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Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Jeffrey Gudin,1 Seferina Mavroudi,2,3 Aigli Korfiati,3 Konstantinos Theofilatos,3 Derek Dietze,4 Peter Hurwitz5 1Rutgers New Jersey Medical School, Newark, NJ, USA; 2Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, Pátrai, Greece; 3InSyBio Ltd, Winchester, UK; 4Metrics for Learning LLC, Queen Creek, Arizona, USA; 5Clarity Science LLC, Narragansett, Rhode Island, USACorrespondence: Peter HurwitzClarity Science LLC, 750 Boston Neck Road, Suite 11, Narragansett, RI 02882, USATel +1917 757 0521Fax +1855-891-8303Email peterh@claritysciences.orgPurpose: Chronic pain is a life changing condition, and non-opioid treatments have been lately introduced to overcome the addictive nature of opioid therapies and their side effects. In the present study, we explore the potential of machine learning methods to discriminate chronic pain patients into ones who will benefit from such a treatment and ones who will not, aiming to personalize their treatment.Patients and Methods: In the current study, data from the OPERA study were used, with 631 chronic pain patients answering the Brief Pain Inventory (BPI) validated questionnaire along with supplemental questions before and after a follow-up period. A novel machine learning approach combining multi-objective optimization and support vector regression was used to build prediction models which can predict, using responses in the baseline, the four different outcomes of the study: total drugs change, total interference change, total severity change, and total complaints change. Data were split to training (504 patients) and testing (127 patients) sets and all results are measured on the independent test set.Results: The machine learning models extracted in the present study significantly overcame other state of the art machine learning methods which were deployed for comparative purposes. The experimental results indicated that the machine learning models can predict the outcomes of this study with considerably high accuracy (AUC 73.8– 87.2%) and this allowed their incorporation in a decision support system for the selection of the treatment of chronic pain patients.Conclusion: Results of this study revealed the potential of machine learning for an individualized medicine application for chronic pain therapies. Topical analgesics treatment were proven to be, in general, beneficial but carefully selecting with the suggested individualized medicine decision support system was able to decrease by approximately 10% the patients which would have been subscribed with topical analgesics without having benefits from it.Keywords: individualized medicine, pain therapy, non-opioid treatment, machine learning, predictive analytics, regression, multi-objective optimization, support vector regression

Introduction: Complex regional pain syndrome (CRPS) is a rare complication after limb injuries. Early recognition of the symptomatology and interdisciplinary interventions are essential to prevent long-term disability and pain., Objective: This article presents results on the incidence of CRPS after surgery in Germany and treatments used by patients with CRPS, using claims data from the BARMER, a German nationwide health care insurance., Methods: A total of N = 85,862 BARMER patients with inpatient surgery on the upper or lower limb in 2018 were included. Patients with CRPS were identified by documented International Statistical Classification of Diseases and Related Health Problems -10 diagnosis within 12 months after surgery. For the same period, medication and nonpharmaceutical therapies for inpatient and outpatient care were assessed., Results: The overall incidence of CRPS within 12 months after surgery was 0.34%. With 0.60%, the incidence of CRPS after surgeries of the upper limb was 3 times higher than after lower-limb surgeries (0.20%). Women were more frequently affected, and most patients were between 50 and 70 years old. About 80% to 90% of patients with CRPS received physiotherapy and nonopioid pain medication within 12 months after surgery. Approximately 40% to 50% were treated with opioids and/or antineuropathic medication. Cortisone, bisphosphonates, pain therapy, and occupational therapy were rarely claimed., Conclusion: We found a low incidence of CRPS after various types of surgeries. Although previous research has focused on distal radius fractures and ankle surgery, our data suggest that clinicians should be aware of CRPS after other types of surgeries as well. Real-world treatment of CRPS does not reflect recommendations in clinical practice guidelines., Competing Interests: H.R. received consultant fees from Gruenenthal and Orion and financial support for a study by Algiax. W.M. received consultant fees from Tafalgie, Kyowa, Mundipharma, Grünenthal, Ethypharm, and Spectrum Therapeutics. His institution received research support from European Commission, Gemeinsamer Bundesausschuss (GBA), Medtronic, Pfizer, Mundipharma, Grünenthal, and Vertanical. K.T., N.R., J.D., D.S., and G.K. have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)

In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification. [ABSTRACT FROM AUTHOR]

