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Summary Envenomation due to a Loxosceles spider bite is a rare event in France and no case concerning the breast has yet been reported. We report the case of a 48-year-old woman who presented at Saint-Etienne University Hospital with a pulsatile pain in her left breast two days after feeling a fleeting bite. An abscess was diagnosed and antibiotics were prescribed. A few days later, a necrotic zone appeared around the areola and 75 percent of the surrounding skin was inflamed. The patient reported a persistent fever and a burning pain in her breast. Loxoscelism was finally concluded and surgical debridement was undertaken, followed by supervised wound therapy and local skin care. Complete healing was achieved after 4 weeks of treatment. The diagnosis of loxoscelism is generally presumptive, as the bite is usually painless and the spider rarely captured. Its diagnosis should be considered when an abscess responds poorly to antibiotics.

Relevance. Our study aimed to determine the main differential diagnosis criteria for temporomandibular joint (TMJ) pain dysfunction syndrome (temporomandibular disorders, Costen's syndrome) and cerebellopontine angle tumours.Materials and methods. We examined 22 people (19 women and three men), aged 21 to 74 years (mean age 37.2 ± 5.1 years), who presented to the prosthodontic clinic with facial pain.Results. The study proposed the following differential diagnostic criteria for TMJ pain dysfunction syndrome and brain tumors: different nature of pain, unilateral ear noise; distal displacement of the mandibular head diagnosed by cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI), as well as articular disc displacement (detected by MRI) in temporomandibular disorders. Unilateral facial burning pain indicated meningioma of the cerebellopontine angle, which head MRI confirmed.Conclusion. The proposed table for evaluating clinical and paraclinical study methods for patients with facial pain helps to differentiate the cause of pain properly and proceed with the optimal treatment method.

Background: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients’ lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9–10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.

BACKGROUND Zoster sine herpete (ZSH) can be misdiagnosed because there are no typical vesicular eruptions characterized by a dermatomal distribution. However, incorrect treatment due to a misdiagnosis can lead to severe pain and fatal complications. CASE SUMMARY A 75-year-old woman complained of sudden onset right shoulder pain and atypical headache. After 18 d, sudden hearing loss occurred in the left ear. In serology tests conducted after the onset of hearing loss, varicella-zoster virus IgM was positive. She had no history of a rash or trauma. Under the suspicion of ZSH, antiviral treatment and stellate ganglion block were administered four times, and the pain was effectively controlled. CONCLUSION Early diagnosis and treatment of ZSH can help not only by reducing pain but also by preventing fatal complications.

Purpose: Patients with erythropoietic protoporphyria (EPP), a severe painful photodermatosis, experience prodromal sensations when exposed to sunlight, which are the “warning signals” to exit the sun, as prolonged exposure causes an excruciatingly painful phototoxic attack. The unique prodromal cutaneous sensations are reversible and differ from the severe burning pain attack lasting 2–7 days. Previously, afamelanotide treatment was studied using time to pain or time outside as primary outcome measures. Since patients have an ingrained fear of sunlight, these measures did not capture the full treatment effect. We retrospectively characterized and evaluated time to prodrome (TTP) as a safer, patient-reported outcome (PRO) measure in afamelanotide-treated patients. Methods: Structured interviews recorded TTP before and during afamelanotide treatment in retrospective US and Dutch cohort studies. Results: Thirty-one US and 58 Dutch EPP patients participated. Before afamelanotide treatment, 54.8% US and 39.7% Dutch patients reported TTP onset

Background Burning mouth syndrome (BMS) is characterized by burning sensation of the oral mucosa. There is a lack of effective treatment. In recent years, a special subtype of BMS has been reported, in which oral burning sensation is alleviated after chewing, speaking, or dopaminergic drug delivery. Currently, there are few reports about the subtype of BMS in China. This study was a retrospective analysis of the clinical data of BMS patients sensitive to dopamine agonist at our hospital, aiming to improve the recognition on this disease. Case summary Eight patients diagnosed with dopamine agonist responsive BMS at the Liaocheng People's Hospital from January 1, 2017 to June 30, 2020 were recruited. The clinical manifestations, treatment, and prognosis were retrospectively analyzed. There were three male and five females in the eight patients. The median age was 56 years (range, 46-65 years). All the eight patients showed burning pain in the mouth. The symptoms were mild in the morning and severe in the evening, and alleviated after chewing, talking, and other oral activities. Four patients were accompanied by restless legs syndrome (RLS). Family history of RLS was positive in two patients. All patients were treated with pramipexol, and symptoms were basically relieved after 2-8 wk. Conclusion Dopamine agonist responsive BMS is a special subtype of BMS, which is alleviated after oral activities. Dopamine receptor agonist is an effective treatment.

