Corrigendum: How does chronic pain impact the lives of dogs: an investigation of factors that are associated with pain using the Animal Welfare Assessment Grid.

[This corrects the article DOI: 10.3389/fvets.2024.1374858.].

Neuropathic Pain in Cancer: What Are the Current Guidelines?

OPINION STATEMENT: Neuropathic cancer pain is experienced by 30-40% of patients with cancer. It significantly reduces quality of life and overall wellbeing for patients living with and beyond cancer. The underlying mechanisms of neuropathic pain in patients with cancer are complex and involve direct tumour involvement, nerve compression or infiltration, chemotherapy and/or radiotherapy-induced nerve damage, or post-surgical complications. It is crucial for healthcare professionals to assess and manage neuropathic cancer pain effectively. There is increasing recognition that standardisation of neuropathic pain assessment leads to tailored management and improved patient outcomes. Pain management strategies, including medication, interventional analgesia, physical and complementary therapy, can help alleviate neuropathic pain and improve the patient's comfort and quality of life.

Peripheral nerve stimulation (PNS) of the phrenic nerve for intractable hiccups: a novel use case report.

BACKGROUND: Intractable hiccups, defined as those persisting for over 1 month, represent a rare but significant clinical challenge often associated with substantial morbidity and refractory to standard treatments. CASE PRESENTATION: This case report describes the innovative use of phrenic nerve peripheral neuromodulation for managing chronic intractable hiccups in a 73-year-old male patient with a 6-year history of daily hiccups. Conventional treatments and interventional procedures had failed to provide lasting relief. Bilateral phrenic nerve peripheral nerve stimulation (PNS) placed under ultrasound guidance resulted in immediate and substantial improvement, with the patient's Hiccup Assessment Instrument score decreasing from 6/10 to 2/10. The patient experienced significant enhancements in speech and quality of life without complications. CONCLUSIONS: This novel application of phrenic nerve PNS highlights its potential as a therapeutic strategy for intractable hiccups, underscoring their pathophysiologic involvement of the diaphragm and respiratory muscles. The findings suggest that phrenic nerve PNS could offer a viable treatment option for patients unresponsive to conventional therapies, warranting further research to establish its long-term efficacy and safety.

Psilocybin and chronic neuropathic pain: a systematic review.

BACKGROUND/IMPORTANCE: Chronic pain affects many people globally, requiring alternative management strategies. Psilocybin is gaining attention for its potential in chronic pain management despite being classified as Schedule I. OBJECTIVE: This systematic review critically evaluates the evidence for psilocybin, a Schedule I substance, in the treatment of chronic pain. The exact purpose of the review is to assess the impact of psilocybin on chronic pain relief, focusing on dosing protocols, treated conditions, and patient outcomes. EVIDENCE REVIEW: A comprehensive review of PubMed, CINAHL, Web of Science, Cochrane Library, and EMBASE was conducted up to January 2024. Eligibility criteria included studies evaluating psilocybin for chronic pain management. The risk of bias was assessed using the MASTER (MethodologicAl STandards for Epidemiological Research) scale, and the strength of evidence was graded using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). FINDINGS: The review identified 28 relevant studies focusing on dosing, treated conditions, and outcomes. The majority of the included studies (76.2%) were of low or very low quality. Several studies with moderate-to-low-quality evidence utilized a 0.14 mg/kg dosing protocol. The findings suggest promise for the use of psilocybin in chronic pain relief, though the quality of evidence is generally low. CONCLUSIONS: The current research shows potential for psilocybin as a treatment option for chronic pain relief. However, methodological issues and a lack of high-quality evidence underscore the need for further investigations with standardized protocols. Despite these limitations, the potential for psilocybin in chronic pain management is encouraging. PROSPERO REGISTRATION NUMBER: CRD42023493823.

Advancing chronic pain care in Canada: History and impact of the Canadian Pain Task Force.

In 2019, Health Canada established the Canadian Pain Task Force. Through this commitment, Canada joined other countries, such as the United States and Australia, in creating a national-level mechanism to support work in the area of chronic pain. This article provides a historical narrative of national and regional advocacy and efforts that led to creation of the Task Force, the broad representation of its members, as well as its mandate and goals. Subsequently it outlines the Task Force's progression through three distinct phases, each marked by extensive consultation and culminating in a comprehensive report submitted to Health Canada. A particular focus is placed on the third phase, which resulted in the formulation of An Action Plan for Pain in Canada, and we present an overview of the recommendations contained therein. Moreover, the article situates the Canadian Pain Task Force within the broader movement to transform how pain is recognized, understood, and treated in Canada. It highlights initial steps taken to address identified priorities, indicating a proactive approach toward effecting meaningful change.