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Sports-related pain and injury is directly linked to tissue inflammation, thus involving the autonomic nervous system (ANS). In the present experimental study, we disable the sympathetic part of the ANS by applying a stellate ganglion block (SGB) in an experimental model of delayed onset muscle soreness (DOMS) of the biceps muscle. We included 45 healthy participants (female 11, male 34, age 24.16 ± 6.67 years [range 18–53], BMI 23.22 ± 2.09 kg/m2) who were equally randomized to receive either (i) an SGB prior to exercise-induced DOMS (preventive), (ii) sham intervention in addition to DOMS (control/sham), or (iii) SGB after the induction of DOMS (rehabilitative). The aim of the study was to determine whether and to what extent sympathetically maintained pain (SMP) is involved in DOMS processing. Focusing on the muscular area with the greatest eccentric load (biceps distal fifth), a significant time × group interaction on the pressure pain threshold was observed between preventive SGB and sham (p = 0.034). There was a significant effect on pain at motion (p = 0.048), with post hoc statistical difference at 48 h (preventive SGB Δ1.09 ± 0.82 cm VAS vs. sham Δ2.05 ± 1.51 cm VAS; p = 0.04). DOMS mediated an increase in venous cfDNA -as a potential molecular/inflammatory marker of DOMS- within the first 24 h after eccentric exercise (time effect p = 0.018), with a peak at 20 and 60 min. After 60 min, cfDNA levels were significantly decreased comparing preventive SGB to sham (unpaired t-test p = 0.008). At both times, 20 and 60 min, cfDNA significantly correlated with observed changes in PPT. The 20-min increase was more sensitive, as it tended toward significance at 48 h (r = 0.44; p = 0.1) and predicted the early decrease of PPT following preventive stellate blocks at 24 h (r = 0.53; p = 0.04). Our study reveals the broad impact of the ANS on DOMS and exercise-induced pain. For the first time, we have obtained insights into the sympathetic regulation of pain and inflammation following exercise overload. As this study is of a translational pilot character, further research is encouraged to confirm and specify our observations.

Summary: Introduction: As a typical consequence of bleeding into muscles and joints, patients with severe hemophilia suffer from acute and chronic pain. In spite of its high prevalence, pain in this patient group is not always sufficiently considered or treated in an effective manner. Aim: The recommendations presented in this paper address possible improvements in pain management in hemophilia patients and particularities that have to be taken into account in this patient group. Method: The manifold aspects of pain management in hemophilia patients were discussed within the framework of an expert meeting. Based on the available literature and the experts' clinical experience, the participants developed a set of recommendations presented in this paper. Results: Pain management in patients with hemophilia is often insufficient, a fact that not only influences the patients' quality of life but also implies the risk of difficult to manage chronic pain. Both the prevalent polypharmacy (due to comorbidities) as well as the underlying disease itself present special challenges to pain therapy in this patient group. The present review and recommendations are intended to support medical professionals in recognising the risks of pain chronicity, applying basic principles of multimodal pain therapy, including the options of psychological intervention and modalities of physical medicine in therapy concepts, and reaching a comprehensive understanding of the range of analgesic options available. [ABSTRACT FROM AUTHOR]

Sports-related pain and injury is directly linked to tissue inflammation, thus involving the autonomic nervous system (ANS). In the present experimental study, we disable the sympathetic part of the ANS by applying a stellate ganglion block (SGB) in an experimental model of delayed onset muscle soreness (DOMS) of the biceps muscle. We included 45 healthy participants (female 11, male 34, age 24.16 ± 6.67 years [range 18–53], BMI 23.22 ± 2.09 kg/m2) who were equally randomized to receive either (i) an SGB prior to exercise-induced DOMS (preventive), (ii) sham intervention in addition to DOMS (control/sham), or (iii) SGB after the induction of DOMS (rehabilitative). The aim of the study was to determine whether and to what extent sympathetically maintained pain (SMP) is involved in DOMS processing. Focusing on the muscular area with the greatest eccentric load (biceps distal fifth), a significant time × group interaction on the pressure pain threshold was observed between preventive SGB and sham (p = 0.034). There was a significant effect on pain at motion (p = 0.048), with post hoc statistical difference at 48 h (preventive SGB Δ1.09 ± 0.82 cm VAS vs. sham Δ2.05 ± 1.51 cm VAS; p = 0.04). DOMS mediated an increase in venous cfDNA -as a potential molecular/inflammatory marker of DOMS- within the first 24 h after eccentric exercise (time effect p = 0.018), with a peak at 20 and 60 min. After 60 min, cfDNA levels were significantly decreased comparing preventive SGB to sham (unpaired t -test p = 0.008). At both times, 20 and 60 min, cfDNA significantly correlated with observed changes in PPT. The 20-min increase was more sensitive, as it tended toward significance at 48 h (r = 0.44; p = 0.1) and predicted the early decrease of PPT following preventive stellate blocks at 24 h (r = 0.53; p = 0.04). Our study reveals the broad impact of the ANS on DOMS and exercise-induced pain. For the first time, we have obtained insights into the sympathetic regulation of pain and inflammation following exercise overload. As this study is of a translational pilot character, further research is encouraged to confirm and specify our observations. [ABSTRACT FROM AUTHOR]

The incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.

