Senso-Immunologic Prospects for Complex Regional Pain Syndrome Treatment

Complex regional pain syndrome (CRPS) is a chronic pain syndrome that occurs in tissue injuries as the result of surgery, trauma, or ischemia. The clinical features of this severely painful condition include redness and swelling of the affected skin. Intriguingly, it was recently suggested that transient receptor potential ankyrin 1 (TRPA1) is involved in chronic post-ischemia pain, a CRPS model. TRPA1 is a non-selective cation channel expressed in calcitonin gene-related peptide (CGRP)-positive primary nociceptors that becomes highly activated in ischemic conditions, leading to the generation of pain. In this review, we summarize the history of TRPA1 and its involvement in pain sensation, inflammation, and CRPS. Furthermore, bone atrophy is also thought to be a characteristic clinical sign of CRPS. The altered bone microstructure of CRPS patients is thought to be caused by aggravated bone resorption via enhanced osteoclast differentiation and activation. Although TRPA1 could be a target for pain treatment in CRPS patients, we also discuss the paradoxical situation in this review. Nociceptor activation decreases the risk of bone destruction via CGRP secretion from free nerve endings. Thus, TRPA1 inhibition could cause severe bone atrophy. However, the suitable therapeutic strategy is controversial because the pathologic mechanisms of bone atrophy in CRPS are unclear. Therefore, we propose focusing on the remission of abnormal bone turnover observed in CRPS using a recently developed concept: senso-immunology.

Costs and consumption of analgesics, with special reference to opiates in Serbia and Montenegro from 2015 to 2019

Background/Aim: Patients in developing countries do not always receive adequate painrelieving treatment. Monitoring of analgesic consumption is of great importance, since this can help assessing the quality of painful condition management. The aim of this paper is to present a five-year consumption and costs of drugs with analgesic effects in developing countries, exemplified by Serbia and Montenegro, and indicate the main reasons for their (in)adequate prescribing. Methods: The observational, retrospective, cross-sectional study was conducted in order to analyse consumption of all analgesics, both opioid and non-opioid, in Serbia and Montenegro, as developing countries. The data concerning analgesic consumption and drug prices were obtained from annual editions of the publications of the Medicines and Medical Devices Agency of Serbia and Montenegro. The WHO methodology with defined daily dose (DDD) as a unit of measure (it is defined by the number of DDD per 1000 inhabitants per day) was used in these publications. Results: In the course of the fiveyear period (from 2015 to 2019) in Serbia, the total allocations for analgesic therapy had a rising trend; from about 43.6 million to 63.3 million of Euros, while in Montenegro expenditures showed annual variations with highest value in 2018. Most of the money in both countries was invested in M01A group of drugs, for which the highest consumption was also recorded. Significantly higher consumption of opioid analgesics in Montenegro comparing with Serbia was observed in the same period, and it predominatly reflected the difference in fentanyl (N02AB03, transdermal patch) prescribing. In Montenegro, consumption of M01group of drugs was prominently higher in comparison to M01AE group during the whole five-year period, similarly like in Serbia in which this was not the case only in 2018. Conclusions: Taking into account the importance of analgesics for everyday medical practice, more rational prescribing of these drugs is necessary both in Serbia and Montenegro in the future.

The Evolution of Peripheral Nerve Treatment for Trigeminal Neuralgia - Peripheral Injections

Trigeminal neuralgia presents as a characteristic severe painful condition that usually afflicts the area(s) innervated by the branches of the facial sensory nerves, especially the elderly females. The diagnosis can usually be made based solely on the presenting clinical signs and symptoms. Early literatures had revealed that there have always been two major means of treatment for trigeminal neuralgia; medical and surgical. Medical treatments involved systemic intake of various drugs or the topical applications of many different materials, not forgetting that bleeding and purging has been tried in the past. The introduction of anti-convulsants during the second World War had changed completely the way this painful condition was treated as this therapy later become the mainstay treatment for trigeminal neuralgia. Their beneficial effects, however may not be long lasting. This review summarises the evolution of peripheral nerve injection as a treatment for trigeminal neuralgia over the last 150 years.

Clinical Audit of Two Standard Surgical Site Treatments Following Dental Extractions and The Impact on Incidence of Alveolar Osteitis Within a Specialist Dental Clinic

