A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in Eastern Libya.

BACKGROUND: Painful Diabetic Neuropathy (PDN) is a complication that affects up to one third of people living with diabetes. There is limited data on the prevalence of PDN from countries in the Middle East and North Africa. The aim of this study was to estimate the point prevalence of PDN in adults in Eastern Libya using the self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. METHODS: We invited patients attending the Benghazi Diabetes Centre who had diabetes for ≥ 5 years to take part in the study. Patients provided consent and completed the Arabic S-LANSS. Anthropometrics, marital status, socioeconomic and education information was recoded and fasting plasma glucose concentration determined. RESULTS: Four hundred and fifty participants completed the study (age = 19 to 87 years, BMI = 17.6 to 44.2 kg/m2, 224 women). One hundred and ninety five participants (43.3%) reported pain in their lower limbs in the previous 6 months and 190/195 participants (97.4%) reported a S-LANSS score of ≥ 12 suggesting they had neuropathic pain characteristics. Thus, 42.2% (190/450) of participants with diabetes were categorised as experiencing pain with neuropathic characteristics. Mean ± SD duration of diabetes for participants with PDN (20.4 ± 6.5 years) was significantly higher compared with those without PDN (11.1 ± 4.6 years). Participants with PDN smoked tobacco for more years than those without pain (7.9 ± 12.3 years versus 1.1 ± 3.9 years respectively); had significantly higher fasting plasma glucose concentration (143.6 ± 29.3 mg/dl versus 120.0 ± 17.3 mg/dl) and had a significantly higher levels of education and employment status. The most significant predictors of PDN were duration of diabetes (OR = 25.85, 95% CI = 13.56-49.31), followed by smoking for men (OR = 8.28, 95% CI = 3.53-9.42), obesity (OR = 3.96, 95% CI = 2.25-6.96) and high fasting plasma glucose concentration (OR = 3.51, 95% CI = 1.99-6.21). CONCLUSION: The prevalence of PDN in people with diabetes in Eastern Libya was 42.2%. Risk factors for developing PDN were high fasting plasma glucose concentration, long duration of diabetes, and higher level of educational and employment status.

Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic.

PURPOSE: The aim of this study was to cross-culturally adapt the PASS-20 questionnaire for use in Libya. METHODS: Participants were 71 patients (42 women) attending the physiotherapy clinic, Ibn Sina Hospital, Sirt, Libya for management of persistent pain and 137 healthy unpaid undergraduate students (52 women) from the University of Sirt, Libya. The English PASS-20 was translated into Arabic. Patients completed the Arabic PASS-20 and the Arabic Pain Rating Scales on two occasions separated by a 14-day interval. Healthy participants completed the Arabic PASS-20 on one occasion. RESULTS: The internal consistency (ICC) for pain patient and healthy participant samples yielded a good reliability for the total score, cognitive anxiety, fear of pain, and physiological anxiety. The test-retest reliability of the Arabic PASS-20 score showed high reliability for the total score (ICC = 0.93, p < 0.001), escape/avoidance (ICC = 0.93, p < 0.001), fear of pain (ICC = 0.94, p < 0.001), and physiological anxiety subscales (ICC = 0.96, p < 0.001) and good reliability for the cognitive anxiety (ICC = 0.85, p < 0.001). Inspection of the Promax rotation showed that each factor comprised of five items were consistent with the theoretical constructs of the original PASS-20 subscales. CONCLUSION: The Arabic PASS-20 retained internal consistency and reliability with the original English version and can be used to measure pain anxiety symptoms in both pain and healthy individual samples in Libya.

The epidemiology of chronic pain in Libya: a cross-sectional telephone survey.

BACKGROUND: Chronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya. METHODS: A cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %). RESULTS: The prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled. CONCLUSIONS: The prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management.

Acupuncture for cancer pain in adults.

