Posts

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.

Multiple Sclerosis (MS) is an autoimmune disease with notable sex differences. Women are not only more likely to develop MS but are also more likely than men to experience neuropathic pain in the disease. It has been postulated that neuropathic pain in MS can originate in the peripheral nervous system at the level of the dorsal root ganglia (DRG), which houses primary pain sensing neurons (nociceptors). These nociceptors become hyperexcitable in response to inflammation, leading to peripheral sensitization and eventually central sensitization, which maintains pain long-term. The mouse model experimental autoimmune encephalomyelitis (EAE) is a good model for human MS as it replicates classic MS symptoms including pain. Using EAE mice as well as naïve primary mouse DRG neurons cultured in vitro, we sought to characterize sex differences, specifically in peripheral sensory neurons. We found sex differences in the inflammatory profile of the EAE DRG, and in the TNFα downstream signaling pathways activated intracellularly in cultured nociceptors. We also found increased cell death with TNFα treatment. Given that TNFα signaling has been shown to initiate intrinsic apoptosis through mitochondrial disruption, this led us to investigate sex differences in the mitochondria's response to TNFα. Our results demonstrate that male sensory neurons are more sensitive to mitochondrial stress, making them prone to neuronal injury. In contrast, female sensory neurons appear to be more resistant to mitochondrial stress and exhibit an inflammatory and regenerative phenotype that may underlie greater nociceptor hyperexcitability and pain. Understanding these sex differences at the level of the primary sensory neuron is an important first step in our eventual goal of developing sex-specific treatments to halt pain development in the periphery before central sensitization is established.

Pain after paediatric appendectomy and tonsillectomy is often undertreated. Benchmarking of hospitals could reveal which measures are associated with improved patient- or parent-reported pain-related outcomes.

We aim to characterize the legal landscape of incarcerated patients' pain management malpractice claims and to discuss the ethical and policy implications that result. The most common rationales for lawsuits were failure to completely treat (38 [46.3%]), failure to offer (34 [41.4%]), and delay of treatment (6 [7.3%]). In cases won by defendants, the most common rationale for verdicts was no deliberate indifference occurred (74 [86.6%]). We found that incarcerated individuals were often unsuccessful in litigating claims for inadequate pain management despite several cases pointing toward treatment strategies far below what would be ethically accepted as standard of care in the community setting.

Although abdominoplasty is growing in popularity, it is still encumbered with considerable postoperative pain, which prolongs recovery.

BACKGROUND This retrospective study from a single center in Turkey aimed to compare the surgical results of regional anesthesia and general anesthesia in 203 patients with upper- and lower-extremity amputations. MATERIAL AND METHODS The study population consisted of patients who underwent extremity amputation between 2017 and 2021. Patients' demographic data, comorbidities, American Society of Anesthesiology (ASA) scores, amputated extremities, causes and extents of amputations, length of hospital stay, associated mortality/morbidity, and postoperative 90-day mortality data were comparatively analyzed between the groups created according to the anesthesia methods used in amputations. RESULTS The study consisted of 203 patients, of whom 80.8% were male. The most commonly used anesthesia method was peripheral nerve blocks (32.5%), followed by spinal anesthesia (31.5%), general anesthesia (31.0%), epidural anesthesia (2.0%), combined spinal-epidural anesthesia (1.5%), and sedo-analgesia (1.5%). Of the amputations performed, 37.0% were upper-extremity and 63.0% were lower-extremity. Peripheral nerve blocks were used most frequently in upper-extremity amputations (71.5%), and spinal anesthesia was used most frequently in lower-extremity amputations (48.9%). The mean length of hospital stay of the patients who underwent surgery under regional anesthesia methods was shorter than that of those who underwent general anesthesia (8.7±7.4 days vs 15.0±20.6 days). The mortality rate was 0.5% in the first 24 h, 0.5% in the next 48 h, and 4.9% in total. CONCLUSIONS The study findings demonstrated that performing extremity amputations under regional anesthesia techniques, particularly peripheral nerve blocks, reduces mortality/morbidity, the need for postoperative intensive care, mean length of stay in hospital, and hospital costs.

Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients.

Cases of large bowel closed-loop phenomenon with cecal perforation are extremely rare, especially when extracolonic epiploic appendage and peritoneal bands are the cause. However, sporadic cases exist in the literature with various presentations, but very few occur in patients in the abdomen without a previous scar.