Both acute and chronic pain caused by sickle cell disease (SCD) is often managed with opioid therapy despite limited evidence for long-term efficacy. Adequately managing SCD pain requires a comprehensive approach, incorporating both pharmacologic and non-pharmacologic interventions. In other conditions, peer-mentored group programs are effective in managing chronic pain; however, their role in SCD is not yet described. Our objective is to understand patients' current pharmacologic and non-pharmacologic SCD management practices as well as further exploring perspectives of pain related to SCD. Participants were interviewed using semi-structured format. Audio-recorded interviews were transcribed. Descriptive statistics and pain management modality frequencies were analyzed with Microsoft Excel. Qualitative analyses, utilizing NVIVO, identified themes through thematic analysis. Thirty-four interviews were conducted. One interview was excluded due to incomplete audio-recording. Participants described a range of coping skills including both pharmacological and non-pharmacologic pain management techniques. 81.8% (23/28) identified a relationship between stress and pain. Most patients were interested in a group intervention for pain related to SCD; 60.9% (17/28) preferred peer moderators to co-lead the intervention with medical professionals. 85.7% (24/28) preferred a fully in-person or a hybrid intervention. Pain descriptions included severe bone pain, sharp and shooting pain, and throbbing and aching body wide pain. Patients with SCD already use many non-pharmacologic methods for pain relief and endorse a desire to learn about and engage in additional techniques. There is considerable interest among patients in participating in group interventions for chronic pain related to SCD, especially if they are facilitated by peers. Future research should focus on the efficacy and benefit of various non-pharmacologic techniques for pain management in SCD.
Pain is common in emergency medical services, and abdominal pain is among the most frequent complaints. This study examined whether documented pain assessment, analgesic treatment, reassessment, and documented end-of-encounter pain status in patients with acute abdominal pain differed by clinician competence (Prehospital Emergency Nurse [PEN] vs. non-PEN), patient sex, age, and prehospital interval. This retrospective observational study was a secondary analysis of adult patients with acute abdominal pain in a previously described cohort. Electronic patient records were reviewed in full, including Numerical Rating Scale (NRS) scores and free-text pain descriptions. Primary outcomes were documented pain assessment, analgesia administration, and any documented reassessment. Secondary outcomes were documented NRS use, analgesia among patients with moderate-severe pain, reassessment after analgesia, and mild pain at the last documented assessment. Age and prehospital interval were dichotomized at the median. Mann-Whitney U and Fisher's exact tests were used, with p < 0.01 considered statistically significant. Of 840 sampled records, 816 were included. Median age was 64 years (IQR 41-79), and median prehospital interval was 38 minutes (IQR 27-60). Compared with non-PEN encounters, PEN encounters had higher rates of pain assessment (67% vs. 53%, p = 0.003), analgesia administration (50% vs. 37%, p = 0.005), and reassessment (31% vs. 17%, p < 0.001). Among patients with moderate-severe pain, analgesia was more frequent in PEN encounters (81% vs. 58%, p < 0.001). Mild pain at the last documented assessment was also more common in PEN encounters (23% vs. 8%, p < 0.001). Younger patients and cases with longer prehospital intervals had higher rates of pain assessment, NRS use, analgesia administration, and reassessment, but not mild pain at last assessment. The PEN encounters showed higher rates of documented pain assessment, analgesia administration, and reassessment, with a higher proportion of patients having mild pain at the last documented assessment. Differences related to age and prehospital interval were mainly limited to process measures. Further research is needed to clarify whether clinician competence and care processes translate into improved pain relief.
This study assessed the level of agreement of perceived improvements among pediatric patients with chronic pain and their parents following an interdisciplinary pain management program. This is a retrospective chart review of a heterogeneous group of pediatric patients with chronic pain who completed an interdisciplinary pain management program (IPMP) and their parents (N = 172 pairs). The IPMP took place in an outpatient pain management center affiliated with an academic rehabilitation hospital. The outcome measures included the Multidimensional Patient Impression of Change (MPIC) and the MPIC parent version were administered post-treatment. The levels of agreement on the MPIC were analyzed between child and parent using the free-marginal kappa statistic. The majority of both the parents and the children evaluated the patients to be much or very much improved in six of the eight domains assessed. The levels of agreement in the ratings were fair to moderate among the patient-parent dyads. Parents endorsed significantly higher levels of improved overall pain and mood than their child did, whereas the patients reported greater levels of improved ability to cope with pain than their parents did. Both the patients and their parents reported high levels of perceived improvement following the IPMP. However, there were some differences in their ratings of improvements in overall pain, mood, and ability to cope with pain. Given that some of the perceptions were discrepant, it is recommended that feedback be obtained from the patient and their parent.