Ulderico Freo,1 Patrizia Romualdi,2 Hans G Kress31Anesthesiology and Intensive Medicine, Department of Medicine DIMED, University of Padua, 35100 Padua, Italy; 2Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, 40126, Bologna, Italy; 3Department of Special Anaesthesia and Pain Medicine, Medical University/AKH of Vienna, Vienna, AustriaAbstract: Neuropathic pain (NP) is an enormous burden for patients, caregivers and society. NP is a pain state that may develop after injury of the peripheral or central nervous system because of a wide range of diseases and traumas. A NP symptom component can be found also in several types of chronic pain. Many NP patients are substantially disabled for years. Due to its chronicity, severity and unpredictability, NP is difficult to treat. Tapentadol is a central-acting oral analgesic with combined opioid and noradrenergic properties, which make it potentially suitable for a wide range of pain conditions, particularly whenever a NP component is present or cannot be excluded. In randomized controlled trials, tapentadol has proved to be effective in relieving NP in diabetic peripheral neuropathy and in chronic low back pain. In observational studies, tapentadol reduced NP in chemotherapy-induced peripheral neuropathies, blood and solid cancers, and the NP component in neck pain and Parkinson’s disease. This narrative review aims to provide clinicians with a broad overview of tapentadol effects on NP.Keywords: neuropathic pain, tapentadol, pain therapy

Pain is a complex perceptual phenomenon. Coordinated activity among local and distant brain networks is a central element of the neural underpinnings of pain. Brain oscillatory rhythms across diverse frequency ranges provide a functional substrate for coordinating activity across local neuronal ensembles and anatomically distant brain areas in pain networks. This review addresses parallels between insights from human and rodent analyses of oscillatory rhythms in acute and chronic pain and discusses recent rodent-based studies that have shed light on mechanistic underpinnings of brain oscillatory dynamics in pain-related behaviors. We highlight the potential for therapeutic modulation of oscillatory rhythms, and identify outstanding questions and challenges to be addressed in future research. Brain oscillatory rhythms across specific frequency bands are altered during acute and chronic pain in rodent and human studies, with consensus on changes in high frequency (gamma) oscillations. There is less consensus among human and rodent studies on changes in low frequency oscillations in acute and chronic pain. Rodent analyses support a key functional role for gamma oscillations in acute pain perception and aversion and in modulation of hypersensitivity in chronic pain. Fast-spiking GABAergic interneurons sculpt local cortical oscillatory rhythms and modulate the activity of other cortical and subcortical areas involved in negative affect and descending modulation of nociception. Insights are emerging on diverse ion channels and gap junction proteins in local and distant oscillatory rhythms that provide a substrate for pharmacological modulation of oscillations in pain therapy. [ABSTRACT FROM AUTHOR]

Medicine pain therapy of musculoskeletal complaints are often not promising because of complex causes and tendency to chronize. On the other hand, it is essential to acute complaints, given its light availability and short-term effects. All the more it requires the treatment of the patients to be fully aware that this is symptomatic therapy, taking thoroughly into account the effectiveness and side effects, dosage and patient education. [ABSTRACT FROM AUTHOR]

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Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Each year, pain imposes significant economic and social burdens, such as increased physician visits, analgesic use, and decreased productivity. Electroacupuncture (EA) was first used in China and is a potential addition to existing pain-relief approaches. Globally and exponentially, the number of fundamental and clinical studies on EA has increased over the past decade. Most bibliometric studies in this area focus on acupuncture therapy. A prevalent quantitative and qualitative approach, bibliometric analysis scrutinizes published scholarly articles and can be used to assess advancements in specific research domains. Yet, to the best of the current authors' knowledge, no specific bibliometric analysis of EA as a pain therapy has yet been conducted., Methods: Article data were taken from the Scopus ® database with the key words electroacupuncture or electro-acupuncture or electric acupuncture and pain. The timeframe was set between 2013 and 2022 in all forms, regardless of language barriers, resulting in a total of 1592 documents. The results of the data search were then analyzed with bibliometrics and VOSviewer., Results: This study showed the rapid growth in the study of EA in the last decade. Additionally, Evidence-Based Complementary and Alternative Medicine is a major journal that frequently publishes articles on EA., Conclusions: Despite China's substantial publication output on EA, international collaboration is limited, particularly among nations other than the United States and China., (Copyright 2024, Mary Ann Liebert, Inc., publishers.)

