H-coil repetitive transcranial magnetic stimulation does not improve executive function in patients with chronic peripheral neuropathic pain: a randomized sham-controlled crossover study.

Introduction: Deep rTMS is an increasingly popular noninvasive brain stimulation technique which has shown promise for treating cognitive impairments. However, few studies have investigated the cognitive effects it could exert in patients with chronic peripheral neuropathic pain. Therefore, we aimed to assess the effects of deep rTMS on executive functioning in patients with peripheral neuropathic pain, in a randomized, double-blind crossover trial. Methods: In total, 17 patients were randomly assigned to receive both active and sham deep H-coil rTMS targeting the primary motor cortex. Each treatment period consisted of five daily rTMS sessions. Selected tests of executive functioning from the CANTAB test battery (paired associates learning, stop signal task, spatial working memory and multitasking test) were performed at baseline, and at 1 week and 3 weeks follow-ups. Results: We did not find any significant interactions between time and treatment for the measures of executive functioning for the patient group, or for patients with reduced cognition compared to normative means. Conclusion: High-frequency deep H-coil rTMS targeting the hand area of the primary motor cortex and delivered over 5 consecutive days did not improve executive functioning in patients with chronic peripheral neuropathic pain. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05488808.

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.

Study Protocol for the Opioid and Pain Treatment in Indigenous Communities Trial: A Systems Level Intervention for Enhanced Screening and Brief Intervention and Referral for Co-Occurring Chronic Pain and Opioid Use Disorder.

American Indian/Alaska Native (AI/AN) individuals have the highest rates of opioid overdose mortality and chronic pain (CP) compared to other racial/ethnic groups in the United States. These individuals also report higher rates of pain anxiety and pain catastrophizing, which are both associated with poorer outcomes and risk for opioid misuse (OM) and opioid use disorder (OUD) among individuals with CP. Yet, no prior studies have examined rates of comorbid pain and OUD among AI/AN adults. This commentary describes an implementation research partnership of 3 AI/AN-serving clinics and a university team that utilizes an implementation hybrid type III design to examine the impact of implementation strategies on adoption and sustainability of evidence-based screening and brief intervention for CP and OM/OUD among AI/AN clients. As part of our community-engaged approach, we embrace both AI/AN models and Western models, and a collaborative board of 10 individuals guided the research throughout. We hypothesize that our culturally centered approach will increase rates of screening and brief intervention and improve identification of and outcomes among AI/AN clients with CP and OUD who receive treatment at participating sites. Each site convenes a workgroup to evaluate and set goals to culturally center screening and brief interventions for CP and OM/OUD. Data collected include deidentified electronic health records to track screening and brief interventions and rates of CP and OUD; provider and staff surveys beginning prior to implementation and every 6 months for 2 years; and a subset of clients will be recruited (N = 225) and assessed at baseline, 6, and 12 months to examine biopsychosocial and spiritual factors and their experiences with culturally centered screening and brief intervention. Cultural adaptations to the measures and screening and brief intervention as well as barriers and facilitators will be addressed. Recommendations for successful Tribal health clinic-university partnerships are offered.

Yoga and Physical Therapy for Chronic Pain and Opioid Use Disorder Onsite in an Opioid Treatment Program: A Randomized Controlled Trial.

BACKGROUND: There is a lack of integrated treatment for chronic pain and opioid use disorder (OUD). Yoga and physical therapy (PT) may improve pain and physical function of people living with (PLW) chronic low back pain (CLBP) and may also reduce opioid craving and use, but PLW with OUD face barriers to accessing these interventions. We hypothesize that compared to treatment as usual (TAU), providing yoga and PT onsite at opioid treatment programs (OTPs) will be effective at improving pain, opioid use, and quality of life among people with CLBP and OUD, and will be cost-effective. METHODS: In this hybrid type-1 effectiveness-implementation study, we will randomly assign 345 PLW CLBP and OUD from OTPs in the Bronx, NY, to 12 weeks of onsite yoga, onsite PT, or TAU. Primary outcomes are pain intensity, opioid use, and cost-effectiveness. Secondary outcomes include physical function and overall well-being. DISCUSSION: This trial tests an innovative, patient-centered approach to combined management for pain and OUD in real-world settings. We rigorously examine the efficacy of yoga and PT onsite at OTPs as nonpharmacologic, cost-effective treatments among people with CLBP and OUD who face barriers to integrated care.

"It is something you live with, like an organ in your body" a qualitative study on the lived experiences of people suffering from chronic low back pain in Lebanon.

PURPOSE: This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage. METHOD: Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0). RESULTS: The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain. CONCLUSION: This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.