BACKGROUND: Forty per cent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. This is an updated version of a Cochrane Review published in Issue 1, 2011, on acupuncture for cancer pain in adults. OBJECTIVES: To evaluate efficacy of acupuncture for relief of cancer-related pain in adults. SEARCH METHODS: For this update CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to July 2015 including non-English language papers. SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated any type of invasive acupuncture for pain directly related to cancer in adults aged 18 years or over. DATA COLLECTION AND ANALYSIS: We planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Data sheets were compared and discussed with a third review author (MJ) who acted as arbiter. Data analysis was conducted by CP, OT and MJ. MAIN RESULTS: We included five RCTs (285 participants). Three studies were included in the original review and two more in the update. The authors of the included studies reported benefits of acupuncture in managing pancreatic cancer pain; no difference between real and sham electroacupuncture for pain associated with ovarian cancer; benefits of acupuncture over conventional medication for late stage unspecified cancer; benefits for auricular (ear) acupuncture over placebo for chronic neuropathic pain related to cancer; and no differences between conventional analgesia and acupuncture within the first 10 days of treatment for stomach carcinoma. All studies had a high risk of bias from inadequate sample size and a low risk of bias associated with random sequence generation. Only three studies had low risk of bias associated with incomplete outcome data, while two studies had low risk of bias associated with allocation concealment and one study had low risk of bias associated with inadequate blinding. The heterogeneity of methodologies, cancer populations and techniques used in the included studies precluded pooling of data and therefore meta-analysis was not carried out. A subgroup analysis on acupuncture for cancer-induced bone pain was not conducted because none of the studies made any reference to bone pain. Studies either reported that there were no adverse events as a result of treatment, or did not report adverse events at all. AUTHORS' CONCLUSIONS: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

Prevalence of chronic pain among Libyan adults in Derna City: a pilot study to assess the reliability, linguistic validity, and feasibility of using an Arabic version of the structured telephone interviews questionnaire on chronic pain.

There are few studies estimating the prevalence of chronic pain in countries from the Middle East. We translated the Structured Telephone Interviews Questionnaire on Chronic Pain from English into Arabic and assessed its reliability and linguistic validity before using it in a telephone survey in Libya to gather preliminary prevalence data for chronic pain. Intraclass correlations for scaled items were high, and there were no differences in answers to nominal items between the first and second completions of the questionnaire. One hundred and 4 individuals participated in a telephone survey. The prevalence of chronic pain was 25.0% (95% CI, 16.7% to 33.3%) and 50.0% (95% CI: 30.8% to 69.2) of the participants with chronic pain scored ≥ 12 on the Arabic S-LANSS. Mean ± SD duration of pain was 2.8 ± 1.2 years, and pain was more frequent in women (P = 0.02). 53.8% of participants had taken prescription medication for their pain, and 76.9% had used nondrug methods of treatment including traditional Libyan methods such as Kamara, a local herbal concoction. Eighty percent believed that their doctor would rather treat their illness than their pain, and 35% reported that their doctor did not think that their pain was a problem. Some participants complained that the questionnaire was too long with a mean ± SD call duration of 20 ± 5.4 minutes. We conclude that the Arabic Structured Telephone Interviews Questionnaire on Chronic Pain was reliable and linguistically valid and could be used in a large-scale telephone survey on the Libyan population. Our preliminary estimate of prevalence should be considered with caution because of the small sample size.

Translation and linguistic validation of the self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale for use in a Libyan population.

BACKGROUND: The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale is used to identify pain of neuropathic origin and has been validated as a self-completed tool (S-LANSS). We translated the S-LANSS into Arabic and evaluated its reliability and linguistic validity for use by Libyan people. METHODS: Thirteen of 45 Libyan nationals living in the UK were identified as having chronic pain and completed an English and Arabic S-LANSS 1 week apart. In addition, 23 of 104 respondents to a telephone interview in Derna City, Libya, were identified as having chronic pain and completed the Arabic S-LANSS. Seven of these 23 completed the S-LANSS again 1 week later. RESULTS: Cronbach's alpha was 0.72 (P < 0.001) for the Arabic S-LANSS and 0.71 (P < 0.001) for the English S-LANSS. There was good measurement of agreement of individual items in Arabic and English S-LANSS tools with kappa coefficients ranging from 0.69 to 1.00. Twelve of the 23 (52.2%) individuals with chronic pain scored 12 or more on the Arabic S-LANSS and were classified as possibly having neuropathic pain. There was good measurement of agreement of individual items in Arabic S-LANSS tools with kappa coefficients ranging from 0.462 to 1.00. There were strong intraclass correlations in both versions for test-retest reliability of total score. CONCLUSION: The Arabic S-LANSS is reliable and linguistically valid to use in Libya. PERSPECTIVE: Our translation of the S-LANSS into Arabic was shown to be linguistically valid and reliable for use in a Libyan population.