En 2019, Santé Canada a créé le Groupe de travail canadien sur la douleur. Par cet engagement, le Canada s'est joint à d'autres pays, comme les États-Unis et l'Australie, pour mettre en place un mécanisme national visant à soutenir le travail dans le domaine de la douleur chronique. Cet article présente un historique des efforts de plaidoyer nationaux et régionaux qui ont conduit à la création du Groupe de travail, la représentation diversifiée de ses membres, ainsi que son mandat et ses objectifs. Il décrit ensuite la progression du Groupe de travail en trois phases distinctes, chacune marquée par de vastes consultations et aboutissant à la présentation d'un rapport complet à Santé Canada. Une attention particulière est accordée à la troisième phase, qui a abouti à la formulation d'un Plan d'action pour la douleur au Canada. Nous présentons également un aperçu des recommandations qu'il contient. En outre, l'article situe le Groupe de travail canadien sur la douleur dans le cadre d'un mouvement plus large visant à transformer la façon dont la douleur est reconnue, comprise et traitée au Canada. Il met en lumière les premières mesures prises pour répondre aux priorités recensées, ce qui témoigne d'une approche proactive visant à apporter des changements significatifs.

The Interplay Between Health Disparities and Acceptability of Virtual Reality: A Survey Study.

Virtual reality (VR) has emerged as a nonpharmacological adjuvant to manage acute and chronic pain symptoms. The goal of this survey study was to determine the acceptability of VR among chronic pain participants hailing from distressed and prosperous neighborhoods in the state of Maryland. We hypothesized that pain severity and interference vary in groups experiencing health disparities, potentially influencing VR's acceptability. From March 11 to March 15, 2020, we surveyed a cohort of clinically phenotyped participants suffering from chronic orofacial pain. Participants were asked to express their willingness to participate in a longitudinal VR study and their expectation of pain relief from using VR. Seventy out of 350 participants with chronic pain completed the survey (response rate: 20%). There was no difference in the likelihood of responding to the survey based on their neighborhood distress. Among survey respondents and nonrespondents, similar proportions of participants were from distressed neighborhoods. Among the respondents, 63 (90%) and 59 (84.3%) were willing to participate and expected to experience pain relief from the VR intervention, respectively. Age, sex, race, neighborhood distress, severity of pain, and prior VR experience did not influence willingness to participate in the VR trial or the expectations of VR-induced improvement. These findings suggest that VR as an adjuvant intervention is potentially accepted by chronic pain participants, irrespective of neighborhood-level social determinants of health.

Mind-body therapy for treating fibromyalgia: a systematic review.

OBJECTIVE: Fibromyalgia is a chronic and disabling condition that presents management challenges for both patients and healthcare providers. The objective of this systematic review was to summarize current evidence on the effectiveness and safety of mind-body therapies in the treatment and/or management of fibromyalgia. METHODS: We searched MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL databases from their inception to December 2023. Eligible articles included adults diagnosed with fibromyalgia participating in a mind-body therapy intervention and were published from the beginning of 2012 onwards. We assessed the quality of the studies using the Joanna Briggs Institute Critical Appraisal Checklists. RESULTS: Of 3866 records screened, 27 studies (30 articles) met our inclusion criteria, in which 22 were randomized controlled trials and 5 were quasi-experimental studies. Mind-body therapies included guided imagery (n = 5), mindfulness-based stress reduction (n = 5), qi gong (n = 5), tai chi (n = 5), biofeedback (n = 3), yoga (n = 2), mindfulness awareness training (n = 1), and progressive muscle relaxation (n = 1). With the exception of mindfulness-based stress reduction, all therapies had at least one study showing significant improvements in pain at the end of treatment. Multiple studies on guided imagery, qi gong, and tai chi observed significant improvements in pain, fatigue, multidimensional function, and sleep. Approximately one-third of the studies reported on adverse events. CONCLUSIONS: This review suggests that mind-body therapies are potentially beneficial for adults with fibromyalgia. Further research is necessary to determine if the positive effects observed post-intervention are sustained. STUDY REGISTRATION: Open Science Framework (https://osf.io) (September 12, 2023; https://doi.org/10.17605/osf.io/6w7ac).

Turkish cross-cultural adaptation, construct validity, and reliability of the treatment expectations in chronic pain scale.

