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The appendix is not an organ exempt from trauma. It comprises part of the first portion of the colon, the cecum, and partial transections of the appendix or total transections with mesoappendix and aggregate lesions have been reported. Late presentation is common and is associated with external marks such as the handlebar or seat belt sign. Its diagnosis is complex and may go unnoticed in a patient with added lesions that may distract attention. Its management is surgical with exploration of the abdominal cavity and appendectomy of the appendicular remnant. We present the case of a 44-year-old male with blunt abdominal trauma who presents with severe abdominal pain, located in the right iliac fossa and positive FAST ultrasound. The transsurgical finding demonstrates a grade IV colon lesion involving transection of the cecal appendix and preservation of the mesoappendix. Appendectomy and lateral-lateral ileocolic anastomosis were performed due to perforation in the terminal ileum and disruption of the meso. He was discharged after 15 days without major complications. Despite the few reports, the floating appendix is a surgical emergency that requires timely treatment, Although its diagnosis is by finding, deciding on an emergency laparotomy is essential., El apéndice no es un órgano exento al trauma. Comprende parte de la primera porción del colon, el ciego, y se han reportado transecciones parciales de apéndice o totales con mesoapendice y lesiones agregadas. La presentación tardía es común y está asociado a marcas externas como la del manubrio o el cinturón de seguridad. Su diagnóstico es complejo y puede pasar desapercibido en un paciente con lesiones agregadas que puedan distraer la atención. Su manejo es quirúrgico con exploración de la cavidad abdominal y apendicectomía del remanente apendicular. Presentamos el caso de un masculino de 44 años con trauma abdominal contuso quien acude por dolor abdominal severo, localizado en fosa iliaca derecha y ultrasonido FAST positivo. El hallazgo transquirúrgico demuestra una lesión en colon grado IV que implicaba transección del apéndice cecal y preservación de mesoapéndice. Se realizó apendicectomía y anastomosis ileocolica latero-lateral por perforación en íleon terminal y disrupción de su meso. Se fue de alta a los 15 días sin complicaciones mayores. A pesar de los pocos reportes, el apéndice flotante es una urgencia quirúrgica que requiere tratamiento oportuno, aunque su diagnóstico sea por hallazgo, decidir una laparotomía de urgencia es primordial.

Objective: The purpose of this study was to evaluate the efficacy of subcutaneous morphine for managing pain crises resulting from various causes in cancer patients attended by the Pain Clinic in the immediate care area of the National Cancer Institute in Mexico City. Materials and Methods: This study was analytical, observational, retrospective, and descriptive. The oncology patients treated in the immediate care area for pain crises between August 1, 2020, and July 1, 2023, made up our study population. We documented the management of pain crises for patients who needed subcutaneous morphine treatment. Results: Considering a reduction in Numeric Rating Scale (NRS) score >30% as effective and a reduction <30% as ineffective, 566 patients didn’t require an additional dose of subcutaneous morphine to control the pain crisis; 11 patients reported a decrease of <30%. A total of 24 patients needed a second rescue. Among this group, only 5 responded well to the second morphine rescue; in the remaining 19 patients, the rescue was deemed ineffective if the NRS decreased by at least 30%. Only 5 individuals experienced moderate pain, and only one patient reported severe pain. The variables were compared using the non-parametric Mann-Whitney U test with significance <0.05. Consequently, it may be said that there is a statistically significant difference between the first and subsequent NRS values obtained. Conclusion: For oncology patients treated by the Pain Clinic in the immediate care section of the National Cancer Institute in Mexico City, subcutaneous morphine is beneficial in managing pain crises of different origins. Keywords: Morphine, Subcutaneous Pain crises, Efficacy, Numeric rating scale

Introduction: The use of botulinum toxin for medical purposes has expanded nowadays through the extensive study of its complex structure and mechanism of action, highlighting its ability to inhibit the release of acetylcholine, and its impact on the chemical signaling cascade involved in different models of pain. Objective: To evaluate the association of the use of botulinum toxin A with the reduction of pain in oncologic patients at Instituto Nacional de Cancerología, México. Methodology: A retrospective, observational, descriptive, and cross-sectional study was performed. Data were obtained from patients attended during the period from January 1, 2022 to September 30, 2023 in whom botulinum toxin was applied as an adjuvant for pain management. Results: Thirty-two patients who met the inclusion criteria were included. After the application of botulinum toxin there was a statistically significant reduction in pain, as measured by the Numeric Pain Rating Scale and Verbal Rating Scale. The degree of satisfaction after the application of botulinum toxin was measured by a Likert-type scale, and 68% satisfaction was found in the patients who underwent the onotoxin treatment. Conclusions: The use of botulinum toxin proved to be an effective and safe therapy, complementary to the multimodal approach for the treatment of different pain patterns in oncologic patients. It can be considered as a pharmacological option for use in this group of patients. Keywords: Oncologic pain, Pain management, Botulinum toxin

Pain is one of the 10 leading causes of medical consultation worldwide and is the alarm symptom of the organism in situations that threaten its integrity, however, when it becomes chronic, it loses its protective capacity and becomes, in many cases, the disease itself. According to the International Association for the Study of Pain (IASP) pain is classified as nociceptive, neuropathic and nociplastic. Mixed pain has been described years ago due to the coexistence of different types of pain. We can conclude that we do not have a screening tool and/or treatment algorithm for mixed pain, so it is preferable that pain management begins with a rigorous assessment, using the latest available tools, followed by individualized evidence-based treatment with multimodal therapy when appropriate. Keywords: nociceptive pain, neuropathic pain, mixed pain.

Introduction: Low back pain is a common problem affecting millions worldwide. Even after surgical treatment some patients do not improve; others suffer from persistent radiculopathy. We define Complex Chronic Low Back Pain (CCLBP) as any low back pain that has lasted for at least three months and has at least two triggering pain mechanisms. Objective: To describe our experience with platelet-rich plasma (PRP) therapy in managing CCLBP with a neuropathic component Methods: Quantitative, retrospective analysis from 57 medical records of patients treated with PRP for CCLBP. We used IBM-SPSS 21 to obtain descriptive statistics, Chi-square, Student T and Odds-Ratio. Results: The mean age of our sample was 59.8 (±14.4) years, with 6.51 (±8.7) years of pain and a follow-up of 9 (±12.2) months. 33.3% had lumbar surgery, 29.8% had lumbar trauma, 31.6% used a walking aid, 56.7% had MODIC changes on MRI, and 42% of them received intraosseous-PRP technic. 84.2% reported severe pain (VAS 8-10). The results showed that 96.5% of patients experienced some improvement after PRP treatment. Additionally, 10.5% experienced pain suppression. No significant differences in age, lumbar trauma, lumbar surgery, diseases, or the use of walking aids between patients who benefited from PRP treatment and those who did not. VAS after treatment shows significance (p<0.01) with 5.36±2.6 points. Subjects with less than five years of radicular pain had an improvement greater than 3 points on VAS (OR 7.38, IC95% 1.72-31.7). Conclusion: Autologous platelet-rich plasma injections for chronic low back pain with a neuropathic component are an effective alternative to address CCLBP’s current challenge. New studies with greater statistical power are necessary to make a statement of efficacy, but with the data obtained, it seems a promising option. Keywords: Platelet-Rich Plasma, Low Back Pain, Radiculopathy, Intraosseous