Musculoskeletal pain is a major concern for agricultural workers worldwide. However, access to safe and non-opioid pain relief measures is limited in resource-scarce settings. Hemp flower oil, a rich source of cannabinoids and terpenes, has been recognised as a promising adjunct pain therapy due to its analgesic and anti-inflammatory activities through the activation of CB2 receptors, TRP channels, cytokine downregulation and antioxidant mechanisms. This study is a systematic scoping review with narrative synthesis conducted in accordance with PRISMA 2020 guidelines which aims at addressing this issue through a comprehensive analysis of available evidence using a phytochemical, mechanistic, genomic and sustainability approach. This review is guided by the PRISMA framework and incorporates a total of n = 44 studies conducted between 2000 and 2025. Preclinical research accounted for a significant proportion of the overall evidence (68%), indicating a strong mechanistic rationale for hemp flower oil as a pain reliever. Clinical trials accounted for a small proportion of the overall evidence (23%), while genomic research accounted for a small proportion of the overall evidence (9%), indicating associations between cytokine polymorphisms and ion channel variants and cannabinoid receptor genotypes. This review aims to bridge the gaps and address the knowledge gaps and research priorities through a comprehensive analysis of available evidence and a roadmap for future research using a novel interdisciplinary approach. Hemp flower oil shows preliminary potential, but current clinical evidence remains limited and of low certainty for managing musculoskeletal pain in agricultural workers.
Oral squamous cell carcinoma (OSCC) is frequently associated with severe nociceptive and neuropathic pain that adversely affects patient quality of life, functional capacity, psychological well-being, and prognosis. Pain in OSCC is increasingly recognized not only as a clinical symptom but also as a dynamic indicator of tumor progression and neuroinflammatory activity. This review summarizes the epidemiological, molecular, neurobiological, and clinical mechanisms underlying OSCC-associated pain and discusses current and emerging approaches for mechanism-based multimodal pain management. Recent evidence demonstrates that tumor-nerve interactions, perineural invasion, inflammatory cytokines, and peripheral and central sensitization play central roles in the pathogenesis of OSCC pain. Molecular alterations involving TP53 mutations, EGFR overexpression, and PI3K/AKT/mTOR pathway activation contribute to inflammatory signaling, neural remodeling, and nociceptive sensitization within the tumor microenvironment. Advances in salivary biomarkers, liquid biopsy approaches, artificial intelligence-assisted pain assessment, and organoid-based translational models are improving the understanding of cancer pain biology and supporting the development of precision analgesia and individualized therapeutic strategies. OSCC-associated pain is a complex and multidimensional phenomenon closely linked to tumor aggressiveness, neuroinflammation, and disease progression. Effective pain management requires mechanism-based multimodal approaches integrating pharmacological, rehabilitative, interventional, and tumor-directed therapies. Emerging precision medicine strategies, combined with equitable access to supportive care, have the potential to improve pain control, treatment outcomes, patient dignity, and overall quality of life in individuals with OSCC.