Opiates are routinely used for chronic pain patients, and up to 44% of them will have a prescription for an opiate medication for pain alleviation. However, of the 76 million adults prescribed opiates for pain management, about 12% report misuse, and a large number of these may find themselves addicted to opioid medications. Opioid addiction is an ongoing epidemic, costing many lives. Withdrawal is very difficult. This requires providers to consider alternative analgesic plans and minimize opiate use. Here we report the use of a dexamethasone-dexmedetomidine combination for a regional nerve block in an elderly woman chronically treated with opiate medications who had previously failed opiate weaning. Following her nerve block, she was able to completely wean off of opioids and continues having good pain control with an opioid-free regimen.

Within the lipidome oxidized phospholipids (OxPL) form a class of chemically highly reactive metabolites. OxPL are acutely produced in inflamed tissue and act as endogenous, proalgesic (pain-inducing) metabolites. They excite sensory, nociceptive neurons by activating transient receptor potential ion channels, specifically TRPA1 and TRPV1. Under inflammatory conditions, OxPL-mediated receptor potentials even potentiate the action potential firing rate of nociceptors. Targeting OxPL with D-4F, an apolipoprotein A-I mimetic peptide or antibodies like E06, specifically binding oxidized headgroups of phospholipids, can be used to control acute, inflammatory pain syndromes, at least in rodents. With a focus on proalgesic specificities of OxPL, this article discusses, how targeting defined substances of the epilipidome can contribute to mechanism-based therapies against primary and secondary chronic inflammatory or possibly also neuropathic pain.

Cancer pain remains a significant clinical problem worldwide. Cancer pain causes are multifactorial and complex and varying with a variety of factors and processes related both to the tumor process and to the host itself. Even though the quality of pharmacologic pain management has improved in the last decades, 1 in 3 patients do not receive pain medication appropriate for the intensity of experienced pain. Chronic cancer pain in urologic patients has different traits, since this carcinoma might originate from various organ:, prostate, kidneys, adrenal glands, urinary bladder or the penis. Urogenital neoplasm very often metastasized into the bones (spine, pelvis and head bones) and they are associated with pathological fractures, hypercalcemia, and neurological deficits, which lead to a significant reduction in quality of life. Pain induced by bone metastases is nociceptive pain, but may also be associated with neuropathic pain if the tumor performs compression or invasion of the nerve, spinal cord or nerve plexus. In 70-90% of urological cancer patients pain can be adequately relieved by consistent adherence to the WHO cancer pain recommendations. However, additional pain relief therapies, such as radiation and psychosocial treatment of these patients have to be considered.

Background: The Combined Mandibulectomy and Neck Dissection (COMMANDO) surgery results in severe postoperative pain and requires multimodal analgesia (MMA) for its management. We speculated that the erector spinae plane block (ESPB) which is the ultrasound (US)-guided regional technique and has been used in various types of surgeries due to its analgesic benefits could be used as an effective analgesic adjunct in COMMANDO surgery. Case presentation: We report a case of a 68-year-old female patient who underwent left side COMMANDO surgery for carcinoma cheek. She was given an ultrasound-guided left erector spinae plane block (ESPB) in the preoperative period with catheter insertion at T3 (3rd thoracic vertebral level). Two boluses of local anesthetic were given each with 10 ml 0.25% ropivacaine one before and one after surgery, and then, the infusion was started with a volumetric pump. The ESPB provided effective intraoperative as well as postoperative pain relief without any side effects. Conclusion: US-guided ESPB could be used as a potential opioid-sparing multimodal analgesic in head and neck surgeries based on the pain relief provided and the spread of contrast on imaging. This hypothesis needs to be explored in the form of case series and adequately powered randomized controlled trials. [ABSTRACT FROM AUTHOR]