Background Alveolar osteitis is a painful condition following dental extraction associated with absence of blood clot and consequent exposure of underlying alveolar bone. It is a condition whose exact aetiology is unresolved and a known complication in up to 30-40% of dental extractions. The following report details a retrospective evaluation of two approved, long-standing wound care treatments used, post-extraction, within our clinic to assess for relationship with alveolar osteitis incidence. Methods Patients undergoing non-acute dental extraction at a dental out-patient clinic in the UK had received two different standard treatments for a period from 2000 to 2014. The treatments were mouth rinse with physiologic saline or surgical site irrigation and mouth rinse with physiologic saline-low dose aqueous chlorine used in wound and burn-site care. Retrospective, post-operative outcome analysis suggested improved outcomes with one of the standard treatments versus the other. A full retrospective audit of consecutive treatment outcomes was implemented to test the hypothesis. The audit data-collection was blinded to the treatment administered and to the identity of the treating clinician. Statistical analysis was carried out independently and blinded to the treatment modality. Results All patients were routinely reviewed within seven days and a determination of un-complicated healing vs alveolar osteitis (requiring further intervention) was made. Our results show that treatment with of aqueous chlorine in physiological saline significantly reduced the incidence of alveolar osteitis versus the control group who received physiologic saline without socket irrigation and chlorhexidine oral rinse home-care. (Odds Ratio 0.0146 Relative Risk 0.029 (95%CI 0.0093 to 0.0928) significance (p<0.001). Conclusions This is the first report to show an extremely significant reduction in the incidence of alveolar osteitis following treatment with low dose aqueous chlorine in physiological saline compared with those receiving the physiologic saline and saline mouth rinse or Corsodyl mouth rinse. This shows an approach to surgical site care is superior to the most common, reported, standard of care treatment. The impact of this has led to improved antibiotic stewardship within the clinic for dental extraction or elective oral surgery, including third molars.

EFFICACY OF AABHADI CHURNA ALONG WITH PATHYA AAHARA AND VIHARA IN GRIDHRASI W.S.R. TO SCIATICA - A RESEARCH ARTICLE

Nowadays due to changing lifestyle, lack of physical activity and long sitting postures lead to a disease called Gridhrasi. Symptoms of Gridhrasi closely resemble the clinical features of Sciatica. Sciatica is a severely painful condition where the sciatic nerve of one or both legs is involved. This study was undertaken to evaluate the clinical efficacy of Aabhadi Churna along with Pathya Aahara and Vihara in Gridhrasi with special reference to Sciatica. The study was conducted on 60 patients who fulfilled the diagnostic and inclusive criteria of sciatica. The clinical assessment was based on subjective parameters (Ruka, Stambha, Toda, Spandana) and objective parameters (Straight leg raising test, standing time and walking time). The subjective and objective parameters before and after treatment were analyzed by using the student "t" test. The t-test results were highly significant for both the groups when the therapy effect was compared before and after the treatment. The inter-group comparison showed that the Group-B treatment method where 84% of patients showed moderate to maximum improvement method was better when compared to Group-A where this percentage was 67% only. Keywords: Gridhrasi, Sciatica, Pathya Aahara, Vihara, Aabhadi Churna.

GAMBARAN KEJADIAN DISMENORE PADA REMAJA PUTRI DI FAKULTAS ILMU KESEHATAN UNIVERSITAS PASIR PENGARAIAN

Dysmenorrhea is a painful condition that occurs during menstruation that can interfere with activities, causing pain in the lower abdomen, which spreads to the lower back and legs. The incidence of dysmenorrhea is experienced by young women around the world on average. The cause of pain is due to an imbalance of the hormone progesterone in the blood. Several factors triggering the occurrence of dysmenorrhea include the first menstruation at an early age, endocrine factors, psychological disorders, allergic, long menstrual periods, heavy menstrual blood flow, smoking, a history of obesity and alcohol consumption. Efforts to overcome dysmenorrhea can be done by non-pharmacological and pharmacological methods. This study aims to describe the incidence of dysmenorrhea in adolescent girls. This study used a descriptive survey method with a questionnaire that was distributed via google form to 73 students of the Faculty of Health Sciences, Pasir Pengaraian University. The results showed that the average menarche at the age of 13-16 years was 39 people (53.43%), the most experienced dysmenorrhea was 52 people (71.23%), the efforts made to reduce dysmenorrhea with rest were 35 people. (47.95 %) and 38 people (52.05%) who tried to reduce the feeling of dysmenorrhea, respondents used drugs to reduce dysmenorrhea, namely 26 respondents (35.62%). The conclusion of this study is that the average age of menarche for adolescent girl is 13-16 years, the majority experience dysmenorrhea, most of the adolescent girl make efforts to reduce dysmenorrhea pain with non-pharmacological and pharmacological methods.

A Comparative Study of Patients with Periarthritis Shoulder on Treatment with Analgesics Only and Analgesics Plus Exercises

Background: Frozen Shoulder is known to be a painful condition affecting the shoulder joint that results in significant loss of range of motion. A number of published comprehensive studies have suggested the different modalities of treatment. In this study, we focussed on the effect of exercise on enhancing the restricted motion and reducing the severity of pain. Objective: The objective is to study the influence of exercise on range of motion and pain severity in Frozen shoulder patients. Materials and Methods: Thirty patients diagnosed with Periarthritis Shoulder were selected from orthopaedic outpatient in Saveetha Medical College, Chennai. These patients were randomly divided in two groups, receiving analgesics as well as exercises and another receiving only analgesic. They were assessed using the Visual Analogue Scale for the severity of their pain and range of motion with a Goniometer and results noted. Results: The group receiving exercise in addition to analgesics showed greater reduction in pain severity and range of motion. Conclusion: Physical exercise of the Shoulder joint helps in restoring the mobility and relieves stiffening of the muscles and hence should be added as the mainstay of treatment with pain relief.

