Food for Special Medical Purposes and Nutraceuticals for Pain: A Narrative Review.

INTRODUCTION: The present paper focuses on the possible contribution of food compounds to alleviate symptomatic pains. Chronic pain can more easily be linked to anticipatory signals such as thirst and hunger than it is to sensory perceptions as its chronicity makes it fall under the behavioural category rather than it does senses. In fact, pain often negatively affects one's normal feeding behavioural patterns, both directly and indirectly, as it is associated with pain or because of its prostrating effects. NUTRITIONAL COMPOUNDS FOR PAIN: Several nutraceuticals and Foods for Special Medical Purposes (FSMPs) are reported to have significant pain relief efficacy with multiple antioxidant and anti-inflammatory properties. Apart from the aforementioned properties, amino acids, fatty acids, trace elements and vitamins may have a role in the modulation of pain signals to and within the nervous system. CONCLUSION: In our opinion, this review could be of great interest to clinicians, as it offers a complementary perspective in the management of pain. Trials with well-defined patient and symptoms selection and a robust pharmacological design are pivotal points to let these promising compounds become better accepted by the medical community.

Critical Illness Polyneuropathy (CIP): a multicenter study on functional outcome.

OBJECTIVES: To describe the functional recovery of consecutive inpatients with Critical Illness Polyneuropathy (CIP) at the time-point of the discharge from rehabilitation units according to Barthel Index scores. To examine whether age, gender, pre-ICU admission diagnosis, tracheostomy performance, heterotopic ossification development and duration of neuro-rehabilitation treatment are among the prognostic factors that can predict the functional outcome in studied patients. METHODS: A retrospective observational clinical study from January 2010 to December 2014 in three rehabilitation units in Greece. RESULTS: Sixteen subjects (57.1%) had >60 BI discharge scores, showing a prospect in gaining further independence. Females presented a tendency for better functional outcome vs males (73.8 ± 12.6 vs 58.6 ± 23.4, p=0.082). Respiratory, septic and neurologic patients demonstrated better rates of functional improvement after the rehabilitation process vs cardiac patients (p minor than 0.001, p=0.009 and p=0.019, respectively vs p=0,072). Heterotopic ossification development proved to be an adverse independent prognostic factor of functional outcome (47.8 ± 25.7 vs 68.8 ± 17.7, p=0.023). CONCLUSIONS: A proportion of included patients experienced severe disability with poor prospect of further functional development and return to work at the discharge from the rehabilitation units. According to the present study, which is the first that focuses only on CIP and its outcome, specific prognostic factors can be defined. Our results can be used as pilot data for larger studies, so that firmer conclusions can be drawn.

Neuromuscular efficiency in fibromyalgia is improved by hyperbaric oxygen therapy: looking inside muscles by means of surface electromyography.

OBJECTIVES: Neuromuscular efficiency (NME) is impaired in fibromyalgia (FM). Hyperbaric oxygen therapy (HBOT) is a medical treatment using 100% of oxygen through an oxygen mask. HBOT in FM induces changes in cortical excitability and a secondary reduction in pain and muscle fatigue. However, there are still no direct data indicating changes in muscle fatigue. The aim of this study was to assess whether the reduction in muscle fatigue so far attributed to a central effect of HBOT can be directly detected by means of non-invasive sEMG as a change in NME. METHODS: The study was an observational longitudinal study on changes in NME induced by 20 sessions of HBOT at 2.4 atmosphere, in 22 patients with FM (3M; 19F) (age 49.8±9.5; height 164.7±7.5; weight 63.8±12.7). sEMG was recorded in single differential configuration from the biceps brachii muscle during the 30-second fatiguing contractions using linear arrays of eight adhesive electrodes. RESULTS: Evaluations made before and immediately after the first session showed that maximal strength did not change (T0 49±20 N, T1 49±19 N, p=0.792), thus suggesting that HBOT did not induce muscle fatigue or potentiation. After 20 sessions of HBOT, NME increased from 1.6±1.1 to 2.1±0.8 (p=0.050), whereas maximal strength, EMG amplitude and muscle fibre CV did not change. CONCLUSIONS: HBOT did not improve muscle strength or change muscle fibre content, but improved the ability of the central motor command to generate the same effort (MVC) with fewer recruited fibres. Our sEMG findings underlined a modified central mechanism related to fibre type recruitment order, thus suggesting that muscle fatigue is not primarily a muscular problem, as also demonstrated by other authors with different methods.