Within the lipidome oxidized phospholipids (OxPL) form a class of chemically highly reactive metabolites. OxPL are acutely produced in inflamed tissue and act as endogenous, proalgesic (pain-inducing) metabolites. They excite sensory, nociceptive neurons by activating transient receptor potential ion channels, specifically TRPA1 and TRPV1. Under inflammatory conditions, OxPL-mediated receptor potentials even potentiate the action potential firing rate of nociceptors. Targeting OxPL with D-4F, an apolipoprotein A-I mimetic peptide or antibodies like E06, specifically binding oxidized headgroups of phospholipids, can be used to control acute, inflammatory pain syndromes, at least in rodents. With a focus on proalgesic specificities of OxPL, this article discusses, how targeting defined substances of the epilipidome can contribute to mechanism-based therapies against primary and secondary chronic inflammatory or possibly also neuropathic pain. [ABSTRACT FROM AUTHOR]

Objective: To alleviate pain after tonsillectomy (TE) with escalating gradual treatment protocols in a prospective trial.Materials& Methods: Following TE, 83 consecutive adult patients were treated with two different four-staged escalating analgesic protocols. Metamizole served as basic medication in protocol 1 (PT1; n = 44), whereas with protocol 2 (PT2; n = 39) ibuprofen was applied as baseline analgesic. Both protocols were escalated according to the patient´s needs to metamizole and ibuprofen vice versa and additional weak to strong opioids. The primary efficacy endpoint was defined as the minimum and maximum pain as well as pain on ambulation (NRS, 0-10). Secondary endpoints comprised analgesic score, patient satisfaction and treatment-related side-effects.Results: Both patient groups exhibited similar demographic characteristics (PT1: Ø 28.8 years; 64% ♀ and PT2: Ø 26.6 years; 56% ♀). Maximum pain (6.7 ± 1.9 vs. 7.6 ± 1.6, t(81) = -2.254, p = 0.027) and pain on ambulation (5.0 ± 1.8 vs. 5.8 ± 1.8, t(81) = -2.114, p = 0.038) were significantly higher with PT2. 68.2% of patients with PT1 needed an escalation of analgesic treatment compared to 100% with PT2 (p < 0.001). The opioid consumption was also significantly higher with PT2 (43.2% vs. 71.8%, p < 0.001). There were no significant differences regarding functional impairments, side-effects and patient satisfaction (7.0 ± 2.0 vs. 7.4 ± 2.4, t(79) = -0.897, p = 0.373).Conclusion: Both treatment protocols yielded in a high degree of patient satisfaction but dissatisfactory pain relief following TE. Metamizole can be recommended as a basic medication allowing for improved pain relief. Reported pain intensities were independent of the amount of opioid intake. Further research is mandatory to standardize and improve analgesic treatment after TE. [ABSTRACT FROM AUTHOR]

The article presents discovery of opioid analgesics, their marketing, as well as notable names connected with this history. [ABSTRACT FROM AUTHOR]

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Chronic pain management requires increasing doses of opioids, the milestone of painkillers, which may result in the onset of tolerance with exacerbated side effects. Maintaining stable analgesia with low doses of opioids is thus imperative. N-palmitoylethanolamine (PEA) is an endogenous lipid compound endowed with pain-relieving as well as anti-inflammatory properties. The ultramicronized formulation of PEA was recently demonstrated to be able to modulate morphine’s effects, delaying tolerance and improving efficacy. To evaluate the possible application to other opioids, in this study, we analysed the capacity of ultramicronized PEA to regulate analgesia and tolerance induced by oxycodone and tramadol. Pre-emptive and continuative treatment with ultramicronized PEA (30 mg kg−1, daily, per os) delayed the onset of opioid tolerance and enhanced opioid analgesia when it was acutely administered in association with tramadol (20 mg kg−1, daily, subcutaneously) or oxycodone (0.5 mg kg−1, daily, subcutaneously). Moreover, PEA exerted antinociceptive effects on tolerant rats, suggesting the use of PEA together with opioids for stable, long-lasting analgesia. To that purpose, the oxycodone dose needed to be increased from 0.3 mg kg−1 (day 1) up to 1 mg kg−1 (day 31) in the oxycodone + vehicle group; the tramadol dose was progressively enhanced from 15 mg kg−1 to 50 mg kg−1 in 31 days in the tramadol + vehicle group. Acute oral co-treatment with PEA (120 mg kg−1) achieved the same analgesia without increasing the dose of both opioids. The behavioural effects of PEA on opioid chronic treatment paralleled a decrease in astrocyte activation in the dorsal horn of the spinal cord (a marker of the development of opioid tolerance) and with a modulation of mRNA expression of IL-6 and serpin-A3. In conclusion, pre- and co-administration of ultramicronized PEA delayed the development of tramadol tolerance, potentiating either oxycodone or tramadol analgesia and allowing a long-lasting analgesic effect with a low opioid dose regimen. The use of PEA is suggested for clinical purposes to support the opioid-based management of persistent pain.

