Search Results (1,357)

Background: Chronic venous disease (CVD) substantially influences workers’ comfort, productivity, and capacity to remain employed, yet many occupational settings complicate the implementation of effective symptom management strategies. Temperature fluctuations, in particular, influence daily functioning: heat often worsens swelling, heaviness, pain, and fatigue, while cold may offer partial relief. This study examines how workplace thermal and organizational conditions affect adults with CVD, paying attention to the challenges they face in applying clinical recommendations. Methods: Fifty adults with CEAP C1–C6 disease were interviewed and observed in clinical settings. A qualitative descriptive approach was adopted to capture workers’ accounts rather than generate a new theory. Data were analyzed using Braun and Clarke’s reflexive thematic analysis within a qualitative descriptive framework. Results: Heat exposure consistently aggravated swelling, pain, and fatigue, whereas moderate cold often improved comfort and functional capacity. Participants highlighted numerous workplace barriers, including rigid schedules, restrictive uniforms, and difficulties maintaining compression in hot environments. Supportive supervisors, micro-breaks, access to hydration, and flexibility in posture facilitated better symptom control. Workers frequently described tensions between clinical advice and job demands, noting that instructions such as leg elevation or frequent breaks were often unrealistic in their occupational context. Conclusions: Aligning clinical guidance with workplace realities is essential for the well-being and long-term employability of individuals with CVD. Climate-sensitive and ergonomic job design represents an important strategy for supporting employees’ ability to manage symptoms and sustain productivity amid increasing thermal variability. Full article

Introduction: Chest drainage is central to thoracic surgery, pleural medicine, and emergency care, yet practice remains heterogeneous in tube caliber, access, suction, device selection, and removal thresholds. This narrative review aims to synthesize evidence and translate it into guidance. Materials and Methods: We performed a narrative review with PRISMA-modeled transparency. Using backward citation from recent comprehensive overviews, we included randomized trials, meta-analyses, guidelines/consensus statements, and high-quality observational studies. We extracted data on indications, technique, tube size, analog versus digital drainage, suction versus water-seal drainage, removal criteria, and key pleural conditions. Due to heterogeneity in device generations, suction targets, and outcomes, we synthesized the findings qualitatively according to converged evidence. Results: After lung resection, single-drain strategies, early use of water-seal, and standardized removal at ≤300–500 mL/day reduce pain and length of stay without increasing the need for reintervention; digital systems support objective removal using sustained low-flow thresholds (approximately 20–40 mL/min). Small-bore (≤14 Fr) Seldinger catheters perform comparably to larger tubes for secondary and primary pneumothorax and enable ambulatory pathways. In trauma, small-bore approaches can match large-bore drainage in stable patients when paired with surveillance and early escalation of care. For pleural infection, image-guided drainage, combined with fibrinolytics or surgery, is key. Indwelling pleural catheters provide relief comparable to talc in dyspnea associated with malignant effusions in patients with non-expandable lungs. Complications are mitigated by ultrasound guidance and avoiding abrupt high suction after chronic collapse; however, these strategies must be balanced against risks of malposition, occlusion or retained collections, prolonged air leaks, and device complexity, which demand protocolized escalation and team training. Conclusions: Practice coalesces around three pillars—right tube, right system, proper criteria. Adopt standardized pathways, device-agnostic thresholds, and volume or airflow criteria. Trials should harmonize “seal” definitions and validate telemetry-informed removal strategies. Full article

Significant pelvic pain is a fairly common malady in the United States. At the same time, the opioid epidemic has changed how pain is thought about and treated, resulting in a clear call for alternative treatment strategies. One of the promising techniques that has emerged over the last several years is cryoneurolysis. Cryoneurolysis allows for personalization of treatment through targeting of specific peripheral nerves, which correspond to a patient’s pain. In the setting of pelvic pain, several viable targets, namely the pudendal nerve and impar ganglion, have been described. This review delineates the mechanism of action in cryoneurolysis, reviews the pertinent literature and describes patient workup and technique. Finally, future directions are discussed. Full article

