en charge des patients. Purpose Bone metastases cause pain and affect patients’ quality of life. Radiation therapy is one of the reference analgesic treatments. The objective of this study was to compare the current practices of a French radiotherapy department for the treatment of uncomplicated bone metastases with data from the literature in order to improve and optimize the management of patients. Material and methods A retrospective monocentric study of patients who underwent palliative irradiation of uncomplicated bone metastases was performed. Results Ninety-one patients had 116 treatments of uncomplicated bone metastases between January 2014 and December 2015, including 44 men (48%) and 47 women (52%) with an average age of 63 years (25–88 years). Primary tumours most commonly found were breast cancer (35%), lung cancer (16%) and prostate cancer (12%). The regimens used were in 29% of cases 30 Gy in ten fractions (group 30 Gy), in 21% of cases 20 Gy in five fractions (group 20 Gy), in 22% of cases 8 Gy in one fraction (group 8 Gy) and in 28% of cases 23.31 Gy in three fractions of stereotactic body irradiation (stereotactic group). The general condition of the patient ( P < 0.001), pain score and analgesic ( P < 0.001), oligometastatic profile ( P = 0.003) and practitioner experience ( P < 0.001) were factors influencing the choice of the regimen irradiation. Age ( P = 0.46), sex ( P = 0.14), anticancer treatments ( P = 0.56), concomitant hospitalization ( P = 0.14) and the distance between the radiotherapy centre and home ( P = 0.87) did not influence the decision significantly. A total of three cases of spinal compression and one case of post-therapeutic fracture were observed, occurring between one and 128 days and 577 days after irradiation, respectively. Eight percent of all irradiated metastases were reirradiated with a delay ranging between 13 and 434 days after the first irradiation. The re-irradiation rate was significantly higher after 8 Gy ( P = 0.02). The rate of death was significantly lower in the stereotactic arm ( P < 0.001) and overall survival was significantly greater in the stereotactic arm ( P < 0.001). Conclusion This study showed that patients’ analysed was comparable to the population of different studies. Predictive factors for the choice of the treatment regimen were identified. Non-fractionnated therapy was underutilised while stereotactic treatment was increasingly prescribed, showing an evolution in the management of patients. [ABSTRACT FROM AUTHOR]

Palliative radiotherapy has been shown to have effects on Quality of Life during painful bone metastasis. This review aimed to determine equivalence in pain relief (PR) and retreatment rate (RR) using both single and multi-fraction irradiations, based on evaluation of the trial’s quality. We performed a systematic review since ICRU 50 Report (1993) to June 2017, then evaluated trials for reproducibility and good methodology criteria. We found five studies that were reproducible in both dose and volume prescription. One study used three-dimensional (3D) treatment planning. Equivalence between single and multi-fraction schedules was demonstrated for PR after 3 months, but a 2–3 time RR appeared after single-fraction schedules, notably in the first year after treatment (primarily during the first four months). Reserving long course therapy for well-preserved patients would allow for better long-term efficacy with lower RR, while altered patients would suffer less from single-fraction treatments. It appears that life expectancy might not be used as a criterion for this choice. [ABSTRACT FROM AUTHOR]

Background Opioid receptors are commonly expressed on various immune cells, macrophages especially. Thus, these cells are prone to stimulation with opioids, which seems to be responsible for opioid-induced immunomodulatory effects. While morphine, fentanyl and methadone influence on mouse immune response was recently studied, little is known about the potential immunomodulatory impact of buprenorphine and oxycodone. Aim The current research aimed to investigate the influence of buprenorphine and oxycodone on immune responses in mice under homeostatic conditions. Methods and results Repeated administration of morphine led to intensification of CHS response in actively sensitized mice, while buprenorphine or oxycodone administration exerted the opposite effect. Further, hapten-conjugated macrophages from mice treated with morphine, when transferred into naive recipients, induced more potent CHS response. The enhanced generation of reactive oxygen intermediates and nitric oxide by macrophages from mice treated with buprenorphine, oxycodone or morphine was also shown, along with increased release of IL-6, TNFα and TGFβ. Treatment with opioids altered expression of antigen phagocytosis and presentation markers. Finally, the inhibitory effect of morphine treatment on induction of humoral immunity by macrophages was demonstrated, while oxycodone failed to influence humoral immune response and buprenorphine actually enhanced B-cell activation. Conclusions Current observations confirm that macrophages greatly contribute to immunomodulatory effects of opioids. Studies on immunomodulation by opioids have great importance related to the evaluation of its beneficial and adverse effects on patient condition. Our research showed that oxycodone exerts the weakest immunomodulatory properties, allowing us to assume this drug as safer than morphine during prolonged therapy. [ABSTRACT FROM AUTHOR]