PATHOPHYSIOLOGY OF PAIN AND USE OF OPIOIDS IN CATTLE

Pain control is an area that is currently gaining great importance, mainly for beef production. Determining the origin and causes of the painful process is a task that demands great attention from professionals, especially so that they can intervene in the best possible way. In addition to seeking to remove the factors that prompted them, they act in the prevention and treatment of the pain mechanism with the use of various drugs available on the market. The use of opioids has been the subject of studies as a pharmacological strategy for the control and management of animal suffering, a fact that induces serious losses and losses for bovine production, at the productive, reproductive and economic level. However, more and more studies are needed regarding the benefits they can provide to cattle, since there are some limitations such as cost and adverse effects.

Slipping rib syndrome: A clinical and dynamic-sonographic entity: A serial cases report

BACKGROUND: Slipping rib syndrome (SRS) consists of false or floating rib hypermobility, which can force the ribs to come into contact with each other. OBJECTIVE: We aimed to examine each case by dynamic ultrasound to determine their ultrasound characteristics and analyze the clinical features of patients with SRS in order to better manage and follow them up. METHODS: Retrospectively, we collected 14 case series presenting to SRS between June 2016 and September 2018. The diagnosis was clinical and confirmed by dynamic ultrasound maneuvers. RESULTS: The mean age was 35.00 ± 10.66 years and 64.29% was male. The pain mechanism was caused by repetitive movements or a traumatic event. Dynamic ultrasound was considered a very useful tool for the diagnosis. Different conservative treatments were applied in most cases. Eco-guided infiltration was also an option. CONCLUSIONS: SRS should initially be based on a clinic suspicion in order to achieve a correct diagnosis and management. It is an underdiagnosed syndrome, so these case series contribute to our knowledge regarding this syndrome.

Pain in chronic prostatitis and the role of ion channels: a brief overview

Background: Prostatitis is the third most common urologic condition affecting more than half the male population at some point in their lives. There are different categories of prostatitis, of which approximately 90% of cases can be classified under the National Institute of Health (NIH) type III category (chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)) with no causative agents identified. CP/CPPS is associated with several symptoms, of which the most prominent being chronic pain. Despite its high incidence, pain management in patients with CP/CPPS has been poor, possibly due to the lack of understanding of aetiological factors and mechanisms underlying pain development. Methods: An extensive literature search of published articles on the molecular mechanisms of pain in CP/CPPS was conducted using PubMed and Google Scholar search engines ( https://pubmed.ncbi.nlm.nih.gov and https://scholar.google.com ). The terms used for the search were: prostatitis, pain mechanism in CP/CPPS, prostatitis pain models, acid-sensing ion channels (ASICs), transient receptor potential vanilloid type 1 (TRPVs), purinergic channels (P2X) in prostatitis pain mechanism and inflammatory mediators in CP/CPPS. The papers were identified based on the title and abstract, and after excluding the articles that did not emphasize the pain mechanism in CP/CPPS. Ninety-five articles (36 review and 59 original research papers) met our criteria and were included in the review. Results: A number of inflammatory mediator molecules and pain channels, including ASICs, transient receptor potential vanilloid channels (TRPVs) and P2Xs have been investigated for their role in prostatitis pain pathology using various animal models. Conclusion: This review summarizes the pain mechanisms in CP/CPPS focusing on the inflammatory mediators, neurotransmitters, pain-transducing ion channels and small animal models developed for studying prostatitis.

The role of TRPM8 in the pathophysiology of migraine

The Transient Receptor Potential Melastatin 8 (TRPM8) is a member of the mammal TRPM subfamily. TRPM8 is involved in menthol-induced cold allodynia, a condition that activates the left lateral thalamus and the primary and secondary somatosensory cortices, which are related to pain processing. Cold is a well-known trigger of migraine. Thirty-nine articles were identified, 27 of which were selected for review after reading the abstracts. Fourteen papers were further excluded. TRPM8 seems to be involved in the pain mechanism of migraine and therefore should be considered as a target for the development of therapies against this type of primary headache.