The exploration of patients' pain perception may provide an opportunity to better develop and design culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The rehabilitation process should incorporate a balanced biopsychosocial approach, addressing both physical and psychosocial elements of pain, to provide more effective care and outcomes for Lebanese patients who predominantly attribute chronic low back pain to biomedical factors.Lebanese healthcare professionals need to improve communication with Lebanese patients regarding the nature of chronic low back pain, using clear communication to help dispel misconceptions and enhance rehabilitation outcomes.

Platelet-Rich Plasma Treatment for the Lumbar Spine: A Review and Discussion of Existing Gaps.

BACKGROUND: Platelet-rich plasma (PRP) is obtained by centrifuging autologous whole blood to extract a layer concentrated with platelets, growth factors found in platelet granules, and cytokines. These components work together to promote and facilitate the healing process at sites of injury. An increasing number of clinical studies are assessing the efficacy of PRP as a treatment for lower back pain. OBJECTIVES: Lumbar back pain is a significant cause of years lived with disability. This paper conducts a thorough review of clinical studies on intradiscal, facet-joint, epidural, and mixed-target PRP interventions in the lumbar spine. Furthermore, gaps in the current literature regarding lumbar spinal PRP injections are identified to help guide future clinical trials. STUDY DESIGN: Literature review. METHODS: An initial search was conducted using Ovid MEDLINE, focusing on PRP injections in the spine. Boolean operators were used to combine MeSH terms and key words such as "spine," "lumbar spine," "thoracic spine," "cervical spine," "intervertebral disc," "platelet-rich plasma," and "inject." The search revealed an absence of papers about PRP injections into the cervical and thoracic spine, so the review was written with a specific focus on the lumbar spine. For the purposes of this paper, the selected manuscripts were separated into categories of intradiscal, facet-joint, epidural, and mixed-target PRP injections. RESULTS: A multitude of case reports, case series, prospective clinical studies, and randomized controlled trials have yielded results supporting the use of intradiscal, facet-joint, and epidural PRP injections in the lumbar spine. However, a handful of papers suggest that PRP lacks efficacy in improving lumbar back pain and function. With the relative dearth of literature assessing the effects of spinal PRP injections, additional double-blinded randomized trials are needed. Important findings from available studies include the observation of PRP's increased efficacy over time, the correlation of the number of targeted injection sites with the efficacy of PRP injections, and the correlation of platelet count with PRP injections' efficacy. LIMITATIONS: There exists wide variability in PRP preparation protocols and in the methods of assessing PRP's therapeutic benefits between each study that evaluates PRP's effects in the lumbar spine. CONCLUSIONS: All clinical studies evaluating PRP as a form of treatment for the lumbar spine should include full transparency and details about the methods used for PRP preparation and injection. Future double-blinded randomized trials can fill in existing gaps by assessing the effects of platelet concentration and dose on the extent of clinical improvement as well as by establishing an expected timeline for clinical improvement after PRP injections. Cross-study standardization of which pain scoring systems to utilize for study evaluation would increase comparability among different papers.

Trainee Insight into Pain Fellowship Programs: A Critical Evaluation of the Current Educational System by the APPD.

BACKGROUND: Since 1992, when the Accreditation Council of Graduate Medical Education (ACGME) acknowledged pain medicine as a subspecialty, the field has experienced significant growth in its number of programs, diversity of sponsoring specialties, treatment algorithms, and popularity among applicants. These shifts prompted changes to the educational model, overseen by program directors (PDs) and the ACGME. The pool of pain fellowship applicants also changed during that period. OBJECTIVES: This study aims to investigate trainees' reasons for applying to pain medicine fellowship programs as well as the applicants' specific expectations, interests, and motivations, thereby contributing to the remodeling and universal improvement of programs across the country. STUDY DESIGN: Online survey via SurveyMonkey. The online questionnaire targeted pain fellowship applicants in 2023 and current fellows in the US. METHODS: Our study was designed by board members of the Association of Pain Program Directors (APPD). The board disseminated a survey to those who applied to ACGME Pain Medicine fellowships in 2023 as well as to existing fellows. The survey was emailed to residency and fellowship PDs for dissemination to their trainees. The participants answered a 12-question survey on their reasons for pursuing pain medicine fellowships, expectations of and beyond those fellowships, and educational adjustments. RESULTS: There were 283 survey participants (80% applicants in residency training and 20% fellows). Participants ranked basic interventional procedures and a strong desire to learn advanced procedures as the most significant factors in pursuing a pain fellowship. Most trainees (70%) did not wish to pursue a 2-year fellowship, and 50% desired to go into private practice. LIMITATIONS: The relatively small number of respondents is a limitation that could introduce sampling error. Since most of the respondents were from the fields of physical medicine and rehabilitation (PM&R) and anesthesia, the use of convenience sampling reduced our ability to generalize the results to the wider community. Furthermore, approximately 80% of the trainees were residents, who might have had less experience in or knowledge of the survey's particulars than did the fellows. CONCLUSION: This survey demonstrated that procedural volume and diversity were important factors in trainees' decisions to apply to the field of pain medicine; however, extending the duration of a pain fellowship was not an option survey participants favored. Therefore, PDs and educational stakeholders in pain fellowship training need to develop creative strategies to maintain competitive applicants' interest while they adapt to our evolving field.