Introduction: Cancer pain remains a critical issue for patients’ quality of life, affecting their physiology, psychology, and social relationships. Despite the widely recognized role of pharmacists in pain management, their involvement in palliative care in Greece remains limited. This study focuses on exploring the perceptions and experiences of pharmacists regarding their role in cancer pain management, identifying barriers, required skills, and proposing strategies for their integration in the multidisciplinary team. Μaterials and Μethods: Qualitative research was conducted through semi-structured interviews with seven pharmacists in the Attica region. The interviews were recorded, transcribed, and thematically analyzed. Results: The analysis revealed four main themes: (1) limited access to medical records and challenges in pharmaceutical decision-making, (2) lack of institutional frameworks and a culture of collaboration, (3) need for specialized education and continuous training, and (4) understaffing and bureaucracy, faced by pharmacists. Discussion: This study highlights the underutilized role of pharmacists in cancer pain management in Greece. Barriers such as restricted access to patient records, weak interdisciplinary collaboration, insufficient training, and bureaucratic constraints limit their contribution. Structured frameworks and collaborative cultures can enhance pharmacists’ involvement, while education and continuous training are essential to strengthen their legitimacy within care teams. Digital tools can improve access to patient information and support evidence-based decisions. Conclusions: Pharmacists’ integration in the patient’s management team has significant benefits for the patient’s quality of life. Strengthening pharmacists’ involvement in cancer pain management requires the establishment of collaborations, continuous education, bureaucratic simplification, and the integration of digital tools. The development of practical resources, such as educational guides, can play a pivotal role in enhancing the quality of care provided. Full article

Focal chondral defects of the knee and ankle remain a challenging clinical condition, particularly in young and active patients, as they often cause pain, mechanical symptoms, and functional limitation without necessarily progressing to osteoarthritis (OA). This narrative review summarises current evidence on non-operative strategies for managing focal chondral lesions in non-arthritic joints, emphasising the role of rehabilitation as the central component of care. A thematic literature search was conducted across major databases for studies published between 2000 and 2025, selecting articles based on clinical relevance. Structured rehabilitation programmes based on load optimisation, neuromuscular retraining, and progressive strengthening represent the foundation of conservative management. Pharmacological agents and intra-articular injectables may provide temporary relief, although the evidence supporting their efficacy remains heterogeneous and primarily short-term. Nutraceuticals and physical modalities show encouraging but inconsistent results, limited by methodological variability and undefined dosing. Overall, conservative treatment should be tailored to the individual patient’s biomechanical and biological profile, integrating rehabilitation with selected adjuncts when appropriate. Future research should focus on developing standardised rehabilitation protocols, identifying predictors of recovery, and clarifying the biological mechanisms that sustain symptom improvement in focal cartilage pathology. Full article

Objectives: The objective of this prospective, controlled observational study embedded in routine spa care was to evaluate the effectiveness of integrating immersive virtual reality (VR) into a three-week spa-based rehabilitation program to reduce pain and improve physical mobility in adults with chronic musculoskeletal or neurogenic disorders. Methods: In this study, fifty-five adults with chronic musculoskeletal or neurogenic disorders completed a three-week spa regimen combining natural therapies, physiotherapy and rehabilitation. Participants were allocated in a preference- and availability-based manner either to the VR-enhanced group (n = 37), which completed interactive 25 min VR sessions three times per week, or to the control group (n = 18) receiving standard care. Pain was assessed using a 100 mm Visual Analog Scale (VAS) and shoulder-related joint mobility by goniometry before and after the intervention. Wilcoxon signed-rank and Mann–Whitney U tests evaluated within- and between-group differences, with subgroup analyses according to disease duration (≤5 vs. >5 years). Results: Both groups achieved significant post-treatment reductions in VAS pain scores (p < 0.001). The VR group exhibited a greater median decrease in pain compared to controls (p = 0.048), with the largest effect among patients with disease duration ≤ 5 years (p = 0.024). Goniometric measurements demonstrated significant mobility improvements across all tested angles in the VR group (p < 0.001), while improvements in the control group were smaller. Conclusions: VR integrated into spa-based rehabilitation was associated with greater pain reduction and mobility gains than standard care. These preliminary, hypothesis-generating findings require confirmation in larger randomized trials with standardized protocols and long-term follow-up. Full article