Parikarthika (Fissure in ano) is one of the most painful condition which is occurring in the ano rectal region. Due to irregular food habits and modern life styles of peoples in the present era has also added to the increase in the rate of incidence of fissure in ano. The aim of the present pilot study was to assess the effectiveness of Murivenna ointment in the management of Parikarthika. This study was conducted in 22 patients diagnosed as acute fissure in ano. Patients Murivenna ointment was applied locally with digitally in fissure bed (Parikartika) of all 22 patients. All patients were advised to follow this twice daily after sitz bath for 4 weeks or till healing of fissure bed whichever is earlier. Adjuvant drug Triphalachurnam 5 gm orally at bedtime with lukewarm water was prescribed daily to all patients with constipation. There was significant relief in symptoms like pain in ano and bleeding per rectum in all patients after 30 days of treatment. The anal sphincter tonicity became normal in 21 patients (95.45%) after 30 days of treatment. Ulcer in ano was completely healed in 19 patients (86.36%) after 30 days of treatment. There was no reoccurrence in all patients after 30 days of follow up. The irritable symptoms like pain and bleeding per rectum were effectively relieved within 14 days of treatment in all patients. It is one of the effective treatments in the management of fissure in ano as it relieved the cardinal symptoms of fissure in ano such as cutting pain and burning pain.

A 7-year-old boy was admitted to the Pediatric Cardiology Department with blood pressure of 160/120 mmHg accompanied by burning pain in his hands and feet and tachycardia, followed by a seizure attack for the first time in his life, which presented shortly after admission. The child underwent a widespread diagnostic process – including laboratory tests and imaging – showing inconclusive results. Acute autonomic neuropathy was eventually diagnosed and successfully treated with intravenous immunoglobulin. The described case illustrates the need for a careful and open-minded approach to patients with hypertension.

Objectives Application of spatially interlaced innocuous warm and cool stimuli to the skin elicits illusory pain, known as the thermal grill illusion (TGI). This study aimed to discriminate the underlying mechanisms of central and peripheral neuropathic pain focusing on pain quality, which is considered to indicate the underlying mechanism(s) of pain. We compared pain qualities in central and peripheral neuropathic pain with reference to pain qualities of TGI-induced pain. Methods Experiment 1:137 healthy participants placed their hand on eight custom-built copper bars for 60 s and their pain quality was assessed by the McGill Pain Questionnaire. Experiment 2: Pain quality was evaluated in patients suffering from central and peripheral neuropathic pain (42 patients with spinal cord injury, 31 patients with stroke, 83 patients with trigeminal neuralgia and 131 patients with postherpetic neuralgia). Results Experiment 1: Two components of TGI-induced pain were found using principal component analysis: component 1 included aching, throbbing, heavy and burning pain, component 2 included itching, electrical-shock, numbness, and cold-freezing. Experiment 2: Multiple correspondence analysis (MCA) and cross tabulation analysis revealed specific pain qualities including aching, hot-burning, heavy, cold-freezing, numbness, and electrical-shock pain were associated with central neuropathic pain rather than peripheral neuropathic pain. Conclusions We found similar qualities between TGI-induced pain in healthy participants and central neuropathic pain rather than peripheral neuropathic pain. The mechanism of TGI is more similar to the mechanism of central neuropathic pain than that of neuropathic pain.

We examined cross-sectional associations between arm lymphedema symptoms and health-related quality of life (HRQoL) in the Health, Eating, Activity and Lifestyle (HEAL) Study. 499 women diagnosed with localized or regional breast cancer at ages 35–64 years completed a survey, on average 40 months after diagnosis, querying presence of lymphedema, nine lymphedema-related symptoms, e.g., tension, burning pain, mobility loss, and warmth/redness, and HRQoL. Analysis of covariance models were used to assess HRQoL scores in relation to presence of lymphedema and lymphedema-related symptoms. Lymphedema was self-reported by 137 women, of whom 98 were experiencing lymphedema at the time of the assessment. The most common symptoms were heaviness (52%), numbness (47%), and tightness (45%). Perceived physical health was worse for women reporting past or current lymphedema than those reporting no lymphedema (P-value P-value = 0.31). Perceived physical health, stress, and lymphedema-specific HRQoL scores worsened as number of symptoms increased (P-values ≤ 0.01). Women reporting tension in the arm had lower physical health (P-value = 0.01), and those experiencing burning pain, tension, heaviness, or warmth/redness in the arm had lower lymphedema-specific HRQoL (P-values