Heeding Pain's Prescription.

Newer definitions of pain remain suggestive of categorization by mainly neurological or psychological bases. All pain recruits cortical interpretation for any sort of directive effects in awareness, attention, and action. That unity of purpose in pain's multi-pathway manifestations can inspire neurophilosophical reflections on the existentiality, subjectivity, and sociality of pain. Pain is neither so subjective as to be relieved of meaning, nor so objective that multi-modal approaches can take turns at targeting its relief. The problem of objectifying the subjective is essential for addressing issues of assessing and treating pain. Integrative plans for pain care make sense if and when all aspects of pain's character are deemed to be integral, and are actually integrated in both theory in practice. A standpoint on the "entity-identity" of pain afflicting the whole person implies that pain is expressed behaviorally and as articulately as circumstances permit. Pain speaks, even for those not able to speak, as their patterns of brain activity may be representative of pain. Heeding pain's prescriptive voice requires collective interpretations before attempting coordinated treatments. Pain's prescription will remain unfilled until its full reality is recognized at a personal level, where comprehensive care is mobilized for the whole patient. Heeding pain looks to the central figure that is never absent from any painful situation, namely the individual person-in-pain. That holistic and humanistic value to mobilizing resources against pain should be reflected in the practice of pain medicine, and the craft of the pain physician.

Virtual Reality as a Treatment for Chronic Musculoskeletal Pain Syndromes.

Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the 'drug-like' effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions.

Perspectives on Online Resources for People Experiencing Pain: A Qualitative Study.

BACKGROUND: Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain. OBJECTIVES: This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs. METHODS: Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis. RESULTS: Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources. CONCLUSION: Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.

How to Distinguish Non-Inflammatory from Inflammatory Pain in RA?

PURPOSE OF THE REVIEW: Managing non-inflammatory pain in rheumatoid arthritis (RA) can be a huge burden for the rheumatologist. Pain that persists despite optimal RA treatment is extremely challenging for patient and physician alike. Here, we outline the latest research relevant to distinguishing non-inflammatory from inflammatory RA pain and review the current understanding of its neurobiology and management. RECENT FINDINGS: Nociplastic pain is a recently introduced term by the international pain community. Its definition encompasses the non-inflammatory pain of RA and describes pain that is not driven by inflamed joints or compromised nerves, but that is instead driven by a functional reorganisation of the central nervous system (CNS). Insights from all areas of nociplastic pain research, including fibromyalgia, support a personalised pain management approach for non-inflammatory pain of RA, with evidence-based guidelines favouring use of non-pharmacological interventions. Future developments include novel CNS targeting pharmacotherapeutic approaches to treat nociplastic pain.

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.

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.

Modified Lichtenstein hernioplasty with concomitant tissue repair: a retrospective study on postoperative chronic pain.

OBJECTIVE: To assess the effectiveness of a modified Lichtenstein Repair combined with Herniorrhaphy in reducing postoperative chronic pain and enhancing recovery and quality of life in inguinal hernia patients. METHODS: This retrospective study, conducted at the Taleghani training center between January 2021 and February 2023, retrospectively examined 289 hernia surgeries, of which 130 employed a modified Lichtenstein technique. The investigation encompassed a detailed analysis of patient demographics, employed surgical techniques, operative methods with a focus on minimal dissection, and an evaluation of postoperative outcomes. RESULTS: In this study of 289 participants, primarily males aged 60-80 years, the modified technique group demonstrated a notably lower incidence of hernia recurrence (1.5%) compared to the Lichtenstein group (3.1%). Additionally, the modified technique was more effective in reducing postoperative pain, with a significantly lower mean Visual Analogue Scale (VAS) score of 0.15, compared to 0.31 in the Lichtenstein group. This suggests enhanced patient comfort and a potentially quicker recovery in the modified technique group. CONCLUSION: The modified Lichtenstein hernioplasty technique, characterized by minimal tissue trauma and precise mesh placement, emerges as an effective approach in inguinal hernia repair. It offers significant benefits in reducing postoperative discomfort and chronic pain, thereby enhancing patient recovery and overall quality of life. This method aligns with current surgical trends towards patient-centric and minimally invasive procedures.