Upper-limb pain is a frequent and disabling sequela following breast cancer treatment, often persisting beyond the acute postoperative period and substantially impairing function, self-management, and quality of life. Telerehabilitation has emerged as a strategy to expand access to physiotherapy-based care; however, its effectiveness for pain management in this population remains unclear. To systematically evaluate the effectiveness of telerehabilitation interventions in reducing upper-limb pain in women after breast cancer treatment. This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261332939). PubMed, CINAHL, Web of Science, and EMBASE were searched through December 2025. Randomized controlled trials evaluating telerehabilitation-based physiotherapy interventions and reporting outcomes related to upper-limb pain were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE framework. Six randomized controlled trials involving 517 women were included. Telerehabilitation interventions varied in delivery format (synchronous, asynchronous, app-based, or telephone-based), intensity, and duration. One trial demonstrated a significant reduction in the proportion of women reporting chronic arm pain, and another reported greater improvement in pain interference, but not pain intensity. The remaining studies showed pain outcomes comparable to usual care or no significant benefit. Methodological limitations included heterogeneity in pain assessment tools, limited individualization of interventions, attrition, lack of blinding, and inconsistent reporting of analgesic use. Overall certainty of evidence was rated as low. Telerehabilitation appears feasible and comparable to usual care for upper-limb pain management after breast cancer treatment; however, consistent superiority has not been demonstrated. Evidence of benefit is primarily associated with structured, high-frequency, and multimodal programs. Further well-designed trials with standardized pain-specific outcomes are needed. Management of upper-limb pain after breast cancer treatment through telerehabilitation requires coordinated input from multidisciplinary healthcare teams, including nurses and physical therapists. Telerehabilitation may facilitate remote pain monitoring, patient education, and self-management across survivorship care, provided that interventions are structured, clearly protocolized, and focused on pain-specific outcomes.
Cancer pain affects 60%-80% of patients with advanced cancer, and approximately 30% of patients experience inadequate pain control. Although the World Health Organization (WHO) three-step analgesic ladder has substantially improved pain management, inadequate analgesia, opioid-related adverse effects, and refractory pain continue to pose significant clinical challenges. This narrative review critically evaluates recent advances in cancer pain management, including novel analgesics, optimized opioid formulations, nanomedicine, invasive interventions (intrathecal drug delivery, neuromodulation, and neurolysis), and complementary integrative therapies, aiming to provide up-to-date insights for clinicians and researchers. Novel analgesics targeting μ-opioid receptor bias, ion channels, and multitarget strategies have shown preclinical promise. Improved opioid formulations and nanomedicine-based approaches may enhance drug delivery and reduce toxicity. Fourth-step interventions, including intrathecal drug delivery, neuromodulation, and neurolysis, provide targeted options for selected patients with refractory cancer pain. Integrative therapies, including mind-body interventions, acupuncture, massage, music therapy, and game-based approaches, may improve symptom burden and quality of life, although evidence for direct analgesic effects remains limited. Cancer pain management is evolving toward a multimodal and increasingly personalized framework. Despite substantial progress, many emerging therapies lack robust cancer-specific validation. High-quality clinical trials, standardized treatment protocols, and improved translational strategies are needed to establish evidence-based precision cancer pain management.
Chronic low back pain (cLBP) significantly impacts functional capacity and psychological well-being. This study investigated the efficacy of a whole-spine electrical stimulation system (StimaWELL 120MTRS) as a multimodal intervention to reduce pain and disability in this population. A controlled trial was conducted with sixty-one participants, assigned to either a treatment group (n = 30) or a waitlist-control group (n = 31). The intervention consisted of 30-minute whole-spine electrical stimulation sessions twice weekly for four weeks. Evaluation parameters included the Numeric Pain Scale (NPS) for pain intensity, the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI) for disability, and the Nottingham Health Profile (NHP) for quality of life (QoL). Analysis focused on both within-group improvements and between-group comparisons to determine the system's clinical impact. The findings demonstrate that whole-spine electrotherapy was associated with improvements in pain at rest and at night, reduced catastrophizing, and enhanced overall QoL compared to no intervention. This technology may offer a noninvasive approach for the comprehensive management of cLBP by addressing both physical symptoms and psychological factors like catastrophizing. Back pain that lasts longer than three months is called chronic low back pain. It is one of the most common health problems worldwide and can make everyday tasks difficult. It can also affect how people feel emotionally, causing negative thoughts about pain; a pattern known as “catastrophizing.” This study looked at whether a special electrical therapy device, called the StimaWELL system, could help people with chronic low back pain. This device applies gentle electrical currents along the entire back using a mat, while also providing warmth. Unlike most electrical therapy devices that treat only a small area, this one covers the whole spine at once. We reviewed the records of 61 people who had previously received this treatment at a physiotherapy clinic. Thirty people received the StimaWELL treatment twice a week for four weeks. The remaining 31 people were placed on a waiting list and did not receive treatment during this time. We measured pain levels, physical disability, negative thoughts about pain, and quality of life before and after the four-week period. The results showed that the treatment group improved more than the waiting list group in several areas, including back pain at rest and at night, physical disability, and negative thoughts about pain. Quality of life also improved in the treatment group. These results suggest that this type of whole-back electrical therapy may be a helpful option for people living with chronic low back pain, either on its own or alongside other treatments.www.clinicaltrials.gov identifier is NCT06638229.
