Search Results (4,523)

Background: Sciatic nerve schwannomas are rare benign tumors that can develop along the nerve’s course, from the pelvis to the thigh. Giant schwannomas, defined as those exceeding 5 cm, are particularly rare and may alter the tumor’s anatomical relationship with the nerve, impacting surgical strategy. Methods: A PRISMA 2020-compliant systematic review was conducted using the terms (“sciatic” AND “schwannoma”) for publications from 2000 to October 2024. Of 166 identified articles, we excluded those lacking giant schwannoma cases or involving syndromic associations. We also report a novel case from our center. Results: Our patient, a 35-year-old woman, presented with tingling and discomfort while sitting, localized to the left thigh, without radicular pain or motor deficits. MRI revealed a 14 × 7 cm mass. This is, to our knowledge, the first reported case of a giant solitary sciatic schwannoma of these dimensions located exclusively in the thigh, resected via intracapsular dissection with nerve monitoring, that was fully documented and reported. The review yielded 22 relevant articles, most involving pelvic or pelvic–thigh junction locations, with low recurrence rates. Conclusions: Giant sciatic schwannomas may be asymptomatic and slow-growing. This case is notable for tumor’s location, large size, and successful nerve-sparing surgical outcome. Full article

Amphibian welfare, particularly pain assessment in anurans, remains understudied despite their ecological and biomedical significance. This study aimed to identify and validate operational pain indicators for adult anurans under professional care. A four-phase approach was used: a systematic literature review, expert validation with risk analysis, field validation in a zoological facility, and development of a preliminary pain index. From 158 publications, 16 potential indicators were identified, encompassing behavioural, clinical, and physiological signs. Expert evaluation by 28 professionals from 12 institutions refined this to seven indicators, achieving over 60% consensus: feeding behaviour changes, abnormal behaviour, impaired locomotion, oedema, reduced movement, retained skin post-moulting, and altered respiration. Field validation in 53 anurans confirmed high observability and ease of measurement, with feeding behaviour changes and oedema scoring highest for practicality (93.5% and 93.0%, respectively). These validated indicators provide a science-based foundation for routine welfare monitoring, enabling timely interventions. Their integration into husbandry protocols can enhance ethical standards, improve conservation outcomes, and increase public confidence in amphibian care, paving the way for a standardised anuran pain index. Full article

Background: Chronic pain significantly impacts quality of life and may lead to physical and psychological dysfunction. Although various tools have been developed to assess pain-related conditions, many are composed of time-consuming multi-item questionnaires, limiting practicality in clinical settings. The Multidimensional Evaluation Scale for Patient Impression of Change (MPIC) was developed as a simple, retrospective tool to assess multiple domains targeted in interdisciplinary pain management. This study evaluated the reliability and validity of the Japanese MPIC in patients with chronic non-cancer pain. Methods: We recruited 101 participants from the Interdisciplinary Pain Center at Keio University Hospital between August 2022 and September 2024. Pretreatment measures included pain intensity, disability, catastrophizing, self-efficacy, psychological distress, and sleep quality. Baseline assessments encompassed pain intensity, disability, catastrophizing, self-efficacy, psychological distress, and sleep quality. Psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS) for the initial cohort of 35 participants and the Kessler Psychological Distress Scale (K6) for the subsequent 66 participants. Following the intervention, participants completed the MPIC, in addition to reassessments of pain intensity, disability, catastrophizing, self-efficacy, psychological distress (HADS or K6), and sleep quality. Retesting the MPIC was performed in a small subgroup of 20 participants for test–retest reliability analysis. Confirmatory factor analysis (CFA), average variance extracted (AVE), Pearson’s correlations with pain-related measures, Cronbach’s alpha, and intraclass correlation coefficients (ICC) were used to assess construct validity, convergent validity, criterion validity, internal consistency, and reliability. Results: CFA indicated marginal fit (CFI = 0.86, RMSEA = 0.23, SRMR = 0.06), with factor loadings from 0.49 to 0.91. AVE supported convergent validity (0.58). Internal consistency was excellent (Cronbach’s alpha = 0.93), and ICC was moderate (0.52). MPIC domains correlated significantly with changes in pain intensity, disability, catastrophizing, self-efficacy, sleep, and psychological distress (p < 0.05), supporting criterion validity. Conclusions: The Japanese MPIC provides preliminary evidence of validity and reliability, with acceptable internal consistency, marginal structural fit, and moderate test–retest reliability. These findings suggest that the MPIC may serve as a concise retrospective instrument for assessing multidimensional treatment outcomes within interdisciplinary pain management programs for chronic non-cancer pain. Full article