BACKGROUND: Measuring treatment expectations using the Treatment Expectations in Chronic Pain (TEC) scale has the potential to help clinicians and researchers better understand the role that treatment expectations play within the framework of multimodal pain management settings. OBJECTIVE: The purpose of this study is to determine the cross-cultural adaptation, construct validity and reliability of the TEC Scale in the Turkish language. METHODS: The study included 191 volunteers aged 22-65 with chronic musculoskeletal diseases. This study composed of a six-stage cross-cultural adaptation process, which included translation, translation synthesis, back-translation, expert committee review, pre-testing and documentation submission. The Positivity Scale and Illness Cognition Questionnaire were used to measure convergent validity while the Hospital Anxiety and Depression Scale was used to test divergent validity. The psychometric properties of the Turkish version of the TEC scale was examined by confirmatory factor analysis (CFA). Scale's internal consistency was examined using Cronbach's alpha. Pearson correlation coefficients were utilized to evaluate both convergent and divergent validity. The significance level was set at p < .05. RESULTS: The results of the CFA showed that factor structure of predicted subscale fitted well the data (x2/df = 3,07;CFI = 0,91,IFI = 0,91 TLI = 0,87,RMSEA = 0,10). The results of the CFA indicated that factor structure of ideal subscale fitted well with the data (x2/df = 2,38;CFI = 0,92,IFI = 0,93,TLI = 0,90,RMSEA = 0,08). Both subscales of the TEC were strongly correlated. The predicted subscale had moderate relationships to depression, anxiety, and positivity (r = -0.37 to r = 0.55) but poor correlations with measures of acceptance, perceived benefits and helplessness (r = -0.24 to 0.35). The ideal subscale had moderate correlations with measures of positivity (r = 0.36) and depression (r = -0.38) but poor correlations with measures of acceptance, perceived benefits helplessness and anxiety (r = 0.14). CONCLUSIONS: The Turkish version of the TEC scale is acceptable, valid, and reliable for use in Turkish patients with chronic musculoskeletal pain in physiotherapy outpatient practice.

Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale.

Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that non-specific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions.

Use of Virtual Reality Therapy (VRT) for Home-Based Pain Management, an Observational Cohort Study.

Chronic pain is prevalent in the Veteran population at a disproportionate rate. Given the concerns for traditional pharmacologic management of pain, many are turning to nonpharmacologic alternatives for the treatment of pain. Virtual reality (VR) is an evidence-based tool, which has been demonstrated to reduce pain in hospitalized patients, and has been used for this purpose within the VA Sierra Nevada Healthcare System (VASNHCS) since 2019. Given the ongoing demonstrated benefit in this setting, these authors set to assess benefit for pain when used in an outpatient setting (demonstrations in the clinic, treatments in the patient's home) and demonstrate safety when used outside of a supervised setting. In this analysis, pain intensity decreased by an average of 22% when comparing pre- and postimmersion pain scores, and by 12.7% when comparing baseline pain scores with the end of the analysis. Patients also reported that the use of VR reduced their stress, decreased pain, and improved their mood, and some participants were able to reduce use of their as-needed pain medications with the use of VR. These findings are limited by a small sample size; however, this study provides encouraging evidence of benefit and a framework for future, larger scale analyses.

Prehabilitation: The underutilised weapon for chronic pain management.

Objective: Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods: Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results: Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions: Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.

An ecosystem of accepting life with chronic pain: A meta-ethnography.

Background: Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods: We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings: We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion: Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.

Effects of insoles adapted in flip-flop sandals in patients with persistent plantar heel pain: A sham-controlled randomised trial.

OBJECTIVE: To evaluate the use of custom-made insoles adapted to flip-flops on pain intensity, foot function, and functional walking ability in individuals with persistent plantar heel pain in the short and medium term. DESIGN: Randomised controlled trial. SETTING: Flip-flop sandals in patients with persistent plantar heel pain. MAIN MEASURES: Participants (n = 80) were assessed at baseline, six and 12 weeks after the intervention, and 4 weeks post-intervention. RESULTS: For the primary outcomes, after 6 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.4 (95% confidence intervals = -1.5 to 0.8). Similarly, after 12 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.7 (95% confidence intervals = -1.9 to 0.6). Finally, at 4 weeks after the end of the intervention, there was no between-group difference in morning pain or pain on walking, mean difference = 0.01 (95% confidence intervals = -1.4 to 1.4). All differences and confidence intervals were smaller than the minimum clinically important difference for pain (2 points). There were no differences between the groups for the secondary outcomes. In addition, the mean differences were smaller than the minimum clinically important differences for pain intensity, foot function and functional walking ability. CONCLUSION: Custom-made insoles fitted to flip-flops did not differ from flip-flops with sham insoles in improving pain intensity, foot function and functional walking ability in people with persistent heel pain.Trial registration: ClinicalTrials.gov (Identifier: NCT04784598). Data of registration: 2023-01-20.