THU0572 THE ROLE OF PRESSURE PAIN THRESHOLD IN A REHABILITATIVE APPROACH TO ANALYZE PAIN PROCESSING MECHANISM IN HAND OSTEOARTHRITIS PATIENTS: A PILOT STUDY.

Background:The hand pain experienced by patients with hand osteoarthritis (OA) is often accompanied by hypersensitivity and sings of peripheral and central sensitization1. The European League Against Rheumatism (EULAR) published a systematic literature review that summarized the current non-pharmacological, pharmacological and surgical approaches for the management of hand OA2. The identified review did not consider interventions that specifically targeted reducing pain sensitivity. A reliable method to assess the presence of hypersensitivity is the pressure pain threshold (PPT)3. During the rehabilitation management considering the pain mechanism involved could be an important factor to address more effective treatments4.Objectives:The aim of the present study was to investigate the role of pain processing mechanism in patients with hand OA through PPT and using a specific functional Magnetic Resonance Imaging (fMRI).Methods:20 patients with hand OA and 20 healthy controls, aged 50 to 90 years, were recruited. Pressure pain threshold (PPT) was assessed bilaterally over the hand, on the C5-C6 zigoapophyseal joint, median, ulnar, radial nerves, and anterior tibial muscle by a blinded assessor respect to the condition of the subjects3. In five participants for each group, PPT over the hand was assessed neurophysiologically by advanced modalities including functional MRI to analyze the pain mechanisms related to hand OA5.Results:The results showed that PPTs were significantly lower over the hand and the median, ulnar, radial nerves (P<0.05), but not over the C5-C6 zigoapophyseal joint and anterior tibial (P>0.05) in OA patients as compared to healthy controls. Both groups demonstrated activation of the thalamus, frontal and somatosensory cortex area during PPT over the hand, although the total brain area activated in OA patients was greater than in control participants.Conclusion:Patients with hand OA shown features of altered pain mechanism that were evident both in PPTs measures than using functional MRI. PPT is a useful marker in detecting pain sensitivity in hand OA and could be used in future pain studies to evaluate pain modulation strategies.References:[1]Villafañe JH, Valdes K, Pedersini P, Berjano P. Osteoarthritis: a call for research on central pain mechanism and personalized prevention strategies.Clin Rheumatol. August 2018.[2]Kroon FPB, Carmona L, Schoones JW, Kloppenburg M. Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis.RMD Open. 2018;4(2):e000734.[3]Pedersini P, Negrini S, Cantero-Tellez R, Bishop MD, Villafañe JH. Pressure algometry and palpation of the upper limb peripheral nervous system in subjects with hand osteoarthritis are repeatable and suggest central changes.J Hand Ther. January 2019.[4]O’Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis.Pain. 2018;159(9):1877-1886.[5]Sofat N, Smee C, Hermansson M, et al. Functional MRI demonstrates pain perception in hand osteoarthritis has features of central pain processing.J Biomed Graph Comput. 2013;3(4).Disclosure of Interests:None declared

Pain in child patients: A review on managements

Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.

Pain in child patients: A review on managements

Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.

Neuropathic Pain: Mechanism-Based Therapeutics

Neuropathic pain (NeP) can result from sources as varied as nerve compression, channelopathies, autoimmune disease, and incision. By identifying the neurobiological changes that underlie the pain state, it will be clinically possible to exploit mechanism-based therapeutics for maximum analgesic effect as diagnostic accuracy is optimized. Obtaining sufficient knowledge regarding the neuroadaptive alterations that occur in a particular NeP state will result in improved patient analgesia and a mechanism-based, as opposed to a disease-based, therapeutic approach to facilitate target identification. This will rely on comprehensive disease pathology insight; our knowledge is vastly improving due to continued forward and back translational preclinical and clinical research efforts. Here we discuss the clinical aspects of neuropathy and currently used drugs whose mechanisms of action are outlined alongside their clinical use. Finally, we consider sensory phenotypes, patient clusters, and predicting the efficacy of an analgesic for neuropathy.