Rejected

The prescription of opioids after elective surgical procedures has been a contributing factor to the current opioid epidemic in North America.

The aim of this cross sectional study was to evaluate frequency of neuropathic back pain in ankylosing spondylitis (AS) patients and to determine the relation with disease variables and occurrence of neuropathic pain.: Fifty-eight AS patients who were not having any comorbid disease and/or using drugs that would cause neuropathy, were recruited to the study. Demographic properties and clinical characteristics (functional status and disease activity assessed by BASFI and BASDAI respectively, ESR, CRP) and quality of life determined by AS quality of life-QoL questionnaire, were recorded. The neuropathic property of back pain was assessed by both Leeds Assessment of Neuropathic symptoms and signs (LANSS) and Douleur Neuropathique 4 (DN4) scales.: 58 AS patients (17 female, 41 male) with a mean age of 45 ± 18 years were included. 33 patients (56.9%) and 31 patients (53.4%) were defined as having neuropathic pain depending on the LANSS (scores >12) and DN4 (scores >4) questionnaire scores respectively. The mean score of LANSS scale was correlated with ASQoL, BASFI, BASDAI, and DN4; and the mean score of DN4 scale was correlated with ASQoL, BASFI and LANSS. The mean levels of BASFI and ASQoL scores were significantly higher in patients having neuropathic pain than in patients not having (p < 0.05).: Neuropathic pain is common and determined in more than half of the patients with AS and related with functional status and quality of life. Diagnosis and treatment of neuropathic pain are warranted in order to increase functional ability and quality of life in patients suffering from AS.

Problematic use of prescribed and over-the-counter analgesics is widespread and increasing among people with chronic pain, but the availability of preventative and treatment services is limited. We evaluated a 21-day online intervention based on compassionate mind training in a prospective, randomized-controlled trial. The participants were 73 adults with concerns about their use of analgesics for chronic pain conditions. Participants completed measures of analgesic use, misuse and dependence, plus self-criticism and self-reassurance (self-inadequacy, self-reassurance, and self-hate), cognitive impulsivity (negative urgency, lack of perseverance, lack of premeditation, sensation-seeking, and positive urgency) and behavioral impulsivity (delay discounting) at baseline, postintervention, and 1-week postintervention follow-up. Following baseline assessment, participants were randomized to compassionate mind training (CMT; = 38) or relaxation music ( = 35), both delivered online. No adverse events or safety issues were reported and high participant retention and exercise completion rates showed that the intervention was acceptable to participants. Repeated measures analysis of variance showed that by comparison with relaxation music, the CMT group had reduced prescription analgesic use, = 6.123, = .015, analgesic dependence, = 14.322, < .001, self-hate, = 12.218, < .001, negative urgency, = 7.323, = .006, and lack of perseverance, = 7.453, = .001, from baseline to postintervention, and those improvements were maintained at follow-up. The results show that exercises based on CMT principles and techniques and delivered online can reduce analgesic use, risk of analgesic dependence, and some aspects of self-criticism and impulsivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

To evaluate fenebrutinib, an oral and highly selective non-covalent inhibitor of Bruton's tyrosine kinase (BTK), in patients with active rheumatoid arthritis (RA).

Critically ill newborn infants undergo a variety of painful procedures or experience a variety of painful conditions during their early life in the neonatal unit. In the critically ill paediatric and neonatal population, clonidine is prescribed as an adjunct to opioids or benzodiazepines aiming to reduce the doses of these drugs that are required for analgesia or sedation, or to facilitate weaning from mechanical ventilation. It has been shown that clonidine premedication might have a positive effect on postoperative pain in children.

Low doses of ketamine have been shown to be safe and effective for pain relief. Adverse effects are generally mild and transient. A 69-year-old woman suffered a witnessed ground-level fall without report of head injury, loss of consciousness, or intoxication. She was in severe pain despite 10 mg of intravenous morphine and paramedics provided intravenous ketamine 16 mg (0.19 mg/kg). Upon arrival to the ED, she was alert and oriented. An X-ray demonstrated an acute comminuted nondisplaced right humeral head and neck fracture. Her pain improved after an additional 4 mg of morphine and placement of a sling. Prior to discharge, the patient developed confusion, difficulty finding words, amnesia to the event, and anterograde amnesia evidenced by repetitive questioning. A head CT and a CT angiogram of the patient's head and neck demonstrated no acute abnormalities and an EEG demonstrated no epileptiform activity. The patient was admitted for observation and her mental status gradually improved overnight. She was discharged the following morning. Low dose ketamine is an important therapeutic option. Delayed or prolonged neuropsychiatric effects may be possible following combined ketamine and opioid analgesia. Clinicians utilizing low dose ketamine should be aware of this potential complication as it could result in the need for additional diagnostic testing and prolonged length of stay.

Pain management is one of the most importantinterventions in the emergency medical services. The femoral nerve block (FNB) is,amongst other things, indicatedfor pre- and post-operative painmanagementfor patients withfemoral fractures but its role in the prehospital setting has not beendetermined.The aim of this review was to assess the effect and safety of the FNB in comparison to other formsof analgesia (or no treatment) for managingacute lower extremity painin adult patients in the prehospital setting.

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Systemic mastocytosis (SM) is a hematologic disease with a wide range of clinical courses ranging from an indolent condition with normal life expectancy to exceedingly aggressive disorder with a poor prognosis. The symptoms and signs of SM result from the release of mast cell mediators with heterogeneous functions, and/or organ damage from neoplastic mast cell infiltration, or both. Diagnostic criteria for SM are well-defined by the World Health Organization (WHO). However, the diagnosis of SM can be difficult when especially it is not in the differential diagnosis. Routinely used radiologic techniques (e.g., X-ray, ultrasound, CT scans can show findings such as lytic-, sclerotic- or mixed-bone lesions, splenomegaly, hepatomegaly, retroperitoneal or periportal mesenteric lymphadenopathy, and omental thickening). It is essential to emphasize that the constellation of these radiologic findings should strongly concern of SM, especially in patients who also have a skin rash, allergic reactions, gastrointestinal tract symptoms (lasting, intermittent nausea, diarrhea), paroxysmal tachycardias, unexplained weight loss, persistent bone pain, cytopenias, liver dysfunction, eosinophilia. These findings, even coincidentally noted, will likely lead to a tissue biopsy, which reveals diagnosis (as we discussed and illustrated some tissue biopsies here). Moreover, the role of MRI and new techniques such as [18-fluorodeoxyglucose positron emission computed tomography, fibroscan] in the diagnosis of SM have been discussed. Furthermore, we reviewed the use of radiologic methods to evaluate treatment response and prognostication of SM..