Chronic opioid use, a key predictor of opioid overdose, is common among adolescents and young adults (AYA) with inflammatory bowel diseases (IBD), underscoring a need for tailored interventions to monitor risk for opioid-related harm. Prior research highlights the need to engage both AYA patients with IBD and IBD-focused clinicians in the development of pain management and opioid safety interventions. Human-centered design offers a promising approach to address this gap by directly engaging patients and clinicians in cocreating solutions. We aimed to explore and identify AYA patient and clinician perspectives to inform the design and development of a digital opioid safety tool. Using convenience sampling, we conducted semistructured interviews with AYA patients with IBD and IBD-focused clinicians (gastroenterologists, surgeons, and nurses) in July-August 2023 in person or by video-based conferencing. Interviews explored patient experiences with pain management, opioid use, and transitions to adult care, as well as clinician experiences in monitoring pain and prescribing opioids. A co-design workshop, following the interviews, brought patient and clinician participants together to reflect as a group on the unique challenges of managing pain in IBD care, and consider potential creative solutions to enhance pain management safety. The workshop was facilitated in person in September 2023 and included 7 patients and 8 clinicians who previously participated in individual interviews. Data were audio recorded, transcribed, and thematically analyzed using an inductive approach to identify themes. Twenty participants (7 AYA patients and 13 clinicians) contributed to the study. Thematic analysis generated three domains of needs that a digital opioid safety tool should address: (1) Intersecting Needs (ie, relevant at the patient and clinician and/or health system levels), (2) Patient-Level Needs (ie, relevant at the patient level only), and (3) Clinician- and/or Health System-Level Needs (ie, relevant at the clinician and/or health system levels only). Intersecting needs included integrating opioid safety interventions into multidisciplinary chronic care, supporting AYA transitions to independence, and acknowledging individual patient differences. Patient-level needs included assessing lived experiences of pain routinely, setting clear expectations about pain management, and connecting patients with safe nonopioid alternatives. Clinician- and/or health system-level needs included accounting for pain management received outside the IBD clinic; addressing gaps in information, education, and resources regarding opioid risk or pain management; and coordinating safety efforts across clinical teams. Incorporating these insights into the development of a digital opioid safety tool may enhance alignment between patient and clinician expectations on pain management and opioid use. This study underscores the value of human-centered design in developing digital opioid safety tools that are practical, patient-focused, and effectively integrated into clinical workflows. Findings may guide future intervention design, prototyping, and testing with continued engagement of AYA patients with IBD and clinicians.
Neonatal procedural and prolonged pain remains a frequent and clinically important problem in neonatal care, particularly among preterm and critically ill infants who undergo repeated invasive procedures. To synthesize evidence on neonatal pain assessment tools and non-pharmacological analgesic strategies, with attention to clinical implementation and emerging objective or digital assessment approaches. PubMed, CINAHL, MEDLINE, the Cochrane Library, Web of Science, Scopus, and Embase were searched for peer-reviewed English-language articles published from January 2000 to May 2025. Eligible studies included primary research, high-quality secondary evidence, and clinically relevant methodological or technological studies involving preterm or term neonates, defined as infants with a birth age of ≤28 days, or infants cared for in neonatal intensive care units. Studies were included if they addressed the development, validation, or clinical application of neonatal pain assessment tools, or the efficacy, safety, or implementation of non-pharmacological analgesic interventions. Studies limited to pharmacological analgesia, older children, or adults were excluded. Thirty-five studies were included. The evidence supports the use of validated multidimensional assessment tools for structured evaluation of neonatal pain. It indicates that family-integrated, sensory, and behavioral non-pharmacological approaches can reduce procedural pain responses. However, the strength and consistency of evidence are greater for single procedures than for repeated or prolonged pain. Artificial intelligence-based facial expression analysis, physiological monitoring, and biomarker-based approaches show potential for more objective pain detection but remain insufficiently validated for routine bedside decision-making. Standardized neonatal pain management should combine validated assessment scales, protocolized first-line non-pharmacological care, staff training, and parent involvement. Future research should prioritize repeated and prolonged pain, high-risk neonatal populations, implementation in routine neonatal intensive care practice, and the prospective validation of digital assessment systems in real-world clinical settings.