Deficient editorial practices, perceived quality, and expedient scholarly publishing in a developing nation.

Background: There is increasing concern about the quality, integrity, and accessibility to research published in the developing world. This study explores the editorial practices and editors' perspectives to gain insight into the standard of scholarly publishing in Libya. Methods: Between 21 st January and 12 th February, 2022, the editors-in-chief (EC) of Libyan academic journals were invited to complete a questionnaire on editorial practices, degree of satisfaction with submitted and published manuscripts, review processes, and journal performance, as well as challenges facing the journals. Journal websites were examined for quality, and indexation coverage and citations were assessed. We examined the number of citations in Google Scholar for all 2019 articles published in each journal. Descriptive statistics were used to quantitatively summarize the data and thematic analysis was used for the narrative text. Results: 48 EC completed the questionnaire. The EC was affiliated with the institution that owns the journal in 92% of cases. Most EC (83%) were satisfied with the peer-review quality, 69% believed that most of their published papers add new ideas or findings, and 96% were satisfied with their journal's performance. However, despite the high degree of satisfaction, only one journal was indexed in Web of Science or Scopus and only 17% of the journals were indexed in Google Scholar. A qualitative assessment of journal websites revealed shortcomings in publishing practices in a large proportion of the journals. Conclusions: The discordance between the satisfaction of the journal editors and the journal quality indicators points to a break in the quality system of Libyan academic publishing. Similar expedient publishing practices might exist in other countries as well. A comprehensive action plan led by academic institutions to enforce high standards for scholarly publishing is needed to advance research and high-quality scholarly publications in developing countries.

Acupuncture for cancer pain in adults.

BACKGROUND: Forty percent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. OBJECTIVES: To evaluate efficacy of acupuncture for relief of cancer-related pain in adults. SEARCH STRATEGY: CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to November 2010 including non-English language papers. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating any type of invasive acupuncture for pain directly related to cancer in adults of 18 years or over. DATA COLLECTION AND ANALYSIS: It was planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Quality scores were given to studies. Data sheets were compared and discussed with a third review author (MJ) who acted as arbiter. Data analysis was conducted by CP, OT and MJ. MAIN RESULTS: Three RCTs (204 participants) were included. One high quality study investigated the effect of auricular acupuncture compared with auricular acupuncture at 'placebo' points and with non-invasive vaccaria ear seeds attached at 'placebo' points. Participants in two acupuncture groups were blinded but blinding wasn't possible in the ear seeds group because seeds were attached using tape. This may have biased results in favour of acupuncture groups. Participants in the real acupuncture group had lower pain scores at two month follow-up than either the placebo or ear seeds group.There was high risk of bias in two studies because of low methodological quality. One study comparing acupuncture with medication concluded that both methods were effective in controlling pain, although acupuncture was the most effective. The second study compared acupuncture, point-injection and medication in participants with stomach cancer. Long-term pain relief was reported for both acupuncture and point-injection compared with medication during the last 10 days of treatment. Although both studies have positive results in favour of acupuncture they should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis. AUTHORS' CONCLUSIONS: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

An investigation into the hypoalgesic effects of transcutaneous piezoelectric current on experimentally induced thermal stimuli in healthy participants.

OBJECTIVES: To investigate the effects of transcutaneous piezoelectric currents on experimentally induced thermal pain in healthy human participants. MATERIALS AND METHODS: A repeated measure cross-over study recorded sensory detection and pain thresholds to contact thermal stimuli during active and placebo (no current) transcutaneous piezoelectric current in 15 pain-free healthy human volunteers. Active transcutaneous piezoelectric current (6 µA) was delivered as 35 high voltage single rectangular pulses (1 Hz) at the LI4 (Hegu) acupuncture point. RESULTS: Repeated measures ANOVA found that active and placebo transcutaneous piezoelectric current elevated thresholds for warm sensation, heat pain, and cold sensation. However, there were no statistically significant effects for active piezoelectric current compared with placebo for any outcome measure. CONCLUSIONS: Reductions in experimentally induced pain were not due to piezoelectric currents per se. These findings challenge claims about the efficacy of transcutaneous piezoelectric currents for pain relief. A clinical trial is needed.