Oral Mucositis in Cancer and Potential Use of Omega-3 Free Fatty Acids in Its Management: A Review

Oral mucositis (OM) is a painful condition caused by chemotherapeutic or radiotherapeutic cancer treatments, occurring in patients with different tumour characteristics and locations. OM greatly impacts a patient’s quality of life and cancer recovery. Current OM management strategies are not providing sufficient prevention and treatment; new approaches to injury management are needed. Studies on the benefit of omega-3 free fatty acids (FFA) in human health have increased significantly in recent years. FFA properties have been studied extensively, including their potential therapeutic use in inflammatory conditions. However, omega-3 FFA’s use as a supplementary treatment for OM has not been clinically tested. Preliminary evidence suggests that utilising FFA to manage OM could be a useful strategy for lesion management, assisting with healthy oral mucosa recovery. This review will describe the incidence, risk factors, biology of OM and the current treatment strategies, leading to a discussion of the utility of omega-3 FFA as a novel therapeutic agent for OM.

NIRAGNI UPANAHA IN THE MANAGEMENT OF VATAKANTAKA: A CASE STUDY

Vatakantaka is one among the Aseethi Vata vikaras explained as a painful condition of the heel caused by its improper placement of the foot on the ground. Vatakantaka is seen as a common disease condition during these days and affects approximately 10% of the population. It is a condition that hinders day to day activities of the patient due to thorny pain in the foot. A diagnosed case of Vatakantaka came with complaints of pain within the heel and sides of the heel of the right foot for 5 months. There was no history of falls or trauma and other systemic illness. Positive family history was noted. Vatakantaka is a Sweda Sadhya Vyadhi and Upanaha is one among the classical line of treatment mentioned by Acharya Susrutha when Vata is vitiated in Snayu Sandi and Asthi. Vata getting localized in the Gulpha (ankle joint) and produces pain in the heel region. So Niragni Upanaha with Godhumadi yoga is administered continuous 7 days. Duration is 12 hours. The clinical features like heel pain and stiffness got relieved markedly on the 4th day itself. After the treatment, the patient got significant relief from symptoms. Upanaha is a type of Ekanga Sweda, and it induces sweating and brings Doshavilayana. It helps in reducing Vata dosha, Shoola, and Stambha

Evaluation of serum neuron specific enolase levels among patients with primary and secondary burning mouth syndrome

Introduction Burning mouth syndrome is a painful condition of the oral cavity with ambiguous pathogenesis and diagnosis. Neuron-specific enolase is increased in several conditions including peripheral neuropathy of diabetes, ophthalmopathies, spinal cord injuries and tumors. Evidence on association of burning mouth syndrome and neuron-specific enolase is limited. Aim This study aims to evaluate neuron-specific enolase levels in primary and secondary burning mouth syndrome patients and compare the levels of neuron-specific enolase with associated conditions in secondary burning mouth syndrome. Methods One hundred and twenty-eight patients of more than 18 years of age with no gender predilection and having clinical symptoms of burning mouth syndrome and 135 healthy subjects were included. All the patients fulfilled Scala’s criteria for the diagnosis of burning mouth syndrome, including “primary” (idiopathic) and “secondary” (resulting from identified precipitating factors) burning mouth syndrome patients. Blood samples were obtained from burning mouth syndrome patients. Serum neuron-specific enolase was evaluated using enzyme-linked immunosorbent assay. To compare means and standard deviations, among primary and secondary burning mouth syndrome, data was analysed with analysis of variance and multiple comparisons test. Results The mean age of the study participants for burning mouth syndrome and healthy subjects was 53.30 and 51.6 years, respectively. Amongst the secondary burning mouth syndrome group, 32 (25%) of the patients had menopause, 15 (11.7%) had diabetes, eight (6.2%) of the patients had nutritional deficiency, seven (5.4%) had combined diabetes, menopause, and depression, six (4.6%) had combined diabetes and depression, four (3.1%) were diagnosed with Sjögren’s syndrome. A minor percentage of 2.3% (three) had gastroesophageal reflux disease, while the remaining three (2.3%) patients in the secondary burning mouth syndrome group were on anti-depressants. There was a statistically significant increase in the levels of neuron-specific enolase in primary burning mouth syndrome as compared to the secondary burning mouth syndrome and healthy groups. Among the subgroups of secondary burning mouth syndrome, diabetic individuals showed a significant increase in neuron-specific enolase level when compared with other conditions in the secondary burning mouth syndrome patients. Discussion and conclusion: The raised serum neuron-specific enolase levels in patients suffering from primary burning mouth syndrome highlight a possible neuropathic mechanism. It was also increased in the sub-group of secondary burning mouth syndrome patients having diabetes. Although it cannot be ascertained whether the deranged values in the diabetic group were due to burning mouth syndrome or due to diabetes, the raised quantity of neuron-specific enolase in the primary burning mouth syndrome group is a reliable diagnostic indicator. Future studies on the assessment of neuron-specific enolase levels as a diagnostic tool for onset and management of primary and secondary burning mouth syndrome are recommended.