Background: Chronic wrist pain is becoming increasingly recognized among athletes engaging in wrist-loading activities such as handstands. However, its prevalence and associated risk factors in handstand practitioners have not been systematically studied. This study aimed to investigate the prevalence of chronic wrist pain and to explore associated factors such as discipline, training habits, and pain management strategies. Methods: This cross-sectional study aimed to investigate the prevalence and associated factors of chronic wrist pain among handstand practitioners. Eligible participants were individuals aged 18 years or older, of any gender, who practiced handstands regularly (defined as at least once per week). Participants were recruited via a combination of open invitations on social media (Facebook, WhatsApp, Instagram) and direct outreach to movement studios and training communities. The survey was administered online using Google Forms and remained open for two months. Participation was voluntary and anonymous. Descriptive statistics were used to present sociodemographic characteristics, including age group, gender, sport discipline, and weekly training hours. Participants reported training habits, equipment use, pain history, and management strategies via a self-developed questionnaire designed for this study. Chronic pain was defined as recurring or persistent wrist pain. Descriptive statistics were used to summarize responses. Associations between chronic wrist pain and survey variables were analyzed using Chi-square or Fisher’s exact tests for nominal data, and Chi-square test for trend for ordinal data. A p-value < 0.05 was considered statistically significant. Results: A total of 321 participants were included in the study. The most represented age group was 25–34 years, comprising 123 (38.3%) of the participants. Gender distribution was 174 (54.2%) males and 147 (45.8%) females. The most common sport disciplines were Yoga (88, 27.4%), Capoeira (60, 18.7%), and Movement (52, 16.2%). Chronic wrist pain was reported by 182 (56.7%) of participants. Younger age was significantly associated with higher pain prevalence (p = 0.042). No significant associations were observed between chronic pain and weekly training hours, warm-up routines, brace use, or grip device use. Female participants demonstrated more proactive pain management behaviors (p = 0.016). Sport discipline and training practices showed non-significant trends toward pain differences. Conclusions: Chronic wrist pain is common among handstand practitioners, particularly among younger athletes. These findings suggest that injury risk may relate more to training intensity and biomechanics than to simple training volume. Further research incorporating objective diagnostics and standardized intervention protocols is warranted. Full article

Background: Pain is a prevalent and distressing symptom for children with cancer, negatively affecting quality of life and family functioning. While most research focuses on hospital-based care, many pain episodes occur at home, where parents act as primary caregivers with limited access to evidence-based symptom management. Young children are particularly vulnerable due to limited self-reporting capacity and reliance on parental assessment. We aimed to explore parent experiences and pediatric oncology clinician perceptions of young children’s cancer pain at home, its impact on families, and recommended supports. Methods: Using an interpretive descriptive qualitative design, we conducted semi-structured interviews with parents of children aged 2–11 years undergoing outpatient cancer treatment and clinicians at two hospitals in Canada and the United States. Data were analyzed using thematic analysis. Results: In total, 21 parents and 21 clinicians participated. Three themes were developed: (1) the multifaceted experience of young children’s cancer pain at home, (2) the ripple effects of a young child’s cancer pain on the family unit, and (3) assessing and treating children’s cancer pain at home. Conclusion: Managing cancer pain at home places substantial emotional and practical demands on the families of young children. Our findings highlight that structured supports providing parents and clinicians with education, effective communication pathways, and collaboration opportunities may optimize home-based pain care, reduce caregiving burden, and improve outcomes for children and their families. Full article

Background: The growing interest in the field of platelet-rich fibrins has led to the development of novel generations of these concentrates, with one of the newest additions being advanced platelet-rich fibrin plus (A-PRF+). The updated centrifuge protocol utilized for the preparation of A-PRF+ has been shown to provide blood clots with more white blood cells and growth factors trapped in the fibrin matrix, presenting a more homogenous distribution. The objective of this study was to assess the available randomized clinical trials (RCTs), in order to evaluate the effects that the addition of A-PRF+ can have on postoperative quality of life and soft tissue healing after dental surgery. Materials and Methods: To perform a systematic review based on high-quality results, only RCTs were taken into consideration. The search included articles published between 1 January 2014 and 31 December 2024, indexed in the PubMed, Cochrane, Library, Embase, Scopus, and Google Scholar databases. Nine full texts were finally acquired after the screening of articles, from which relevant data were extracted. Results: A-PRF+ positively influenced the postoperative quality of life in patients. The subjective analysis of pain and its management via painkiller intake indicated that, in general, the addition of A-PRF+ into protocols results in less pain, pain that lasts for a shorter time, and pain that is more easily managed through medication, as a lower number of pills was needed to restore comfort. Furthermore, the occurrence of facial swelling and trismus was also reported to be lower in the A-PRF+ groups. As for soft tissue healing, A-PRF+ significantly enhanced the epithelialization process, total wound area reduction, and inflammation in the surrounding tissues. This positive effect was most noticeable at 7- and 14-day follow-ups. The addition of A-PRF+ also had a positive effect on postoperative bleeding by significantly reducing the bleeding time, providing benefits for patients undergoing antiplatelet drug therapy in particular. Conclusions: The addition of A-PRF+ into the surgical protocol can positively enhance the patient’s quality of life, reduce the need for postoperative medication, and improve the patient’s confidence by reducing potential swelling and trismus. A-PRF+ also positively influences soft tissue wound healing, further enhancing the postoperative well-being of patients, and provides an excellent hemostatic effect even in patients that are on antiplatelet drug therapy. Full article