Empathy for patients' pain is a core component of compassionate nursing care and is increasingly recognised as important for care quality and workforce sustainability. Nursing interns commonly experience poor sleep quality and burnout during clinical placement, yet the interrelationships between these factors and pain empathy remain unclear. To examine the association between sleep quality and pain empathy among nursing interns and the potential serial mediating roles of burnout and moral identity in this association. A multicentre cross-sectional study. A convenience sample of 1108 final-year nursing interns undertaking clinical placements at 102 public hospitals in East and North China was recruited between October and November 2025 through participating nursing schools. Data were collected using the Pittsburgh Sleep Quality Index, Maslach Burnout Inventory, Moral Identity Measure and Empathy for Pain Scale. Descriptive statistics and Pearson correlations were performed using SPSS 27.0. Serial mediation was examined using PROCESS Macro (Model 6) with 5000 bootstrap resamples after adjustment for age, gender and educational level. Poorer sleep quality, higher burnout and lower moral identity were each significantly associated with lower pain empathy (all p < 0.001). Burnout and moral identity demonstrated significant independent and serial indirect associations in the relationship between sleep quality and pain empathy, with the total indirect effect accounting for 31.43% of the total effect. Sleep quality was significantly associated with pain empathy among nursing interns, with burnout and moral identity demonstrating significant independent and serial indirect associations. Strategies targeting sleep health, burnout and professional value development may be relevant for supporting empathic care during the transition to professional nursing practice. Nurse managers should consider sleep-supportive placement scheduling, early burnout monitoring and value-based mentorship strategies to strengthen empathy, wellbeing and workforce readiness among nursing interns.
This study explored the experiences of military personnel with chronic pain accessing care during their service and their transition to civilian life. Database and grey literature searches were conducted on December 2, 2022 and January 5, 2024. The analysis was structured in three stages: pilot, initial, and focused coding, following the qualitative meta-synthesis methodology. Each stage involved analysis, synthesis, and discussion of themes and findings among four researchers and a Veteran partner. Themes were synthesized from 19 studies on the impact of military lifestyle, culture, and mindset on military personnel with chronic pain. The findings showed how military lifestyle and culture create different challenges and experiences for military personnel with chronic pain. Chronic pain onset is often linked to prolonged exposure to high-stress environments, strenuous activities, and combat zones. The military has a prevalent culture of pain avoidance, often leading personnel to minimize their symptoms to fit the ideal soldier image. A mission-first ethos and the military's hierarchical structure can sometimes conflict with personal health needs. As military personnel transition to civilian life, they encounter challenges in a health care system that is not always attuned to their unique needs. The analysis also underscores the importance of tailored care and robust social support networks, with other Veterans playing a pivotal role in facilitating smoother transitions. Recognizing the unique challenges and needs of military personnel navigating military culture and lifestyle is crucial for developing tailored health care interventions and ensuring person-centred care during and after service. This study looked at how military personnel with chronic pain experience getting the care they need while serving and after leaving the military. The authors reviewed 19 studies to understand how military culture affects people with chronic pain. They found that the tough, mission-first mindset of the military often makes soldiers ignore or downplay their pain to appear strong. This culture, along with high-stress and physically demanding environments, contributes to the onset and persistence of chronic pain. When transitioning to civilian life, many struggle to get proper care because civilian health care systems may not understand their specific needs. Support from other Veterans and personalized care can help make this transition easier. Cette étude a exploré les expériences du personnel militaire éprouvant des douleurs chroniques qui accédaient aux soins pendant leur service et leur transition à la vie civile. Des recherches ont été réalisées dans les bases de données et la documentation parallèle le 2 décembre 2022 et le 5 janvier 2024. L’analyse a été structurée en trois étapes : période pilote, période initiale et codage ciblé en fonction de la méthodologie qualitative de la méta-synthèse. Chaque étape comprenait une analyse, une synthèse et la discussion des thèmes et des observations entre quatre chercheur(se)s et un(e) partenaire vétéran(e). Les thèmes ont été synthétisés à partir de 19 études traitant des effets du mode de vie, de la culture et de l’esprit des militaires sur le personnel militaire atteint de douleurs chroniques. Les résultats ont démontré que le mode de vie et la culture des militaires entraînent des expériences et des enjeux différents auprès du personnel militaire éprouvant des douleurs chroniques. L’apparition de la douleur chronique est souvent liée à une exposition prolongée à des environnements très stressants, à des activités ardues et à des zones de combat. Les militaires possèdent une culture prévalente d’évitement de la douleur, qui incite souvent les membres du personnel à minimiser leurs symptômes pour correspondre à l’image du soldat idéal. La philosophie de prioriser la mission et la structure hiérarchique des militaires peut parfois s’opposer aux besoins de santé personnels. Lorsque les membres du personnel militaire transitionnent vers la vie civile, ils sont aux prises avec des problèmes dans le système de santé, lequel n’est pas toujours sensible à leurs besoins particuliers. L’analyse fait également ressortir l’importance de soins adaptés et de réseaux de soutien social vigoureux, les autres vétéran(e)s assumant un rôle crucial pour favoriser des transitions plus harmonieuses. Il est capital de reconnaître les difficultés et les besoins uniques du personnel militaire qui évolue dans la culture et le mode de vie des militaires pour élaborer des interventions de santé adaptées et s’assurer que les soins soient axés sur la personne pendant et après le service.
