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The accessory navicular bone (ANB) is one of the most common accessory bones in the foot. Certain pathologies, such as posterior tibial tendon insufficiency are associated with ANB, and should be differentiated from midfoot and hindfoot fractures such as navicular tuberosity avulsion fractures. There are few studies addressing the prevalence and types of ANB in Saudi Arabia.

To evaluate the additional effect of high frequency (HF) or low frequency (LF) transcutaneous electrical nerve stimulation (TENS) in a specific therapeutic exercise program for the treatment of patients with chronic neck pain.

Migraine is a common disabling disease with a complex pathophysiology. Headache is a frequent side effect after intravenous adenosine administration, while adenosine receptor antagonist, caffeine, relieves migraine headache. These observations suggest a possible involvement of adenosine signaling in headache and migraine pathophysiology.In a randomized, double-blinded, placebo-controlled, crossover study, 18 participants diagnosed with migraine without aura received 120 µg/kg/min adenosine or placebo over 20 minutes.Headache intensity, migraine associated symptoms, vital signs, the diameter of the superficial temporal artery (STA), blood flow velocity in the middle cerebral artery (VMCA) and facial skin blood flow were measured at baseline and every 10 minutes until two hours post-infusion start. The primary endpoint was the difference in incidence of migraine attacks after adenosine compared to placebo.Eighteen participants completed the study. We found no difference in incidence of migraine following adenosine (7/18, 39%) compared to placebo (3/18, 17%) (P = 0.29). Fourteen participants (14/18, 78%) reported headache after adenosine compared to placebo (6/18, 33%) (P < 0.01). Adenosine increased heart rate (P < 0.001), facial skin blood flow (P < 0.05) and STA diameter (AUCT0-20min, P = 0.01), and decreased VMCA (AUCT0-20min, P < 0.001) compared to placebo.Adenosine induced headache accompanied by a short-lasting (< 30 min) dilation of intra- and extracerebral arteries. The non-significant migraine induction might be due to the presence of several adenosine receptors with counteracting signaling, highlighting the need of more selective modulators to dissect the implication of adenosine in migraine.

Post-operative healing after clitoral reconstruction (CR) for Female Genital Mutilation/Cutting (FGM/C) can be long and painful due to prolonged clitoral re-epithelialization time (3 months). Autologous Platelet-Rich Plasma (A-PRP) might reduce post operative clitoral epithelialization time and pain.

Temporomandibular disorders (TMD) include a group of musculoskeletal disorders that may involve increased responsiveness of nociceptive neurons in the central nervous system (i.e. central sensitization). To test this hypothesis further, the present study examined whether, as compared with healthy subjects, patients with chronic TMD have a greater susceptibility to develop secondary mechanical hyperalgesia – a phenomenon that can be confidently attributed to central sensitization.In this case-control study, we assessed the area of secondary mechanical hyperalgesia induced experimentally by delivering high-frequency electrical stimulation (HFS) to the volar forearm skin in 20 participants with chronic TMD and 20 matched healthy controls. HFS consisted in 12 trains of constant-current electrical pulses (5mA) delivered at 42 Hz. The area of secondary mechanical hyperalgesia was evaluated 30 minutes after applying HFS.The area of secondary mechanical hyperalgesia induced by HFS was on average 76% larger in the chronic TMD group (M = 67.7 cm2, SD = 28.2) than in the healthy control group (M = 38.4 cm2, SD = 14.9; p = .0003). Regarding secondary outcomes, there was no group difference in the intensity of secondary mechanical hyperalgesia, but allodynia to cotton after HFS was more frequent in the chronic TMD group.To our knowledge, this is the first study to show that individuals with chronic TMD have an increased susceptibility to develop secondary hyperalgesia in a site innervated extra-trigeminally. Our results contribute to a better understanding of the pathophysiology of chronic TMD.

Migraine surgery is a debilitating disorder that produces high costs and compromises the quality of life. This study aimed to evaluate surgery success and the longevity of the surgical benefit by trigger site.