Background and objectives: Hemiarthroplasty (HA) remains one of the most common treatments for displaced femoral neck fractures in the elderly, providing pain relief, early mobilization and a low reoperation risk. Acetabular erosion is a recognized late complication of this procedure, but early cartilage wear and its potential relationship with infection remain poorly understood. The aim of this study was to describe the clinical and microbiological characteristics of patients who required conversion to total hip arthroplasty (THA) because of acetabular erosion and to analyze the possible role of unexpected infection as a contributing factor. Materials and methods: A retrospective observational study was performed including all patients treated between 2007 and 2019 who underwent conversion of a failed HA to THA due to acetabular erosion after femoral neck fracture. Microbiological analysis was performed in all cases through multiple intraoperative samples. Patients were classified into two groups, with and without infection, according to positive microbiological cultures. Results: Forty-four patients were included, with a median age of 80.5 years (74–85). The median time to acetabular erosion was 25.4 months (10.4–47.4). Infection was identified in six patients (13.6%), all within the first six months after fracture (p = 0.029). The median time to erosion was shorter in infected patients (4.0 versus 29.8 months, p < 0.001). No other demographic, functional, or implant-related variables were associated with infection. There were three re-revisions, two due to recurrent dislocation and one periprosthetic infection in a hip without unexcepted positive culture. All patients with positive intraoperative culture were successfully managed with antibiotherapy. Postoperative functional scores improved significantly in both groups. Fifteen patients (34.1%) died during follow-up. Conclusions: Early acetabular erosion after hemiarthroplasty may represent a manifestation of previously unrecognized low-grade infection, particularly in frail elderly patients. Despite advanced age and multiple comorbidities, conversion to THA achieved significant functional improvement with an acceptable complication rate. Prospective studies with larger populations are warranted to confirm the relationship between infection and early acetabular cartilage loss. Full article

Background/Objectives: Knee osteoarthritis (KOA) is a common pathology characterized by impaired joint cartilage. Mesenchymal stromal cell (MSC)-based treatments, such as stromal vascular fraction (SVF), are increasingly being used for their potential cartilage-generating capabilities; however, there is still insufficient evidence to confirm their effectiveness. The aim of the study was to assess the efficacy of SVF treatment in KOA in terms of pain relief. Methods: An experimental clinical trial was performed. We included adults with symptomatic KOA who attended Celular Clinic (Andorra). A laboratory-manufactured and standardized SVF product (Celstem^®) was applied to selected patients. Clinical, functional, and radiological assessments using the visual analog scale, KOOS (Knee Injury and Osteoarthritis Outcome Score), SF-36 scale, and MOCART classification (Magnetic Resonance Observation of Cartilage Repair Tissue) were performed. Variables were compared before treatment and at one, six, and twelve months after treatment. Adverse effects were reported. Results: In total, 184 patients were included in the clinical trial, 78 of whom were finally analyzed. There were statistically significant differences in both resting and activity-related pain and in all KOOS subscales after SVF treatment (p < 0.001). The quality of life also showed significant changes (p = 0.021). No significant changes were observed in MOCART values. However, a positive association was found between MOCART and cell yield. Few adverse effects were reported. Conclusions: Our nonrandomized uncontrolled clinical trial showed that SVF treatment has promise to reduce pain in patients with KOA. Improvements in functionality and quality of life were also observed. Future randomized controlled trials regarding SVF versus placebo therapies will further clarify this potential. Full article

Postoperative pain following pediatric tonsillectomy remains a significant clinical challenge. Inadequate management leads to delayed recovery, dehydration, and increased healthcare utilization. Multimodal analgesia, including combining systemic analgesics, local anesthetic techniques, and adjunctive medications, has emerged as the standard of care. This review highlights current perioperative pain management strategies, including recent evidence on multimodal and opioid-sparing approaches. Local infiltration and nerve blocks provide site-specific pain relief, reducing opioid requirements and improving patient comfort. A comprehensive understanding and careful selection of analgesic regimens are crucial for enhancing outcomes in this population. Full article

Oral diseases pose a major public health challenge, especially in low-income countries where dental care is limited due to high costs. In this context, phytotherapy has gained attention as a complementary approach due to its bacteriostatic, anti-inflammatory, healing, and analgesic properties. These therapeutic effects are mainly attributed to plant-derived bioactive metabolites, which interact with cellular structures, especially the plasma membrane, to modulate inflammation, stimulate tissue regeneration, and support antimicrobial defense. This review systematically examined the scientific literature to identify Latin American medicinal plants with therapeutic potential in dentistry. Based on their clinical and ethnobotanical applications, the analysis focused on species with anti-inflammatory, healing, analgesic, and relaxing effects, particularly in conditions such as dental pain, gingivitis, and periodontitis. Given the close relationship between pain, inflammation, and periodontal disease, these conditions cannot be studied in isolation. Gingivitis and periodontitis often present with painful symptoms and inflammatory responses that overlap with mechanisms of tissue damage and repair. Therefore, broadening the scope of this review allows for a more comprehensive understanding of how Latin American medicinal plants can contribute not only to pain relief but also to periodontal health, inflammation control, and wound healing. Fifty plant species were identified. Among these, 35 exhibited anti-inflammatory activity, 28 had healing properties, 20 showed analgesic effects, and 12 were associated with relaxing properties. Mexico accounted for the highest proportion of species (60%), followed by Colombia and Peru (54%) and then Brazil (32%). These percentages represent the proportion of plant species reported in studies originating from each country, relative to the total number of species identified in the review. The most studied species were Salvia rosmarinus Spenn. (Lamiaceae), Moringa oleifera Lam. (Moringaceae), Aloe vera (L.) Burm.f. (Asphodelaceae), and Ocimum basilicum L. (Lamiaceae). Latin American medicinal plants demonstrate strong potential not only in dental therapy but also in the management of periodontal inflammation and oral diseases. However, further research and clinical validation are needed to ensure their safe integration into conventional treatments. Full article