Application of music has positive effects on physical, emotional and spiritual well-being, stress reduction, patients' and medical staff mood improvement, making the work environment more pleasant for both patients and staff. The aim of this narrative review is to present facts about perioperative music implementation and effects on patients and medical staff. In highly developed countries, music provided by professionals in the form of music therapy is incorporated in patients' care on the wards or in the recovery room to improve their mood, prevent depression and enable physical rehabilitation and relaxation. Perioperative music application decreases postoperative pain intensity and anxiety level, and increases patient's satisfaction. So far, music therapy application was studied in patients undergoing gynecological procedures, Caesarean section, breast surgery, urological procedures, cardiovascular surgery, abdominal surgery, orthopedic and maxilofacial surgery and different kinds of diagnostic and interventional procedures. Moreover, in real life, music is present on daily bases during performances in the operating rooms all over the world. There is an open question about music's influence on surgical team performance. In the operating room, choice of music and its perception differs depending on professional status and medical specialty. Music can improve surgeons' performance in the operating room. Type of music and its volume needs to be carefully chosen if music is used in the operating room, to prevent distraction of medical staff during performance. In surgical patients, music as nonpharmacological method can be safely used in the perioperative period as adjuvant therapy to pain medications, for anxiety and pain relief.

Understanding neuropathic pain presents several challenges, given the various mechanisms underlying its pathophysiological classification and the lack of suitable tools to assess its diagnosis. Furthermore, the response of this pathology to available drugs is still often unpredictable, leaving the treatment of neuropathic pain still questionable. In addition, the rise of personalized treatments further extends the ramified classification of neuropathic pain. While a few authors have focused on neuropathic pain clustering, by analyzing, for example, the presence of specific TRP channels, others have evaluated the presence of alterations in microRNAs to find tailored therapies. Thus, this review aims to synthesize the available evidence on the topic from a clinical perspective and provide a list of current demonstrations on the treatment of this disease.

Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients' preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients., Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients' preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance., Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients' preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes., Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ 2 2 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ 2 2 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (r s {58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables., Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually., (©Michael Alexander Harnik, Alina Scheidegger, Larissa Blättler, Zdenek Nemecek, Thomas C Sauter, Andreas Limacher, Florian Reisig, Martin grosse Holtforth, Konrad Streitberger. Originally published in JMIR Formative Research (https://formative.jmir.org), 29.04.2024.)

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Context: Foam rolling (FR) is considered an effective postexercise modality for reducing delayed-onset muscle soreness and enhancing recovery of muscle function. However, the effects of FR on muscle and joint proprioception have not been investigated. Objective: To examine the effects of FR on muscle and joint proprioception after an intense exercise protocol. Design: Controlled laboratory study. Setting: University-based laboratory. Patients or Other Participants: A total of 80 healthy, physically active male students were randomly assigned to either the FR (n = 40; age = 22.8 ± 3.3 years, height = 176.4 ± 5.3 cm, mass = 74.2 ± 6.4 kg) or passive-recovery (PR; n = 40; age = 23.0 ± 3.2 years, height = 178.1 ± 5.5 cm, mass = 74.6 ± 6.2 kg) group. Intervention(s): Participants in both groups performed 4 sets of 25 repetitions of voluntary maximal eccentric contractions at 608/s from 208 to 1008 of knee flexion to induce exercise- induced muscle damage. The exercise was followed by either PR or 2 minutes of FR immediately (1 hour) and 24, 48, and 72 hours postexercise. Main Outcome Measure(s): Muscle soreness, pressure- pain threshold, quadriceps-muscle strength, joint position sense, isometric force sense, and threshold to detect passive movement at baseline and immediately, 24, 48, and 72 hours postexercise after FR. Results: Foam rolling resulted in decreased muscle pain, increased pressure-pain threshold, improved joint position sense, attenuated force loss, and reduced threshold to detect passive movement compared with PR at 24 and 48 hours postexercise. Conclusions: Foam rolling postexercise diminished de- layed-onset muscle soreness and improved recovery of muscle strength and joint proprioception. These results suggested that FR enhanced recovery from exercise-induced damage. [ABSTRACT FROM AUTHOR]