Erythromelalgia is a rare neurovascular disorder characterized by erythema, warmth, and episodic burning pain, often felt in the face, hands, and feet. Symptoms are typically worse with heat, exercise, stress, and during the overnight hours. Management often requires a multidisciplinary approach, including pain trigger avoidance, cool water baths, and topical and oral neuropathic medications. The use of spinal cord stimulation has been described in multiple case reports with success reported out to 24 months. To our knowledge, the use of dorsal root ganglion (DRG) stimulation for erythromelalgia-related pain has not been described. Herein, we present a case of erythromelalgia-related pain at the bilateral plantar surfaces of the feet, which was treated successfully with bilateral sacral S1 nerve root DRG stimulation.

Introduction: One of the most important disadvantages of propofol injection is intense burning pain. The present study was conducted with the aim to assess the effect of low dose Ketamine (100 µg/kg) in the alleviation of pain on propofol injection. Materials and Methods: Patients who underwent surgical procedures under general anaesthesia were allocated into two groups viz. Group K (n=35) - pre-treatment with ketamine 100µg/kg (1ml) and Group S (n=35)- pre-treatment with 0.9% normal saline (1ml) in this double-blinded, randomized study. After venous occlusion, ketamine was injected over 10 seconds, after which the occlusion was removed and over 20 seconds, the first 25% of the calculated dose of propofol was injected. The evaluation of the severity of pain was done by the verbal rating scale (VRS) during the injection of the induction agent for every 5 seconds and graded as 0 to 3.The data were recorded and analysedusing unpaired‘t’ test and chi-square test as and where appropriate. Results: The demographic profiles were comparable between the two groups. It was observed that 42.9% of patients in normal saline and 80% in ketamine groups experienced no pain (p0.05). Conclusion: It may be concluded that pre-treatment with low dose ketamine with a tourniquet just before propofol injection, significantly reduced the incidence and degree of propofol induced pain without significant adverse hemodynamic effects. Keywords: Induction, Propofol, Pain, Low dose ketamine, Alleviation.

Introduction: Persistent post-surgical pain (PPSP) is significant issue following breast cancer treatment that leads to disability and psychological distress and is often difficult to manage. Objectives: Primary objective of this study was to determine the frequency of persistent pain in patients after breast cancer surgery while the secondary objective was to see the distribution and characteristics of pain in these patients. Methods: In this prospective observational single cohort study all adult female patients with biopsy proven carcinoma of breast who were scheduled for elective definitive breast cancer surgery from 1st August 2016 to 31st January 2017 were enrolled. Total 120 patients were followed for up to three months after surgery and those who had persistent pain were followed up for six months after operation. Results: Out of the 120 patients, twenty six (21.7%) patients developed persistent post-surgical pain for up to three months while in seventeen (14.2%) patients pain continued for up to six months after operation. Of twenty six patients with PPSP, eleven (42.3%) had burning pain, ten (38.5%) had throbbing pain, three (11.5%) patients had numbness while two patients had mixed character of pain. Eleven patients developed pain at more than one site. Pain was distributed in axilla, chest wall, upper arm and surgical scar area. Fifteen out of twenty six patients (57.7%), had pain in axilla. Continuous...

The aim was to validate the SYM VEIN consensus 3D scoring tool in chronic venous disease (CVD).This was a prospective cohort study with a total of 35 consecutive patients with CVD. Patients with CVD undergoing saphenectomy were assessed with the revised Venous Clinical Severity Score (r-VCSS), the CIVIQ-20 quality of life score questionnaire, and the SYM VEIN consensus statement 3D system, pre-operatively and four weeks post-operatively. The total 3D score was tested for reliability, construct validity, and responsiveness.The total 3D score demonstrated good reliability and internal consistency (Cronbach's alpha 0.85). Principal component analysis identified three groups of symptoms (paraesthesia, burning pain, and pruritus, vs. heaviness, sensation of swelling and aching/pain, vs. restless leg and throbbing pain) demonstrating a high intragroup correlation and likely to share similar pathophysiology, indicative of adequate construct validity. The total 3D score showed a significant correlation with r-VCSS and CIVIQ-20 score (rho .46, p = .005 and rho .65, p .001, respectively) indicative of adequate convergent validity. After saphenectomy, significant reductions (p .001) of the total 3D, and 3D scores for all but two individual venous symptoms were observed, indicative of excellent responsiveness. Median total 3D score was reduced from 31 to 6 (83.8% decrease, p .001), median r-VCSS was reduced from 6 to 0 (100% decrease, p .001), and median CIVIQ-20 score was reduced from 24 to 14 (40% decrease, p .001). The difference of median percentage change between r-VCSS and CIVIQ-20 score vs. total 3D score was significant (p = .005 and p .001, respectively).The total SYM VEIN 3D score has good reliability, construct validity and excellent responsiveness, although less prone to change after saphenectomy compared with r-VCSS.