Comprising ulcerative colitis (UC) and Crohn’s disease (CD), inflammatory bowel disease (IBD) denotes a series of long-standing, relapsing inflammatory disorders of the digestive tract. There is increasing evidence in the literature indicating that IBD pathogenesis is associated with the dysfunction of ion channels, with Transient Receptor Potential (TRP) channels being of particular importance. Through this systematic review, the significance of various TRP channel types in the pathogenesis of colitis and IBD will be appraised. A comprehensive literature search was conducted in PubMed, ScienceDirect, and Google Scholar, encompassing original research articles, using the principles of the PRISMA statement (last search: 15 May 2025). The search terms used were “Transient Receptor Potential Channels”, “TRP channels”, “TRPV1”, “TRPA1”, “TRPV4”, “TRPV2”, “TRPM2”, “TRPM3”, “TRPM7”, “TRPM8”, “TRPC3”, “colitis”, “inflammatory bowel disease”, “IBD”, “ulcerative colitis”, “Crohn Disease”. A total of 48 studies met the inclusion criteria. Risk of bias was assessed using SYRCLE’s Risk of Bias tool for preclinical studies and the GRADE approach for clinical studies. According to a review of the literature, some TRP channels may exhibit contradictory effects when evaluating pain sensitivity or inflammation, while no conflicting effects have been observed for other TRP channels. Thus, TRPV1 and TRPA1 channels demonstrated opposing effects on pain sensitivity, but TRPV4, TRPM2, TRPM3, and TRPM8 were exclusively linked to elevated pain. Only anti-inflammatory activity was shown for TRPV3, TRPC1, and TRPC6 channels. In contrast, TRPV6, TRPM2, and TRPM3 channels were exclusively associated with a pro-inflammatory role. Concurrently, both pro- and anti-inflammatory effects were manifested for TRPA1, TRPV1, TRPV4, and TRPV5. The literature suggests that these TRP channels exert significant and diverse effects on the pathophysiology of colitis and IBD. Understanding the specific contributions of each TRP channel may pave the way for the development of targeted therapeutic interventions aimed at controlling inflammation and alleviating the symptoms of IBD. This systematic review was funded by the Russian Science Foundation (grant #24-25-00267). Full article

Major Depressive Disorder (MDD) represents a global challenge due to its high prevalence worldwide. Inflammation is the most extensively studied and plausible biological pathway involved in the onset of MDD. Individuals with MDD often exhibit low-grade inflammation, characterized by immune system dysregulation and activation of pro-inflammatory pathways. Elevated inflammation is also associated with a reduced response to antidepressant therapies, suggesting that targeting inflammation could represent a promising therapeutic approach for MDD. MDD frequently co-occurs with other pathological conditions, including cardiometabolic, autoimmune, and chronic pain disorders. These comorbidities further complicate MDD treatment and contribute to reduced antidepressant efficacy. Like MDD, these disorders are characterized by a strong inflammatory component, and several cytokines and pro-inflammatory mechanisms altered in MDD are also found in these comorbid conditions. This narrative review explores inflammation as a shared biological mechanism in MDD and its most frequent comorbidities, to provide a comprehensive understanding of the interplay between inflammation and these comorbid conditions. Persistent low-grade inflammation may help explain the high rate of bidirectional co-occurrence between MDD and its comorbidities. Moreover, it may represent a target for better understanding the molecular mechanisms driving this co-occurrence, potentially contributing to the development of tailored treatment and improving antidepressants response rates. Full article