Most women take medication during pregnancy despite limited scientific evidence on safety. We investigated medication use, including changes in and reasons for changes in use during pregnancy, with attention to medication use in pregnant women with chronic conditions. We conducted an online survey of pregnant women aged ≥18 years ( = 1,226). We calculated descriptive statistics for aspects of medication use and performed multivariable logistic regression to examine associations between change in use and chronic conditions. Seventy-nine percent of women took at least one medication during pregnancy. Among those, 63.2% made at least one medication change: 42.0% started, 34.9% stopped, 30.0% missed dose(s), and 18.1% lowered dose(s) from that originally prescribed or recommended. More than a third (36.5%) of women who stopped, lowered, or missed medication did so independent of health care provider advice; 54.0% cited concern about birth or developmental defects as reasons for change. Odds of medication change were higher for women with chronic conditions: digestive conditions-starting (adjusted odds ratio [AOR] = 1.8, 95% confidence interval [CI] = 1.1-2.7), stopping (AOR = 2.1, 95% CI = 1.4-3.3), and lowering (AOR = 2.4, 95% CI = 1.7-3.3) medication; mental health conditions-starting (AOR = 1.6, 95% CI = 1.2-2.2), stopping (AOR = 3.0, 95% CI = 2.3-4.0), or missing (AOR = 2.1, 95% CI = 1.6-2.8) medication; pain conditions-stopping (AOR = 2.9, 95% CI = 2.0-4.2); and respiratory conditions-starting (AOR = 2.0, 95% CI = 1.3-3.1), stopping (AOR = 1.7, 95% CI = 1.1-2.6), and missing (AOR = 2.2, 95% CI = 1.4-3.4) medication. Most pregnant women take medication and many, including those with chronic conditions, change their medication use during pregnancy. Medication change may occur independent of health care provider advice and due to women's safety concerns.

Active duty (AD) women suffer with chronic pelvic pain (CPP) while providers tackle diagnoses and treatments to keep them functional without contributing to the opioid epidemic. The purpose of this randomized trial was to determine the effectiveness of noninvasive, self-explanatory mindfulness-based stress reduction (MBSR) or self-paced healthy lifestyle (HL) interventions on CPP in AD women. A 6-week, interventional prospective study with AD women aged 21-55 years at Mountain Home (MTHM), Idaho, was conducted. Women were randomly assigned to MBSR ( = 21) or HL ( = 20) interventions. The primary outcome was pain perception. The secondary outcomes were depression and circulating cytokine levels. Women in the MBSR group exhibited reduced pain interference ( < 0.01) and depression ( < 0.05) alongside decreased interleukin (IL)-4 ( < 0.05), IL-6 ( < 0.05), eotaxin ( < 0.05), monocyte chemoattractant protein-1 ( = 0.06), and interleukin-1 receptor antagonist (IL-1ra) ( < 0.01) and increased vascular endothelial growth factor ( < 0.05). Women in the HL group did not have changes in pain; however, they did exhibit reduced depression ( < 0.05) alongside decreased granulocyte-macrophage colony-stimulating factor ( < 0.05) and increased tumor necrosis factor alpha ( < 0.05), stromal cell-derived factor-1 ( < 0.01), and IL-1ra ( < 0.01). AD women receiving MBSR or HL had reduced depression scores and altered circulating cytokine levels; however, only those receiving MBSR had reduced pain perception. Findings support MBSR as an effective and viable behavioral treatment for AD women suffering from CPP and provide premise for larger randomized controlled studies. MOCHI-An RCT of mindfulness as a treatment for CPP in AD Women NCT04104542 (September 26, 2019).

Occipital Neuralgia (ON) is a well-defined type of headache, whose treatment algorithm is still debated across medical specialties. From the analysis of the literature, it appears that surgical decompression of the occipital nerves is the most effective invasive approach to improve the quality of life of patients suffering from ON refractory to medications. We describe here a minimally invasive nerve and muscle sparing technique to decompress the occipital nerves.