Rejected

Epidemiological studies based on hospital population, geographic isolates, smaller population, and focused groups provide valuable information on the pattern of diseases, but do not reflect on the true prevalence rates or the changing trends of disease over a period of time in different communities. The present study was undertaken to determine the prevalence and pattern of various neurological disorders in Himachal Pradesh.

Discogenic pain is recognized as the most important and most common cause of low back pain (LBP). Intradiscal pulsed radiofrequency (ID-PRF) is used for the treatment of chronic discogenic pain.

Interdisciplinary multimodal pain therapy (IMPT) is based on the biopsychosocial model of pain and describes an integrated treatment for patients with chronic pain. IMPT incorporates a close cooperation of different disciplines, including physicians, psychotherapists, physiotherapists, and others. IMPT mainly aims to restore and increase patients' physical, social and psychological functional capacity. The efficacy of IMPT has been evidenced by systematic reviews and meta-analyses. A number of studies further indicate IMPT's cost-efficiency. Psychotherapy is an essential component of IMPT. Its main goal within the framework of IMPT is to identify and modify dysfunctional patterns of pain coping, and to diagnose and potentially treat psychological comorbidities. Pain psychotherapy comprises mostly cognitive-behavioral interventions which address dysfunctional coping at the three levels of the pain experience (i.e., cognitive, emotional, and behavioral). Research into the efficacy of pain psychotherapy is rather sparse and studies have mostly focused on chronic back pain, yet existing results show promising evidence both for psychotherapy within IMPT and for psychotherapy as a monotherapy. This paper aims at providing an overview of (a) commonly employed cognitive-behavioral psychotherapeutic approaches and strategies in the treatment of chronic pain, and (b) the existing empirical evidence of pain psychotherapy both within the framework of IMPT and as a monotherapy. Future research should include a wider range of pain diagnoses and also investigate the potential benefit of individually-tailored treatments.

Nonunion of a femoral periprosthetic fracture is a rare occurrence in orthopedic practice. Failure of a periprosthetic fracture to heal can lead to substantial disability and pain for patients as well as the potential need for component revision. Relatively little literature exists describing their management and outcome.

Carpal tunnel syndrome (CTS) and vitamin D deficiency are two conditions that cause chronic pain and are thus associated with psychological issues as well. The aim of the present study was to evaluate vitamin D levels, daily calcium intake, musculoskeletal pain and psychological symptoms in patients with CTS. The study included 48 patients with CTS and age-sex matched controls. Serum vitamin D levels were measured, and psychological symptoms were assessed using a Hospital Anxiety and Depression Scale. A Pain DETECT questionnaire was used to assess musculoskeletal pain (MSP) sites and severity. The results showed that vitamin D deficiency was considerably more prevalent in patients with CTS (95.8%) compared with controls (22.9%). Clinical anxiety (35.4 vs. 6.3%) and clinical depression (29.2 vs. 4.2%) were also more common in patients with CTS compared with controls. All the patients with CTS exhibited MSP, whereas none of the controls reported any MSP. Anxiety was significantly and inversely associated with vitamin D levels (r=-0.482; P<0.01), total daily calcium intake (r=-0.294: P<0.05), and positively associated with body mass index (BMI; r=0.200; P≤0.05) and depression (r=0.587; P<0.01). Depression was significantly and inversely associated with vitamin D levels (r=-0.269; P<0.01) and total daily calcium intake (r=-0.236; P<0.05). Logistic regression analysis showed that with every unit increase in serum vitamin D levels, the odds of CTS were decreased 1.22x. While a one-unit increase in anxiety total score was associated with a 14% increase in the odds of having CTS after adjusting for different confounders. In conclusion, vitamin D deficiency, MSP and psychological symptoms are common in patients with CTS. Serum vitamin D levels and anxiety were significant independent predictors of CTS. Based on the results of the present study, it was shown that housewives had an equivalent chance of suffering from CTS morbidity as other high-risk professions. Further studies are required to confirm if vitamin D supplementation could prevent the onset of CTS.

The use of opioid analgesics for pain management in hospitalized patients is associated with a high risk of adverse events, including respiratory depression which may lead to respiratory arrest and death. Patients who experience opioid-related adverse drug reactions (ADRs) have been shown to experience longer and more costly hospital stays and have a higher risk of requiring a readmission after discharge. In this study, we report on the impact of the introduction of Wesley Medical Center's Safe Medication Practice Protocol on opioid-related ADRs.

[This corrects the article on p. 2-24 in vol. 5.].

To study the application of ultrasound-guided indwelling epidural catheter in painless labour.

Trigeminal neuropathic pain (TNP) can present as a constant, unremitting unilateral facial pain. Current management is based on expert recommendation that includes pharmacologic agents and psychological therapy. However, treatment success with pharmacologic management is poor. We adopted a novel strategy that proved to be effective in providing durable relief.

Pain is agreed to be understood as a multi-causal, biopsychosocial phenomenon. A sufficient health care delivery shall therefore contain a corresponding interdisciplinary approach in diagnostic and therapy, respectively. Factors contributing to the process of chronification should be considered early in treating patients suffering from recurrent or persistent pain. Close collaboration of multidisciplinary protagonists in health care as well as interdisciplinary comprehensive medical treatment offer are two of the prerequisites for good practice in health care treating patients with pain.The article introduces into existing knowlegde about pain and risk factors for chronicity. The background (evidence and theoretical) of corresponding health care approaches and a detailed concept of interdisciplinary pain diagnostic by a multiprofessional team consisting of pain physician, physiotherapist and clinical psychologist are described and discussed.