Novel neurophysiological evidence for preserved pain habituation across chronic pain conditions.

OBJECTIVE: The present study aimed to investigate whether subjective and objective measures of pain habituation can be used as potential markers for central sensitization across various chronic pain patients. METHODS: Two blocks of contact-heat stimuli were applied to a non-painful area in 93 chronic pain patients (low back pain, neuropathic pain, and complex regional pain syndrome) and 60 healthy controls (HC). Habituation of pain ratings, contact-heat evoked potentials (CHEP), and sympathetic skin responses (SSR) was measured. RESULTS: There was no significant difference in any measure of pain habituation between patients and HC. Even patients with apparent clinical signs of central sensitization showed no reduced pain habituation. However, prolonged baseline CHEP and SSR latencies (stimulation block 1) were found in patients compared to HC (CHEP: Δ-latency = 23 ms, p = 0.012; SSR: Δ-latency = 100 ms, p = 0.022). CONCLUSION: Given the performed multimodal neurophysiological testing protocol, we provide evidence indicating that pain habituation may be preserved in patients with chronic pain and thereby be of limited use as a sensitive marker for central sensitization. These results are discussed within the framework of the complex interactions between pro- and antinociceptive mechanism as well as methodological issues. The prolonged latencies of CHEP and SSR after stimulation in non-painful areas may indicate subclinical changes in the integrity of thermo-nociceptive afferents, or a shift towards antinociceptive activity. This shift could potentially affect the relay of ascending signals. SIGNIFICANCE: Our findings challenge the prevailing views in the literature and may encourage further investigations into the peripheral and central components of pain habituation, using advanced multimodal neurophysiological techniques.

Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models.

BACKGROUND: Thoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population. METHODS: A retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity. RESULTS: Gender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week. CONCLUSIONS: The study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.

Prevalence and Severity of Chronic Pain in Patients Receiving Mastectomy with Alloplastic Immediate Breast Reconstruction: A Survey Study.

Introduction: Breast cancer is the most frequently diagnosed cancer worldwide. For those undergoing mastectomy, the choice of alloplastic immediate breast reconstruction (IBR) is increasingly favored. Post-operative chronic pain is an important consideration in this decision, but there is a paucity of data for those undergoing alloplastic IBR. We sought to examine the prevalence, severity, and risk factors for the development of chronic pain in this cohort using validated patient-reported outcome measures. Methods: A cross-sectional survey study was conducted among patients receiving mastectomy with alloplastic IBR. Participants completed 3 surveys querying chronic pain, specifically the Breast Cancer Pain Questionnaire (BCPQ), Brief Pain Inventory (BPI), and BREAST-Q. Participant medical records were reviewed for demographic and surgical variables. Results: A total of 118 patients participated in the study-a response rate of 33.6%. Chronic pain prevalence was high (52.5%), and only 29.0% of these patients had consulted a physician regarding their pain. Among those reporting chronic pain (n = 62), the median severity of pain was 3.1 on an 11-point scale. Chronic pain was associated with radiation (p = .018), bilateral reconstruction (p = .05), worse emotional health (p = .0003), less self (p = .022), and sexual confidence (p = .044). Inter-tool reliability was high, with no significant difference in responses between the 3 surveys. Conclusion: In this cohort, chronic pain is supported as a significant concern among patients who have undergone mastectomy with alloplastic IBR. Given the burden of chronic pain, there is an opportunity to intervene with preventative measures and support for its management.