Background and Objectives: Epidural analgesia remains the gold standard for intrapartum pain relief; however, its influence on labor dynamics and neonatal outcomes in nulliparous women continues to be debated. This prospective cohort study aimed to investigate the effects of epidural analgesia on labor progression and neonatal outcomes among women experiencing spontaneous term labor. Materials and Methods: A total of 100 nulliparous women with singleton, cephalic pregnancies at 37–41 weeks of gestation were prospectively enrolled. Participants self-selected into either the epidural analgesia group (n = 50) or the no epidural analgesia group (n = 50) after standardized counseling on pain management options. Demographic data, labor characteristics, and neonatal outcomes, including the durations of the active and second stages of labor, the use of episiotomy or instrumental delivery, and the 1- and 5-min Apgar scores, were recorded and compared between groups. Group comparisons showed statistically significant differences when p values were below 0.05. Results: The active phase of labor was significantly longer in women receiving epidural analgesia compared with those without it, showing an approximately 60-min difference with a p value less than 0.001. The second stage was also modestly prolonged in the epidural group (p < 0.001). Although the episiotomy rate was higher among women with epidural analgesia, there were no significant differences in perineal tears or instrumental delivery. Neonatal outcomes were comparable between groups, with similar 1- and 5-min Apgar scores. Conclusions: Epidural analgesia modestly prolongs the active and second stages of labor in nulliparous women but does not adversely affect neonatal well-being. These findings support the continued use of epidural analgesia as a safe and effective option for labor pain management, providing substantial maternal comfort without compromising neonatal outcomes. Full article

Objectives: Non-subungual glomus tumors (NSGTs) are rare neoplasms arising outside the nail bed, typically presenting with disproportionate pain. Surgical excision usually achieves complete relief. Delayed or incorrect diagnosis of glomus tumors may also result in incomplete excision, which is the major cause of recurrence. Ultrasound is a well-recognized tool for preoperative evaluation, but the rarity of NSGTs complicates differentiation from angioleiomyomas (ALMs) and hemangiomas, which have alternative managements. This study aimed to establish an ultrasound diagnostic model and scoring system for NSGTs. Methods: A total of 58 NSGTs, 68 ALMs, and 67 hemangiomas confirmed pathologically between January 2014 and March 2025 were analyzed. Clinical and ultrasonographic features were evaluated, and significant variables were incorporated into a scoring time using the binary logistic regression. A total of 11 NSGTs, 10 ALMs, and 10 hemangiomas (April–August 2025) were used to validate the diagnostic performance of the scoring system. Results: Four independent predictors were identified: pain, upper extremity location, diameter < 10 mm, and vascular stalk sign (p < 0.05). The model differentiated NSGTs from ALMs and hemangiomas, yielding an AUC of 0.91, with sensitivity of 75.86% and specificity of 90.37%. The overall accuracy was 86.01%. Conclusions: Ultrasound proves valuable in diagnosing NSGTs. A logistic regression model based on pain, location, size, and vascular stalk sign shows high diagnostic performance and clinical utility in distinguishing NSGTs from other superficial soft tissue tumors. Full article

Background: A focused anamnesis of symptoms is essential in medical practice, especially in oncology, where new or increasing symptoms often indicate disease progression or therapy side effects. However, there are only a few studies in dermato-oncology that address the question of how symptoms should ideally be recorded. There are no validated questionnaires specifically tailored to the needs of dermato-oncology. Patients and Methods: Over a one-year period, all patients at the skin cancer centre were given a standardised questionnaire to record relevant symptoms before consultation. This was followed by the attending dermato-oncologist completing an additional section regarding therapeutic measures based on the reported symptoms. Results: 809 patients with 1879 consultations were included. In most patient contacts, patients did not report an increase in symptoms (n = 840; 44.7%). Fatigue, restlessness/anxiety, pruritus, and pain were the most recorded distressing symptoms. The chi-square test revealed that increased symptoms led to significantly more frequent interventions. Overall, symptom relief was observed at follow-up. Analysis using Generalised Estimating Equations showed patients benefited significantly from interventions for sleep disorders. Subgroup analysis showed that patients in ongoing therapy benefitted significantly from interventions for pain and nausea. Those in advanced disease stages benefitted significantly from interventions for pain. In those groups, if symptoms were explicitly stated as having worsened using the questionnaire, measures taken by physicians also showed significant benefit for obstipation and nausea along with pruritus. Conclusions: Targeted symptom screening is feasible and provides valuable insights for guiding diagnostic or therapeutic interventions. However, the questionnaire is most useful at higher tumour stages, as it is only effective when distressing symptoms are present. Full article