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Background Given the unacceptably high miss rates of non-image-guided injections into the sacroiliac joint, either fluoroscopy or ultrasound is recommended for guidance. The real success rate of both techniques was assessed by cadaver dissection. Methods Twenty bodies donated to science (40 joints: 15 female and 5 male) were investigated bilaterally. Fluoroscopy and a lower ultrasound-guided approach were performed in 10 bodies each. Conditions during puncture, the subjective feeling of the needle being intra-articular, and, for fluoroscopic guidance, the intra-articular spread of the contrast were assessed. First, 0.5 cc of Iopamidol was injected, followed by 2 mL of red-colored latex. The spread was investigated by dissection via anterior opening of the sacroiliac joint and the dorsal ligaments. Results Ultrasound guidance was used in 1/20 (5%, 95% CI = 0.9–23.6%) intra-articular injections. In 19/20 (95%, 95% CI = 0.9–23.6%) cases, latex spread in the interosseous sacroiliac ligament was used. Conditions of structural visibility were classified as good in 11/20 (55%, 95% CI = 34.2–74.2%) cases, puncture condition as good in 16/20 (80%, 95% CI = 58.4–91.9%) cases, and subjective feeling of the needle being intra-articular was present in 10/20 (50%, 95% CI = 34.2–74.2%) cases. Fluoroscopy showed an intra-articular injection in 10/20 (50%, 95% CI = 34.2–74.2%) cases. The structure visibility in fluoroscopy was good in 9/20 (45%, 95% CI = 25.8–65.8%), puncture conditions good in 8/20 (40%, 95% CI = 21.9–61.3%), intra-articular contrast spread visible in 10/20 (50%, 95% CI = 34.2–74.2%), and subjective feeling of being intra-articular was present in 17/20 (85%, 95% CI = 64.0–94.8%) cases. Conclusions Fluoroscopy clearly showed a higher success rate of intra-articular sacroiliac joint injection. [ABSTRACT FROM AUTHOR]

Background: Acute pain is a common reason for calling emergency medical services (EMS) and can require medication depending on the pain intensity. German EMS personnel feel strong pressure to reduce a patient's pain but are restricted by law. Currently, German federal law only allows the administration of opioid-containing drugs by or on the order of a physician, while in other European countries (e.g. Switzerland and The Netherlands) the administration of opioid-based analgesia by trained and certified paramedics is common practice. Consequently, a patient in Germany experiencing acute pain needs the attendance of an emergency physician in EMS missions. According to international standards pain reduction on the numeric rating scale (NRS) score by ≥2 or a NRS score ≤4 at the end of the patient transport is considered to be adequate.Objective: Comparison of two different algorithm-based concepts for analgesia with consultation of a physician analyzing the efficacy, tolerance and safety of application.Material and Methods: In a retrospective cohort study in two different regions, two physician-supported algorithm-based analgesia concepts, a call back-supported concept (EMS Schleswig-Holstein: RKiSH) and a tele-EMS physician-based concept (EMS Aachen: RDAC), were compared over 2 years. The call back-supported concept is based on specific algorithms and certification of EMS personnel. In Aachen, the tele-EMS physician is integrated into the routine EMS system and includes immediate vital data transmission.Results: Over a period of 2 years call back-supported analgesia was administered in 878 cases (2016: 428, 2017: 450) and telemedically assisted analgesia was used in 728 cases (2015: 226, 2016: 502). Call back vs. telemedicine: initial NRS scores were 9 (8-10) and 8 (6-9), respectively (p < 0.0001); NRS scores were reduced by 4 (3-5) and 5 (3-6), respectively (p = 0.0002), leading to mean NRS scores of 4 (3-6) vs. 3 (2-4), respectively (p < 0.0001) at patient handover/emergency room arrival. Clinically relevant pain reduction was achieved in both groups. Complete NRS documentation was conducted in 753 (85.8%) vs. 673 (92.4%) cases, respectively, p = 0. Severe adverse events did not occur in either of the groups.Conclusion: The administration of analgesia by EMS personnel with teleconsultation of a physician is effective and has a low rate of complications, particularly morphine. Overall, algorithm-based call back-supported as well as telemedically supported analgesia concepts based on regular training improve the management of pain in the prehospital setting. In addition, the resources of the emergency physician remain available for life-threatening emergencies. The training, certification and supervision of EMS personnel is very important in both systems to ensure the best pain management care and patient safety. Adjustments to the federal law on the administration of analgesics would facilitate the realization of algorithm-based concepts by paramedics as pain reduction could be performed with delegation by a medical director without consulting another physician. [ABSTRACT FROM AUTHOR]

