Rejected

Since early work attempting to characterize the brain's role in pain, it has been clear that pain is not generated by a specific brain region, but rather by coordinated activity across a network of brain regions, the "neuromatrix." The advent of noninvasive whole-brain neuroimaging, including functional magnetic resonance imaging, has provided insight on coordinated activity in the pain neuromatrix and how correlations in activity between regions, referred to as "functional connectivity," contribute to pain and its modulation. Initial functional connectivity investigations assumed interregion connectivity remained stable over time, and measured variability across individuals. However, new dynamic functional connectivity (dFC) methods allow researchers to measure how connectivity changes over time within individuals, permitting insights on the dynamic reorganization of the pain neuromatrix in humans. We review how dFC methods have been applied to pain, and insights afforded on how brain connectivity varies across time, either spontaneously or as a function of psychological states, cognitive demands, or the external environment. Specifically, we review psychophysiological interaction, dynamic causal modeling, state-based dynamic community structure, and sliding-window analyses and their use in human functional neuroimaging of acute pain, chronic pain, and pain modulation. We also discuss promising uses of dFC analyses for the investigation of chronic pain conditions and predicting pain treatment efficacy and the relationship between state- and trait-based pain measures. Throughout this review, we provide information regarding the advantages and shortcomings of each approach, and highlight potential future applications of these methodologies for better understanding the brain processes associated with pain.

Primary hip and knee arthroplasties are some of the most frequent surgical procedures in the Spanish Healthcare System. This study was carried out with the aim of identifying the current clinical practices held in the territory for such processes, as well as future trends.

Migraine patients can exhibit autonomic dysregulation, in turn leading to cardiac conduction and repolarization abnormalities. This systematic review and meta-analysis evaluated the electrocardiographic changes in migraineurs.

Existing studies indicate low levels of trust and shared decision making exist in the process of prescribing opioids for noncancer pain. Patient-provider communication has not been compared between patients receiving non-opioid pain medication, and those receiving opioids. This pilot study evaluated communication about pain management between patients with noncancer pain and their provider.

The management of chronic degenerative joint disorders such as osteoarthritis (OA) with ayurvedic medicines provides a safe and effective alternative. Ayurvedic medicines possess analgesic, anti-inflammatory, anti-oxidant and immunomodulator activities.

Saccadic intrusions such as opsoclonus and ocular flutter are often due to a paraneoplastic or a parainfectious condition. Toxins/drugs may rarely cause them. Herein, we report a rare case of ocular flutter/opsoclonus due to phencyclidine (PCP) toxicity. Our patient is a 21-year-old male who presented with a 3-day history of headache, generalized ill health, and aggressive behavior. He was admitted with reduced level of consciousness following generalized seizures. He had features of sympathetic overactivity with ocular flutter and opsoclonus. Urine toxicology was positive for PCP. Despite supportive care, he succumbed to complications of rhabdomyolysis. Several drugs including cocaine, phenytoin, lithium, and amitriptyline are known to cause ocular flutter/opsoclonus rarely. It is poorly described with PCP. This case highlights PCP as a rare cause of toxin-induced saccadic intrusions and attempts to postulate its pathogenesis. Moreover, our report is the first case of PCP intoxication in Sri Lanka and one of the few documented reports in the South Asian region. Therefore, it represents a significant worrisome alarm about the spread of this substance in this region.

Osteoarthritis (OA) is the most common form of arthritis, affecting 1 in 3 people over age 65 and women more so than men. The prevalence of OA is rising due, in part, to the increasing prevalence of OA risk factors, including obesity, physical inactivity, and joint injury. OA-related joint pain causes functional limitations, poor sleep, fatigue, depressed mood and loss of independence. Compared to age and sex-matched peers, OA patients incur higher out of pocket health-related expenditures and substantial costs due to lost productivity. Most people with OA (59-87%) have at least one other chronic condition, especially cardiometabolic conditions. Symptomatic OA may impair the ability of people with cardiometabolic conditions to exercise and lose weight, resulting in increased risk for poor outcomes. People with OA and other chonic conditions are less likely to receive a diagnosis or recommended treatment. Further, in these individuals the most effective and safest treatment is physical activity/exercise coupled with self-management strategies, which is only moderately effective. Given the already high, and growing, burden of OA, enhanced effort is required to identify better – more effective and safe – treatments for the majority of people with OA who are living with other chronic conditions.

Butorphanol and tramadol, the synthetic opioid analgesics, have been used alone or in combination with a local anesthetic in supraclavicular brachial plexus block.