La neuropatía periférica es una complicación presente en menos del 5 % de los casos de intoxicación por monóxido de carbono. El presente artículo describe las características clíni- cas de tres pacientes que acudieron con síntomas de lesión de nervio periférico tras estar expuestos a un incendio. Las variaciones clínicas incluyeron debilidad de miembros inferiores, parestesias y dolor tipo ardor. Se usaron estudios de electrodiagnóstico a los 14 días del evento, los cuales mostraron cambios no específicos. Al año del evento, uno de los pacientes confirmó lesión desmielinizante y axonal de nervio periférico. La presencia de signos y síntomas en conjunto con el antecedente de inhalación de humo, establecen el nexo etiológico con la intoxicación por monóxido de carbono. Este caso demuestra la importancia de considerar la intoxicación por monóxido de carbono como causa de neuropatía periférica. El diagnóstico debe fundamentarse en una historia clínica completa y puede apoyarse de electrodiagnóstico.

Complex regional pain syndrome (CRPS) is a regional, neuropathic pain disorder, with disproportionate symptoms, that does not respect dermatomes or nerve distribution. A 28-year-old female patient with personal history of two breast augmentation surgeries consulted for breast reduction after dissatisfaction with the size and form of her breasts. Breast reduction was undertaken with prosthesis exchange. During the first 10 days, she presented swelling, hyperesthesia, and burning pain mainly around her left breast. An ultrasound showed seroma collection which was drained in two occasions. She was referred to physical therapy to desensitize and initiate additional treatment for symptoms. Three weeks after surgery, bilateral pain persisted, as well as hyperesthesia, edema, and local hyperthermia; thus, referral to an anesthesiologist specialized in pain management with a CRPS type II diagnosis was undertaken which confirmed the diagnosis and additional analgesics were initiated. A week into treatment, she referred decreased signs and symptoms in her breasts. During the second month, symptoms decreased and medication was gradually lowered. At the end of the third month, medication was suspended and she began her normal activities with no symptoms. This case report highlights the importance of clinical suspicion of CRPS. Signs and symptoms should be interpreted in a timely fashion to allow a prompt treatment and speedy recovery. Level of evidence: Level V, risk study.

Background: Burning mouth syndrome (BMS) is a chronic pain disorder affecting the oral cavity. Previous work has shown promising analgesic results of bodily illusions in other chronic pain conditions. The aim of this proof‐of‐concept, pilot study was to investigate whether bodily illusions reduce pain in BMS patients. Methods: Nine participants diagnosed with BMS underwent bodily illusions using a MIRAGE‐mediated reality system. All participants completed 4 conditions and performed standardised movements of the tongue. First, a baseline condition was performed while the tongue was viewed at normal size and colour. Then, three conditions were performed in random order: resizing shrink, colour‐based (blue tongue), and incongruent movement illusions. During each condition, participants rated overall pain intensity as well as the intensity of burning pain/sensation on the tongue. Results: There was no difference in overall pain intensity ratings between conditions. However, a significant effect of condition was found for burning pain/sensation of the tongue. The colour illusion significantly reduced burning pain compared with baseline (MD = ‐12.8, 95% CI ‐20.7 to ‐4.8), corresponding to an average pain reduction of 32%. Exploratory analyses showed the colour illusion also significantly reduced pain compared with the shrink illusion (MD = ‐11.7, 95% CI ‐22.2 to ‐1.1). Conclusion: Using visual illusions to change tongue colour to blue resulted in significant reductions in burning pain/sensations in BMS patients for the duration of the illusion. This proof‐of‐concept study suggests that BMS patients may benefit from bodily illusions, and supports additional research using larger samples and more comprehensive control conditions. Refereed/Peer-reviewed