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Summary Objectives Acute pain in sports tells us what not to do. Persisting pain limits the athletes' activity and threatens his career. The reduction of pain is sought being highly beneficial for the sportsman, as it is shown that pain has only a weak connection to injury but a strong connection to the body image. Thus, pain therapy in sports medicine is a primary need of the athlete. Principle treatment goals are pain relief and return to play as quick as possible. Therapies in sports should primarily focus on conservative than on invasive approaches, with drugs being avoided as far as possible. There is a broad range of treatment approaches that could be applied in concert based on scientific and clinical decision making to reduce symptom severity, pain-associated dysfunction, and the risk of pain to be a tremendous cut in an elite athlete's career. Knowledge on this non-pharmacologic conservative pain medicine should not be restricted to health professionals, but the whole entourage of the athlete. This review highlights the current evidence with a focus on recreational and elite athletes. Based on their clinical evidence, it is hands-on techniques that can be recommended (Grade A: nerve blocks and injection techniques, ultrasound and laser therapy, manipulation mobilization, massage and traction; Grade B: acupuncture and dry needling). The occurrence of possible side-effects is, as far as reported, very unlikely. However, the methodological quality of the majority of retrieved studies limits the overall generalizability. Conclusion Conservative non-pharmacologic therapies reflect an adequate strategy to relief pain in elite athletes. Chronic states of pain reflect more complex scenarios requiring further comprehensive techniques. Future research should thus also address multimodal approaches combining several of the mentioned therapies. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain in the abdomen occurs as a consequence of malignancy in these parts of the body, surgical, of radiological and chemotherapy treatments. It may also be as a result of relapse of the basic process. Non-invasive therapy of oral and transdermal analgesic was successful for some time, where necessary applies and epidural catheter. Case Report: The patient had a diagnosis of chronic postoperative pain malignant etiology. He is already used transdermal fentanyl and Nonsteroidal Anti-Inflammatory Drugs, but without success (VAS score 8-10). We increased doses of analgesics, but without success. In order of pain therapy, peridural catheter placed in the level L3 - L4. 5 ml of a solution of 8 ml of 0.25% bupivacaine, 2 ml (100 micrograms) of fentanyl and 10 ml of saline was administered every 6 hours through epidural catheter. The former chronic non-invasive treatment of pain did not stop. The first three to five days of pain relief was quite satisfactory in this way. Then the pain intensified but the peridural catheter had to be removed due to local infection. New peridural catheter was placed in the level L2 -L3. Then, 5 ml of the solution: of 8 ml 0,25% bupivacaine, 2 ml (100 micrograms) of fentanyl and 10 ml of saline is administered through peridural catheter. Peridural catheter was total used for 45 days. We had a need for more and more frequently administering analgesics through a catheter during use. The patient was using transdermal fentanyl and Nonsteroidal Anti-Inflammatory Drugs, all the time. The patient soon died due to progression of the underlying disease. Conclusion: After long-term administration of opioids, it is necessary to change the type and route of administration of the drug to achieve the success of the therapy. In this case it was the use of analgesics and local anesthetics through the peridural catheter.

Marta Kiałka,1 Tomasz Milewicz,1 Krystyna Sztefko,2 Iwona Rogatko,2 Renata Majewska3 1Department of Gynecological Endocrinology, Jagiellonian University, Medical College, Kraków, Poland; 2Department of Clinical Biochemistry, Jagiellonian University, Medical College, Kraków, Poland; 3Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland Background: Despite the strong preclinical rationale, there are only very few data considering the utility of metformin as a potential pain therapeutic in humans. The aim of this study was to determine the association between metformin therapy and pressure pain threshold (PPT) in lean women with polycystic ovary syndrome (PCOS). We hypothesized that metformin therapy in lean PCOS women increases PPT. Materials and methods: Twenty-seven lean PCOS women with free androgen index phenotype >5 and 18 lean healthy controls were enrolled in the study. Fifteen of the PCOS women were randomly assigned to be treated with metformin 1,500 mg daily for 6 months. PPT and plasma β-endorphin levels were measured in all women at the beginning of the study and after 6 months of observation. Results: We observed an increase in PPT values measured on deltoid and trapezius muscle in the PCOS with metformin group after 6 months of metformin administration (4.81±0.88 kg/cm², P