Accurate assessment of pain in young children remains a persistent challenge, as many existing self-report tools demonstrate limitations in children under 6 years of age. Developmentally appropriate measures are needed to support reliable pain evaluation in this population. This article presents the theoretical rationale, structure, and intended administration of the Zoographic Indicator for Pediatric Pain (ZIPP) Scale, a new tool proposed to address this gap in pediatric pain assessment by utilizing concepts commonly understood by children as young as two years old. Proposed procedures for formal psychometric testing of the tool are outlined. The ZIPP Scale is introduced as an early-stage instrument requiring validation prior to use in clinical care. The ZIPP Scale introduces a developmentally responsive approach to pediatric pain assessment, advancing conceptual and methodological development in the evaluation of pain in young children, with potential to enhance quality of life for children and their families.
Off-label ketamine infusions are often used to manage chronic non-cancer pain (CNCP), including neuropathic pain, central sensitisation and opioid dose reduction. There are variable treatment regimens and routes of delivery based on clinical trials but there is the distinct lack of any clearly defined treatment guidelines. The goal of the scoping review was to determine whether there has been progress with the availability of published guidelines. Our inclusion criteria were publications that contained ketamine infusion, chronic pain and guidelines or protocols. We excluded publications that contained only acute pain, cancer pain or the paediatric population. A literature search was conducted on 10 May 2024 and included the medical scholarly literature databases MEDLINE and Embase and the evidence-based database Trip (formerly Turning Research into Practice; now Trip only; Trip Database Ltd, UK) Pro and limited to English language papers. Additional publications that were encountered during background reading were also included. A total of 42 publications were examined against the inclusion/exclusion criteria by the first three authors. The included full-text publications were then reviewed to determine whether they were considered a guideline. The three identified publications were then comparatively reviewed against the National Health and Medical Research Council standards for guidelines as a qualitative assessment, with 34-76% of standards met. This review found no published guidelines in Australia for use of ketamine in CNCP, despite ongoing clinical use. The authors' conclusion is that this is an area that should be addressed. Efficacy and adverse effects of off-label ketamine use should be able to be measured against an established guideline. Without a consistent and standard approach, the role of ketamine in this setting is unable to be thoroughly assessed. Such a guideline may be developed through expert consensus.
Loneliness is associated with high-risk medication use in older adults in cross-sectional studies, but the direction of this relationship is unclear. The aim of this study was to examine the association between loneliness and initiation of potentially inappropriate pain and psychotropic medications, and test for sex interactions. We conducted a retrospective cohort study of community-dwelling respondents to the Canadian Community Health Survey-Healthy Aging who were interviewed between December 1, 2008, and November 30, 2009, aged ≥66 years, and Ontario residents. Self-reported loneliness was defined at baseline as a score of ≥6 on the Three-Item Loneliness Scale. Survey responses were linked to health records; respondents were followed for 3 years to assess initiation of a potentially inappropriate pain or psychotropic medication, defined using the 2019 American Geriatrics Society's Beers Criteria. We used weighted Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) and tested for sex interactions. Of 2348 respondents (female 54.6%, mean age 75.4 years), 383 (12.3%) were lonely. Compared with those who were not lonely, lonely female respondents had higher rates of initiating potentially inappropriate pain medications (HR at 90 days: 1.57, 95% CI 0.96-2.27; 630 days: 1.52, 95% CI 1.05-2.12; 1080 days: 3.22, 95% CI 1.22-7.78) and potentially inappropriate psychotropic medications, but the latter estimates were imprecise. No association was found in males. Lonely older females initiate potentially inappropriate pain and psychotropic medications at higher rates than those who are not lonely. Screening for loneliness could prioritize patients for medication reviews, possible deprescribing, and interventions that address root causes.