Background/Objectives: Cervical spine disease requiring surgical intervention is a major cause of disability. Anterior cervical discectomy and fusion (ACDF) is a well-established procedure for treating cervical pathology; however, there remains no consensus on whether 1-level versus 2-level ACDF yields comparable outcomes. This study compares 1-level versus 2-level ACDF by evaluating surgery-related and postoperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs). Methods: PubMed, Embase, Scopus, and Cochrane Library were searched through 10 July 2024. Studies comparing 1-level with 2-level ACDF were included. Data on operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), complications, and PROMs, including Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, were extracted. Results: Thirteen studies met our inclusion criteria, comprising 2091 patients (1078 undergoing 1-level and 1013 2-level ACDF). No statistically significant differences were observed in EBL or LOS between the cohorts. However, the 2-level ACDF group showed significantly longer OR times (p-value < 0.001) and higher odds of developing dysphagia (p-value = 0.05). Patients undergoing 2-level ACDF showed greater correction in cervical lordosis. Both cohorts reported similar statistically and clinically significant improvements in VAS neck and NDI scores at final follow-up. There was no difference in adjacent segment disease or revision surgery at final follow-up. Conclusions: Both 1-level and 2-level ACDF improve clinical and radiographic outcomes. The choice should be tailored to the patient’s pathology and anatomy while considering the higher dysphagia risk with additional fusion levels. This study highlights the importance of individualized surgical planning to optimize postoperative outcomes while minimizing complications. Full article

Pain assessment in cats is challenging, especially for non-veterinarians. Most validated acute pain scales are designed for clinical use, limiting their applicability for pet owners. This study developed a feline acute pain assessment scale for owners and evaluated its criterion validity, internal consistency reliability, and agreement with three veterinary scales: Glasgow Composite Measure Pain Scale-Feline (CMPS-Feline), Feline Grimace Scale (FGS), and Colorado State University Feline Acute Pain Scale (CSU-FPS). Of 146 enrolled cats, 130 were analyzed after exclusions. The owner-assessed scale showed strong correlation with CMPS-Feline (rho = 0.66) and moderate correlations with FGS (rho = 0.53) and CSU-FPS (rho = 0.57) (all p < 0.001). Agreement was substantial with CMPS-Feline (kappa = 0.74), moderate with FGS (kappa = 0.44), and fair with CSU-FPS (kappa = 0.28) (all p < 0.001). Internal consistency was acceptable (Cronbach’s alpha = 0.76). Receiver operating characteristic analysis demonstrated good discriminatory ability for identifying cats requiring analgesia, with area under the curve values of 0.87 (CMPS-Feline), 0.79 (FGS), and 0.75 (CSU-FPS). A cut-off score of 9 achieved 96% sensitivity and 78% specificity relative to CMPS-Feline. These results support the scale’s potential as a valid tool for pain detection by cat owners in non-clinical settings. Full article

Losing a loved one is a painful process that usually diminishes over time. Despite that, one out of ten bereaved adults are at risk of developing Prolonged Grief Disorder (PGD) Internet-delivered cognitive-behavioral therapies (iCBTs) can reach individuals in need of therapy and are both cost-effective and clinically effective. This study aimed to investigate the feasibility of an iCBT for Spanish-speaking individuals with PGD (GROw) compared to the same intervention delivered in a face-to-face videoconferencing format. As a secondary objective, the potential efficacy of GROw was explored. A total of 31 participants were randomized to the experimental group (N = 16) (GROw) and the active control group (N = 15) (videoconferencing treatment). There were four assessment points: baseline, after intervention, and 3- and 12-month follow-ups. Both GROw and videoconferencing treatments were well accepted in terms of preferences, expectations, satisfaction and evaluation about the usefulness of the intervention, and showed significant symptomatology reduction with large effect sizes in most of the outcomes. The dropout rate was 50% in the GROw and 33.33% in the videoconferencing group. GROw is a feasible, well-accepted iCBT for the treatment of PGD with promising results related to its potential efficacy. Full article

Background/Objectives: Gender (roles as household load and job strain, and identity) represent an effect modifier of the interference between pain experience and sex because it is different between men and women. This study validates a new scale developed to assess how life functioning is impacted by Chronic Non-Cancer Pain (CNCP) due to gender. Methods: A total of 193 Spanish ambulatory CNCP patients (60 [51–73] years old, 69.4% women, 31% retired) were interviewed. Exploratory Factor Analysis (EFA) yielded 3-factor structure: Gender Self-identity, Roles, and Chronic Pain Impact on Social, Familial, Work and Sexual Life. Results: The Gender-Pain Questionnaire, with the presented factor structure, is an evaluation instrument with enough reliability and internal validity for CNCP patients. Conclusions: This study presents the psychometric properties of a scale for assessing the interference of CNCP patients’ experience on gender and how it affects their daily life activities, relationships and self-identity. It represents the first original questionnaire known in Spanish language to date. This measure could potentially help researchers and clinicians to obtain gender key information to design appropriate and equity healthcare interventions. Full article