Chronic pain is a pervasive global health issue that significantly impairs quality of life and remains inadequately managed by current therapeutic options. Traditional pharmacological treatments often offer limited relief and are associated with significant side effects, highlighting the urgent need for safer and more effective alternatives. Among emerging strategies, mesenchymal stem cell (MSC)-derived secretome, an acellular product composed of bioactive molecules such as cytokines, growth factors and extracellular vesicles, has gained increasing attention for its potent anti-inflammatory, neuroprotective and immunomodulatory properties. Unlike whole-cell therapies, secretome-based interventions offer advantages, including lower immunogenicity, higher safety and easier standardization and storage. Preclinical studies demonstrated that MSC secretome effectively alleviates pain-like behavior across various models of neuropathic, inflammatory and degenerative pain, primarily through neuroimmune modulation and glial cell reprogramming. In vitro experiments confirm its role in promoting neuronal survival, regulating opioid receptor expression and modulating (neuro)inflammatory responses. Preliminary clinical evidence supports its analgesic efficacy in conditions such as osteoarthritis, chronic low back pain and post-surgical pain, with a favorable safety profile and promising therapeutic outcomes. However, challenges remain, including variabilities in secretome composition, lack of standardized production protocols and absence of large-scale clinical trials. Despite these limitations, MSC secretome therapy represents a transformative approach in pain medicine. Continued research efforts are essential to optimize formulation, dosing and delivery strategies, as well as to clarify the regulatory landscape. With further validation, the MSC secretome could emerge as a novel, scalable and clinically viable solution for the management of chronic pain, bridging critical gaps in current treatment paradigms. Full article

Background/Objectives: Spinal decompression surgery shows variable outcomes, with reoperation rates up to 37.5%. Surgeons lack objective intraoperative tools to assess decompression adequacy. Mechanomyography (MMG) measures nerve excitability through mechanical muscle responses to electrical stimulation. While compressed nerves require higher stimulation thresholds, optimal quantification approaches remain undefined. We explored associations between intraoperative MMG threshold changes and six-week pain outcomes, comparing metrics anchored to a 2.0 mA reference threshold versus percentage-based measures. Methods: Prospective exploratory pilot study of 42 patients (112 nerves) undergoing lumbar or cervical decompression. MMG thresholds were recorded pre- and post-decompression. Numeric Pain Scale scores were obtained preoperatively and at six weeks. Three metrics were compared: percentage change, Threshold Reduction Ratio (TRR; measuring proportion of threshold elevation above 2.0 mA eliminated by decompression), and Threshold Excess (TE; residual threshold remaining above 2.0 mA), with TRR and TE anchored to 2.0 mA based on published normal ranges. Results: Among 40 patients with baseline pain, threshold-anchored metrics showed substantially stronger correlations with pain improvement than percentage-based measures (TRR: r = 0.656, p < 0.001 vs. percentage: r = 0.397, p = 0.011). Threshold Excess was associated with a linear dose–response: each 1 mA above 2.0 mA corresponded to 6.3% less pain improvement (p = 0.001). Patients achieving ≤2.0 mA had 6.1-fold increased odds of complete pain relief versus those above 2.0 mA (76.5% vs. 34.8%, p = 0.013). Internal leave-one-out cross-validation suggested internal stability (TRR shrinkage ≈ 9.3%; TE’s dose–response slope remained stable). Conclusions: In this exploratory pilot study, threshold-anchored MMG metrics (TRR and TE) showed stronger correlations with early pain outcomes than percentage-based measures. These exploratory findings require external validation in independent cohorts before clinical implementation. If validated prospectively, these metrics could provide objective, real-time feedback for clinical interpretation to inform surgical decision-making during spinal decompression, enabling surgeons to tailor decompression to individual physiology rather than relying on standardized anatomical criteria. Future work should explore patient-specific threshold targets that account for age, chronicity, and comorbidities. Full article