Intramuscular hemangiomas are rare benign vascular tumors of skeletal muscle that are frequently misdiagnosed due to their deep location and vague presentation. These lesions may present similarly to common orthopedic pathology. We report a 17-year-old male high school athlete with chronic, progressively worsening anteromedial knee pain following prior trauma, associated with progressive swelling. Symptoms persisted despite conservative management, limiting sports participation without impairment in ambulation. The outside radiology report of the patient showed a cystic-appearing lesion in the anteromedial aspect of the knee, initially interpreted as consistent with a ganglion cyst, and less likely a malignancy. Given the chronicity of symptoms and functional limitation, surgical excision was indicated. Surgical pathology report confirmed an intramuscular hemangioma. Postoperatively, the patient experienced improvement in pain with no signs of early recurrence at two-week follow-up. Intramuscular hemangioma should be considered in adolescents with chronic periarticular pain or deep soft-tissue lesions, particularly when symptoms significantly limit activity, chronicity is involved, and imaging suggests an intramuscular vascular process. Surgical excision can be diagnostic and potentially curative when complete resection is achieved, and awareness of this pathology may reduce delays in diagnosis and unnecessary interventions.
Current guidelines for postdural puncture cerebrospinal fluid (CSF) leakage advocate conservative management, extrapolated from general populations. Patients with refractory cancer pain (RCP) often have advanced disease, malnutrition, and hypoalbuminemia, which may compromise tissue repair and reduce the reliability of spontaneous dural closure. The role of prophylactic epidural blood patch (PEBP) in this high-risk subgroup is undefined. This multicenter retrospective cohort study enrolled RCP patients undergoing intrathecal drug delivery system (IDDS) implantation (Jan 2023-Aug 2025). Patients received either intraoperative PEBP (10-15 mL autologous blood) or conservative management (strict bed rest for 24-48 h, intravenous hydration 1,500-2,000 mL/day, oral caffeine). Propensity score matching (1:1) balanced recorded baseline and available procedural covariates. The primary outcome was moderate-to-severe postural headache syndrome (PHS). After matching (78 patient pairs, N = 156), PEBP was associated with lower rates of moderate-to-severe PHS (6.41% vs. 25.64%; p < 0.001), exploratory imaging-confirmed CSF leakage (7.69% vs. 24.36%; p = 0.003), and remedial EBP requirement (2.56% vs. 15.38%; p = 0.006). The absolute risk reduction for moderate-to-severe PHS was 19.23%, corresponding to a number needed to treat (NNT) of approximately 5. Headache duration and hospital stay were also shorter in the PEBP group. Subgroup findings were exploratory. Minor adverse events occurred in 11.54% of PEBP patients. No clinically evident neuraxial seeding was observed during short-term follow-up (median 3 months, range 2-5 months). In this retrospective cohort, intraoperative PEBP was associated with fewer early CSF leakage-related complications and shorter recovery after adjustment for recorded covariates. These findings support further prospective evaluation of PEBP in carefully selected patients. Prospective randomized controlled trials are warranted to validate these results. Causal inference, long-term safety, and patient-centered benefit require confirmation.