Total knee arthroplasty (TKA) is a commonly conducted surgery to relieve pain and enhance mobility in patients with end-stage knee osteoarthritis. Patient-reported outcome measures are often used whereas biomechanical variables are too complicated for clinicians and patients to assess functional improvement. There is a need for a simplified integrated knee biomechanics index (KBI) to compare improvements in TKA patients across various daily activities and examine the relationships between clinical functional tests and daily activities. Age-, gender-, and BMI-matched three groups (20 each in posterior stabilized TKA, bi-cruciate stabilized TKA, and healthy controls) were recruited and tested pre-op and 6-month post-op to perform walking on level, slope, and stairs, and two clinical tests (timed-up-go, 10-time sit-to-stand). Knee joint kinematics and kinetics variables were calculated from motion data and ground reactions captured at 120 Hz and 1200 Hz, respectively. KBI was developed based on these variables relative to healthy controls. The longitude comparison of KBI and the differences of KBI across various daily activities were identified using repeated-measure ANOVA. Pearson correlation analysis was used to compare clinical tests and KBI of daily activities. KBIs of five daily activities were significantly increased following TKA follow-up. KBI improvement during level walking was significantly higher than those during stair ascending and descending. Significant correlations were found between timed-up-go test time and KBIs for stair ascending and descending. Full article

Background and Objectives: Cancer pain continues to be a major clinical problem nowadays. This study aims to evaluate the World Health Organization (WHO) analgesic ladder effectiveness in patients with colorectal cancer and develop machine learning models to predict treatment response for precision pain management. Materials and Methods: In a retrospective observational study, a total of 107 oncological patients were analyzed, with a detailed subgroup analysis of 42 patients with colorectal cancer, hospitalized between July and September in 2022. The pain assessment used numerical rating scales at baseline and 2–3 weeks follow-up. Clinical variables included demographics, disease staging, metastatic patterns, analgesic progression, and medication usage. Machine learning algorithms (e.g., Random Forest, CatBoost, XGBoost, and Neural Network) were used to predict pain reduction outcomes. The UMAP dimensionality reduction and clustering identified the patient phenotypes. Results: Statistical analyses included descriptive methods, Chi-square and Mann–Whitney tests, and the models’ performance was evaluated by AUC. Among patients with colorectal cancer, 73.8% achieved clinically pain improvement, with a mean reduction of 2.62 points and median improvement of 3.00 points. The metastatic site significantly affected outcomes: visceral metastases patients showed median improvement of 3.00 points with high variability, patients with bone metastases demonstrated heterogeneous responses (range: −2.00 to +8.00 points), while non-metastatic patients exhibited consistent improvement. Random Forest achieved optimal predictive performance (AUC: 0.9167), identifying the baseline pain score, bone metastases, Fentanyl usage, anticonvulsants, and antispasmodics as key predictive features. The clustering analysis revealed two distinct phenotypes, requiring different analgesic intensities. Conclusions: This study validates the WHO analgesic ladder effectiveness while demonstrating superior outcomes in patients with colorectal cancer. The machine learning models successfully predict the treatment response with excellent discriminative ability, supporting precision medicine implementation in cancer pain management. Full article

A 56-year-old man, accompanied by city hall staff, visited our neurorehabilitation clinic. Despite hyperuricemia being diagnosed several years ago, he refused treatment. He had no history of hypertension and antihypertensive drug use. He developed painful joint tophi around the age of 51, which were managed with over-the-counter painkillers. At age 54, a knee tophus was removed, histologically confirming gouty tophi. Subsequently, he lost his chef’s job, and his lifestyle deteriorated. Gouty tophi were observed in the right ear, knuckles, elbows, and ankles, with some ulceration. Blood tests showed anemia and hyperuricemia (10.1 mg/dL: reference 3.6–7.0 mg/dL). Chest–abdominal CT demonstrated calcification of the aorta. Brain MRI revealed an old putaminal hemorrhage and numerous microbleeds. Dementia (Clinical Dementia Rating: 1) was diagnosed based on neuropsychological testing. Public services and social assistance were arranged for him. This case is hypothesis-generating. In settings with adequate healthcare access, the presentation of severe, uncontrolled gouty tophi with poor engagement should prompt a selective, stepwise evaluation—beginning with cognitive screening and proceeding to neurologic assessment if indicated; routine preventive brain imaging is not recommended. The presence of lobar and deep microbleeds should be interpreted within the context of standardized diagnostic criteria and lesion distribution patterns to inform differential diagnosis. Full article