Introduction: Le cancer du sein est le cancer le plus souvent diagnostiqué dans le monde. L'option de reconstruction mammaire immédiate (RMI) alloplastique est de plus en plus souvent choisie par les patientes subissant une mastectomie. La douleur chronique postopératoire est un important facteur à prendre en compte dans cette décision, mais nous ne disposons que peu de données pour les patientes ayant une RMI alloplastique. Nous avons cherché à étudier la prévalence, la sévérité et les facteurs de risque de survenue d'une douleur chronique dans cette population de patients au moyen de mesures validées de déclaration des résultats. Méthodes: Une enquête transversale a été réalisée parmi les patientes ayant bénéficié d'une RMI alloplastique. Les participants ont répondu à trois enquêtes portant sur la douleur chronique (plus spécifiquement le questionnaire sur la douleur dans le cancer du sein [BCPQ], le Questionnaire court sur la douleur [BPI ou Brief Pain Inventory] et le BREAST-Q). Les dossiers médicaux des participantes ont été examinés à la recherche des variables démographiques et chirurgicales. Résultats: Un total de 118 patientes a participé à l'étude, soit un taux de réponse de 33.6%. La prévalence de la douleur chronique était élevée (52.5%) et seulement 29.0% de ces patientes avaient consulté un médecin à propos de cette douleur. Parmi les participantes signalant une douleur chronique (n = 62), la sévérité médiane de la douleur était de 3,1 sur une échelle de 11 points. La douleur chronique a été associée à la radiothérapie (p = .018), à une reconstruction bilatérale (p = .05), à une aggravation de la santé émotionnelle (p = .0003), à une moindre confiance en soi (p = .022) et sur le plan de la sexualité (p = .044), La fiabilité inter-outils a été élevée, sans différence significative entre réponses dans les trois enquêtes. Conclusion: Il est confirmé que, dans cette cohorte, la douleur chronique est une préoccupation importante chez les patientes ayant subi une mastectomie avec RMI alloplastique. Considérant le fardeau que représente la douleur chronique, il y a une opportunité d'intervention en utilisant des mesures préventives et en apportant un soutien pour sa gestion.

Identifying the genetic association between the cerebral cortex and fibromyalgia.

Fibromyalgia (FM) is a central sensitization syndrome that is strongly associated with the cerebral cortex. This study used bidirectional two-sample Mendelian randomization (MR) analysis to investigate the bidirectional causality between FM and the cortical surface area and cortical thickness of 34 brain regions. Inverse variance weighted (IVW) was used as the primary method for this study, and sensitivity analyses further supported the results. The forward MR analysis revealed that genetically determined thinner cortical thickness in the parstriangularis (OR = 0.0567 mm, PIVW = 0.0463), caudal middle frontal (OR = 0.0346 mm, PIVW = 0.0433), and rostral middle frontal (OR = 0.0285 mm, PIVW = 0.0463) was associated with FM. Additionally, a reduced genetically determined cortical surface area in the pericalcarine (OR = 0.9988 mm2, PIVW = 0.0085) was associated with an increased risk of FM. Conversely, reverse MR indicated that FM was associated with cortical thickness in the caudal middle frontal region (ß = -0.0035 mm, PIVW = 0.0265), fusiform region (ß = 0.0024 mm, SE = 0.0012, PIVW = 0.0440), the cortical surface area in the supramarginal (ß = -9.3938 mm2, PIVW = 0.0132), and postcentral regions (ß = -6.3137 mm2, PIVW = 0.0360). Reduced cortical thickness in the caudal middle frontal gyrus is shown to have a significant relationship with FM prevalence in a bidirectional causal analysis.

Interventional Strategies for Alleviating Severe Abdominal Pain in Chronic Pancreatitis and Abdominal Cancer: A Case Report on the Use of Splanchnic Nerve Radiofrequency Ablation and Erector Spinae Plane Block.

A cancer diagnosis marks the beginning of a difficult path filled with a profound battle against the excruciating pain associated with the illness. Cancer-related pain, which is complex and emotionally distressing, presents unique challenges in terms of treatment. Abdominal cancers and metastases frequently result in severe and unmanageable pain that does not respond well to traditional medications. In such situations, interventions like neurolysis and radiofrequency ablation of the splanchnic nerves and celiac plexus have emerged as effective strategies, providing enhanced pain relief and reducing the need for narcotic painkillers. In this case report, we describe a case of a 38-year-old man with a longstanding history of chronic pancreatitis with a polypoid growth close to the ampulla in the duodenal bulb. The patient was given pain medications to alleviate the pain, but the severe stomach pain, vomiting, and fever persisted. Imaging tests supported the diagnosis and showed chronic pancreatitis, a continuing inflammatory process, and a periampullary adenocarcinoma. The patient had significant pain while being positioned prone for the diagnostic block, hence an erector spinae plane block was done before the radiofrequency ablation. The patient received radiofrequency ablation at the T11 and T12 levels after receiving a diagnostic splanchnic nerve block, significantly reducing pain. The effectiveness of these interventional procedures in enhancing the patient's quality of life and decreasing their dependence on narcotic drugs was highlighted by follow-up visits at two, four, and six months that revealed little to no discomfort. This instance emphasizes the importance of considering neurolysis and radiofrequency ablation as essential alternatives for treating severe abdominal pain brought on by chronic pancreatitis and abdominal cancer.