GERD outcome after bariatric surgery: A protocol for systematic review and meta analysis.

BACKGROUND/AIM: Obesity is associated with increased incidence of gastroesophageal reflux disease (GERD), and it has been suggested that GERD symptoms may be improved by weight reduction. However, various patterns of bariatric surgery may affect symptoms of GERD due to the changed anatomy of stomach and esophagus. The aim of this systematic review and meta-analysis is to analyze the effect of bariatric surgery on GERD. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, EMBASE, and the Cochrane Library from January 2005 to January 2019, combining the words obesity, gastroesophageal reflux with different types of bariatric surgery and weight loss. The methodological quality of randomized controlled trials and non-randomized controlled trials published in English and have at least 1-year follow-up data were included and assessed by Cochrane Collaboration's tool for assessing risk bias and Newcastle-Ottawa scale. Only clinical trials were included, and case series or case reports were excluded. RESULTS: We anticipate that our review will provide the exact estimates of the burden and phenotype of GERD among patients that have undergone bariatric surgery. CONCLUSION: GERD may improve in obese patients who underwent laparoscopic sleeve gastrectomy (LSG); however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. PROSPERO REGISTRATION NUMBER: CRD42018090074.

Nutrient Composition of Popularly Consumed African and Caribbean Foods in The UK.

(1) Background: Traditional foods are important in the diets of Black Africans and Caribbeans and, more widely, influence UK food culture. However, little is known about the nutritional status of these ethnic groups and the nutrient composition of their traditional foods. The aim was to identify and analyse African and Caribbean dishes, snacks and beverages popularly consumed in the UK for energy, macronutrients and micronutrients. (2) Methods: Various approaches including focus group discussions and 24-h dietary recalls were used to identify traditional dishes, snacks, and beverages. Defined criteria were used to prioritise and prepare 33 composite samples for nutrient analysis in a UK accredited laboratory. Quality assurance procedures and data verification were undertaken to ensure inclusion in the UK nutrient database. (3) Results: Energy content ranged from 60 kcal in Malta drink to 619 kcal in the shito sauce. Sucrose levels did not exceed the UK recommendation for adults and children. Most of the dishes contained negligible levels of trans fatty acid. The most abundant minerals were Na, K, Ca, Cu, Mn and Se whereas Mg, P, Fe and Zn were present in small amounts. (4) Conclusion: There was wide variation in the energy, macro- and micronutrients composition of the foods analysed.

Translation and cultural adaptation of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale into Arabic for use with patients with diabetes in Libya.

In Libya neuropathic pain is rarely assessed in patients with diabetes. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale is used worldwide to screen for neuropathic pain. There is no Arabic version of LANSS for use in Libya. The aim of this study was to develop an Arabic version of LANSS and to assess its validity and reliability in diabetic patients in Benghazi, Libya. LANSS was translated into Arabic by four bilingual translators and back translated to English by a university academic. Validity and reliability of the Arabic LANSS was assessed on 110 patients attending a Diabetes Centre in Benghazi. Concurrent validity was tested and compared with the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS). Test-retest reliability was conducted 1-2 weeks later. Internal consistency and inter-class correlation (ICC) between LANSS and S-LANSS was also tested. Internal consistency within first completion of the Arabic LANSS was acceptable (Cronbach's alpha = 0.793) and similar to the Arabic S-LANSS (0.796) and the second completion of the Arabic LANSS (0.795). ICC between the Arabic LANSS and the Arabic S-LANSS was 0.999 (p < 0.001). Test-retest reliability (ICC) between first and second completions of the Arabic LANSS was 0.999 (p < 0.001). Kappa measurement of agreement between the two Arabic LANSS completions and S-LANSS was high on all seven items (Kappa >0.95, p < 0.0001). We concluded that the Arabic version of LANSS pain scale was valid and reliable for use on Libyan diabetic patients. This study provided results suggesting that the S-LANSS could also be used on diabetic patients.

Quality of systematic reviews: an example of studies comparing artificial disc replacement with fusion in the cervical spine.