Damage control surgery (DCS) has become the standard of care in the management of severe abdominal trauma, particularly in military settings. Although this approach improves survival, it frequently results in significant disruption of the anterior abdominal wall and subsequent development of large ventral hernias. Reconstruction in this context is technically challenging due to adhesions, distorted anatomy, and loss of normal tissue planes. While open retromuscular repair is generally preferred, it is often not feasible following DCS. Laparoscopic intraperitoneal on-lay mesh repair with primary fascial closure (IPOM plus) may offer an alternative. However, evidence in post-traumatic populations remains limited. This study aimed to compare the feasibility, safety, and short-term outcomes of laparoscopic IPOM plus and open repair techniques in patients undergoing ventral hernia repair after DCS. A retrospective cohort study was conducted at a single military centre between June 2022 and December 2025. A total of 79 male patients with large ventral hernias following abdominal shrapnel injuries were included. Patients underwent either open repair (sub-lay or on-lay, n = 46) or laparoscopic IPOM plus repair (n = 33). Baseline characteristics were comparable between groups. Early postoperative outcomes within 90 days were analysed, including operative time, length of hospital stay, postoperative pain, time to recovery of bowel function, and complication rates. Laparoscopic IPOM plus repair was feasible in all cases, with successful primary fascial closure achieved in every patient. Operative time did not differ significantly between groups. The laparoscopic approach was associated with a significantly shorter hospital stay (p < 0.001), lower early postoperative pain on postoperative days 1 and 2 (p < 0.05), and earlier recovery of bowel function (p < 0.01). Rates of postoperative complications, including seroma formation, were lower following laparoscopic repair but did not reach statistical significance. No surgical site infections, reoperations, or readmissions were observed in either group. In patients with large ventral hernias following DCS, laparoscopic IPOM plus repair appears to be a feasible and safe alternative to open reconstruction. It is associated with improved early postoperative recovery without an increase in short-term complications. Further prospective studies with long-term follow-up are required to confirm these findings.
Knee osteoarthritis (OA) is a common musculoskeletal condition linked to aberrant joint loading, pain, and reduced function. While effective rehabilitation should target both local knee problems and the entire kinetic chain, direct comparisons between proximal (core stability) and distal (foot-ankle) interventions are limited. This randomized controlled trial evaluated the efficacy of an 8-week core stability exercise (CSE) program versus foot-ankle strengthening (FAS) in individuals with knee OA. One hundred participants (aged ≥ 40 years, Kellgren-Lawrence grade II-III) were randomly assigned to either CSE (n = 50) or FAS (n = 50). Both groups performed conventional knee exercises three times weekly for 8 weeks, supplemented by their respective group-specific training. The primary outcome was resting pain intensity evaluated via a visual analogue scale (VAS). Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, functional performance tests (40-m fast-paced walk, 30-second chair stand, and 11-step stair climb), and distal structural measures (Achilles tendon thickness and navicular/foot ratio). Assessments were conducted at baseline and after 8 weeks, with between-group differences analyzed using ANCOVA adjusted for baseline values. The CSE group showed significantly greater improvements across all outcomes compared to the FAS group. Between-group differences exceeded validated minimal clinically important differences (MCID) for resting pain and all KOOS subscales, met MCID thresholds for the walk and chair-stand tests, and safely surpassed minimal detectable changes (MDC) for the stair-climb test and distal structural parameters; large effect sizes favored core stability training. These findings indicate that proximal core stabilization added to conventional knee exercises provides superior short-term improvements in functional mobility and distal structural surrogates compared to foot-ankle strengthening combined with conventional knee exercises in knee OA rehabilitation. Crucially, these static distal structural modifications are exploratory, likely reflecting localized soft-tissue fluid shifts rather than permanent anatomical remodeling, and demand future validation via advanced diagnostic imaging.Trial Registration: ClinicalTrials.gov ID= NCT06766877 (registered 9 January 2025).
Osteoid osteoma (OO) of the scaphoid is an uncommon entity, particularly in pediatric patients, where diagnosis is often delayed due to its rarity and overlapping presentation with more common wrist pathologies. We report the case of a pediatric athlete with persistent wrist pain initially diagnosed as a scaphoid fracture. Imaging progression from radiographs to MRI suggested fracture, but confirmatory CT revealed a 5-mm radiolucent lesion with central mineralization, consistent with OO. Surgical excision via volar approach was performed due to intraosseous lesion location and proximity to articular surfaces, with demineralized bone matrix placement and no fixation required. Postoperative recovery was notable for resolution of pain and functional restoration by 2 months. This case highlights the importance of considering OO in atypical locations and the role of CT for definitive diagnosis when MRI is inconclusive. Early recognition can expedite management, reduce morbidity, and prevent long-term sequelae in pediatric athletes.