Cervical artificial disc replacement (C-ADR) is now an alternative to anterior cervical discectomy and fusion (ACDF). Many studies have evaluated the efficacy of C-ADR compared with ACDF. This led to a series of systematic reviews and meta-analyses to evaluate the evidence of the superiority of one intervention against the other. The aim of the study presented here was to evaluate the quality of these reviews and meta-analyses. Medline via Ovid, Embase, and Cochrane Library were searched using the keywords: (total disk replacement, prosthesis, implantation, discectomy, and arthroplasty) AND (cervical vertebrae, cervical spine, and spine) AND (systematic reviews, reviews, and meta-analysis). Screening and data extraction were conducted by two reviewers independently. Two reviewers then assessed the quality of the selected reviews and meta-analysis using 11-item AMSTAR score which is a validated measurement tool to assess the methodological quality of systematic reviews. Screening of full reports of 46 relevant abstracts resulted in the selection of 15 systematic reviews and/or meta-analyses as eligible for this study. The two reviewers' inter-rater agreement level was high as indicated by kappa of >0.72. The AMSTAR score of the reviews ranged from 3 to 11. Only one study (a Cochrane review) scored 100% (AMSTAR 11). Five studies scored below (AMSTAR 5) indicating low-quality reviews. The most significant drawbacks of reviews of a score below 5 were not using an extensive search strategy, failure to use the scientific quality of the included studies appropriately in formulating a conclusion, not assessing publication bias, and not reporting the excluded studies. With a significant exception of a Cochrane review, the methodological quality of systematic reviews evaluating the evidence of C-ADR versus ACDF has to be improved.

Argument for the need of investigation of the relationship between body fatness and experimental pain sensitivity.

In this communication, we argue about the need for an extensive investigation of the relationship between body fatness and fat distribution and experimental pain to explore the factors that might contribute to the increased prevalence of pain conditions in obese individuals.

The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis.

BACKGROUND: To date, there are no systematic reviews of epidemiological studies of chronic pain in the developing world. AIM: To estimate the prevalence of chronic pain worldwide paying particular attention to data from countries with a Human Development Index (HDI) of less than 0.9. METHODS: A literature search was conducted for cross-sectional surveys of chronic pain (≥3 months) in the adult general population using Medline, Embase, CINAHL, SportDiscus, Sciencedirect, CAS ILLUMINA, Academic search complete, PsycINFO and AMED. Forty-eight studies were identified and 29 of these were excluded because they surveyed children, the elderly or were longitudinal studies. RESULTS: Weighted mean ± SD prevalence of chronic pain worldwide was 30.3% ± 11.7% (19 studies, 65 surveys, 34 countries, 182,019 respondents). There was no correlation between HDI and prevalence. In countries with a HDI < 0.9 prevalence was 33.9% ± 14.5% and significantly higher than prevalence in countries with a HDI of ≥0.9 (29.9% ± 12.7%), although removal of a large study that may have included a sample of individuals with comorbidities reduced the worldwide estimate to 28.0% ± 11.8% (47 surveys, 33 countries, 139,770 participants). Interestingly, the estimate of countries with a HDI < 0.9 to 24.8% ± 8.9% (7 surveys, 7 countries, 6122 participants) became significantly lower than the estimate of countries with a HDI ≥ 0.9 which was 28.1% ± 11.6% (40 surveys, 21 countries, 133,648 participants). CONCLUSION: The review provides further evidence that the prevalence of chronic pain in the general population is high. However, there was insufficient reliable data to estimate with any certainty the prevalence of chronic pain in countries with an HDI < 0.9 with variability in estimates between surveys being of concern. Subtle differences in review and survey methodology appeared to impact markedly on estimates. There is a need for epidemiological studies that estimate the prevalence of chronic pain in developing countries to determine the scale of the problem.

A Cochrane systematic review of acupuncture for cancer pain in adults.

BACKGROUND: Cancer-related pain is a significant and debilitating problem. Non-pharmacological treatments such as acupuncture may have an adjunctive role in controlling pain without the undesirable side effects of drug regimens and yet the evidence base remains limited. OBJECTIVES: The main objective of this systematic review was to evaluate the effectiveness of acupuncture in the management of cancer-related pain in adults. Subgroup analyses were planned for acupuncture dose and for the outcome of studies investigating acupuncture for cancer-induced bone pain. METHODS: Six electronic databases were searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, AMED and SPORTDiscus. Studies included in the review were randomised controlled trials investigating the use of acupuncture for cancer pain using pain as a primary outcome measure. In total, 253 published references were identified but only three studies met the inclusion criteria and were included in the final review. RESULTS: Of the three included studies, only one was judged to be of high methodological quality and showed auricular acupuncture to be superior to placebo acupuncture and ear seeds at placebo points. However, the study was relatively small and blinding was compromised. The two low-quality studies gave positive results in favour of acupuncture for cancer pain, but these results should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis. CONCLUSION: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

Avicenna's concept of pain.

Ibn Sina (Latin name - Avicenna, 980-1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire.

Cold pressor pain responses in healthy Libyans: effect of sex/gender, anxiety, and body size.

BACKGROUND: Studies have suggested that sex/gender, ethnicity, and anxiety toward pain affect pain sensitivity response. However, most studies have been conducted in a developed (Western) country, where the "ethnic" comparison group was in the minority. OBJECTIVES: This study measured the responses of Libyan men and women to cold pressor pain, and also examined the effect of anxiety about pain and of body characteristics such as height, weight, and body mass index (BMI) on pain responses. METHODS: Students attending Garyounis University, Benghazi, Libya, took part in an experiment in 2007 that consisted of 2 cold pressor pain tests. During each test, participants plunged their nondominant hand into a slurry of ice. Time to pain threshold, time to pain tolerance (removal of the hand from the ice), and pain intensity and unpleasantness were measured using a 100-mm visual analog scale. Participants also completed a 20-item Pain Anxiety Symptoms Scale (PASS-20) questionnaire, with each item scored on a 6-point Likert scale anchored by descriptive phrases (0 = never, 5 = always). RESULTS: Fifty-eight self-declared students (29 men, 29 women; age range, 19-38 years) participated in the study. Pain threshold was significantly higher for men (mean difference, 8.2 sec; 95% CI, -1.7 to 18.0; P = 0.04), but there were no significant differences in pain tolerance, intensity, or unpleasantness. Women had significantly higher scores on the PASS-20 total score (P = 0.03), and on the PASS-20 dimensions of escape/avoidance (P = 0.04) and physiological anxiety (P = 0.006). Height, but not weight or BMI, was correlated with pain threshold in women (r = 0.52; P = 0.019) but not in men. Significant predictors of linearity of pain tolerance in women, but not men, were height (r = 0.49; P = 0.028) and the cognitive anxiety dimension score of the PASS-20 (r = -0.69; P = 0.004). Pain intensity rating was significantly higher in both women and men in the presence of an investigator of the opposite sex. CONCLUSIONS: Libyan women had higher pain sensitivity response to cold pressor pain than did Libyan men, but both sexes had lower pain responses than their Western counterparts. Height and anxiety may have contributed to the differences between the sexes in this study.

A preliminary investigation into the effect of coffee on hypolagesia associated with transcutaneous electrical nerve stimulation.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, inexpensive analgesic technique used to relieve pain. It has been suggested that caffeine, an adenosine antagonist, may interfere with TENS action. This double-blind controlled pilot study investigated the effect of coffee on response to TENS in healthy human participants experiencing experimentally induced pain. Twelve participants (7 female, age range = 20-41 years) took part in two experiments separated by 24 h. Each experiment lasted 80 min and consisted of 3 x 15 min cycles: pre-TENS, during TENS predrink and during TENS postdrink [coffee (100 mg caffeine) or decaffeinated coffee randomized across experiments]. During each cycle, thresholds for electrical (EPT), mechanical (MPT) and cold pressor (CPT) pain were recorded. The statistical analysis modelled the responses for the coffee and decaffeinated coffee conditions during TENS (i.e. as a standard crossover) and detected no statistically significant effects between coffee and decaffeinated drinks for the natural logarithm (ln) transformed values of electrical pain threshold [ln EPT Coffee-ln EPT Decaffeinated coffee mean (standard error) = 0.0147 (0.2159)], mechanical pain threshold [ln MPT Coffee-ln MPT Decaffeinated coffee mean (standard error) = 0.1296 (0.0816)] and cold pain threshold [ln CPT Coffee-ln CPT Decaffeinated coffee mean (standard error) = 0.0793 (0.1139)]. We conclude that a single cup of coffee (100 mg caffeine) had no detectable effect on TENS outcome. Reasons why coffee did not produce a detectable effect on pain threshold are discussed.