Search Results (2,257)

Spinal cord stimulation (SCS) has expanded beyond pain treatment, becoming a neuromodulatory method capable of recruiting spinal and supraspinal circuits involved in motor recovery. This review summarises mechanistic knowledge, supports engineering developments, and describes the changing clinical translation of SCS in rehabilitation. Mounting scientific data shows that SCS’s effects go beyond dorsal column modulation and may involve segmental networks that promote activity-dependent plasticity and sensorimotor pathway restoration, probably due to a combination of Hebbian and non-Hebbian mechanisms (synaptic potentiation, interneuronal reorganisation, and altered afferent–efferent coupling). More recent advances, such as bursts and the high-frequency paradigm, closed-loop control, and data-driven parameter optimisation methods, improve the precision, stability, and calibration of stimulation for each individual. By combining SCS with non-invasive forms of neuromodulation (TMS, tDCS, and peripheral nerve stimulation), one can potentially further intensify corticospinal plasticity and maintain improvements in functions. Spinal cord stimulation remains an established treatment for chronic neuropathic pain, including failed back surgery syndrome and complex regional pain syndrome. In recent years, however, increasing attention has been directed toward its potential role in motor recovery after spinal cord injury and stroke. Progress in this area is limited by patient heterogeneity, variability in outcome measures, the complexity of multimodal rehabilitation protocols, and regulatory and logistical constraints—particularly when adaptive or closed-loop systems are used. Current evidence suggests that motor-restorative applications of SCS should be interpreted cautiously and integrated within carefully designed rehabilitation programmes, with attention to patient selection and realistic expectations regarding the durability of the benefit. Full article

Background: Lumbar disc herniation (LDH) is the most common etiological cause of low back pain (LBP). Objective and precise pain evaluation is of significant clinical value. Functional near-infrared spectroscopy (fNIRS) as a noninvasive neuroimaging modality, has been increasingly validated to reflect subjective pain perception through hemodynamic correlates. This study aimed to analyze the fNIRS changes in patients with LDH about to receive Unilateral Biportal Endoscopy and to further explore the feasibility of fNIRS as an objective biomarkers for clinical assessment of LDH. Methods: Resting-state fNIRS data were acquired from 67 preoperative LDH patients and 20 healthy controls (HC). Brain functional maps—including z-standardized fractional amplitude of low-frequency fluctuations (zfALFF) and seed-based functional connectivity (FC)—were extracted and quantified. Group-level comparisons were performed between LDH and HC groups across four predefined regions of interest; additionally, correlation analyses were conducted between fNIRS metrics and clinical assessment scores within the LDH cohort. Results: Compared with HC, LDH patients exhibited significantly altered zfALFF in the medial prefrontal cortex (mPFC): decreased amplitude at channel CH12 (t = −2.031, p = 0.045) and increased amplitude at CH21 (t = 2.462, p = 0.016). Whole-brain FC analysis further revealed widespread changes—particularly between the parietal somatosensory cortex and prefrontal regions. Among all tested FC–clinical indicator associations, 56 reached statistical significance after FDR correction (q < 0.05). VAS_ lumbar and SF-36_SF exhibited the highest number of significant connections. Conclusions: LDH patients with LBP exhibit notable alterations in prefrontal resting-state ALFF and FC between the parietal somatosensory cortex and prefrontal cortex relative to HC. Importantly, these neural alterations exhibit significant associations with both pain severity (VAS) and long-term health-related quality of life (SF-36), thereby strengthening their candidacy as neural correlates meriting prospective validation as objective, mechanism-informed biomarkers for clinical evaluation of lumbar disc herniation (LDH). Moreover, these findings highlight candidate neural targets for future longitudinal studies investigating early prognostic prediction and treatment response monitoring in LDH. Full article

Background/Objectives: Left ventricular free wall rupture is a rare but catastrophic complication of acute myocardial infarction with extremely high mortality. Deaths occurring in water environments present unique forensic challenges requiring systematic evaluation of drowning, intoxication, trauma, and natural disease. This case report describes a fatal left ventricular free wall rupture occurring shortly after successful percutaneous coronary intervention (PCI), emphasizing the medicolegal differential diagnosis and the importance of comprehensive postmortem evaluation. Results: A 58-year-old man with non-ST-elevation myocardial infarction underwent successful PCI with three drug-eluting stents and was discharged home. Six hours later, he developed severe back pain and was found unresponsive in a bathtub. Autopsy demonstrated a 2.6 cm transmural rupture of the anterolateral left ventricular free wall with 150 mL of hemopericardium. Postmortem computed tomography (PMCT), performed as part of routine forensic evaluation, had identified hemopericardium prior to autopsy. Histology showed coagulative necrosis with neutrophilic infiltration. The rupture site was remote from stented vessels with no procedural injury. Toxicology revealed therapeutic medication levels. Pulmonary and scene findings did not support drowning as a cause of death. Conclusions: Ventricular free wall rupture remains a relevant cause of sudden death following myocardial infarction despite successful revascularization. Comprehensive forensic evaluation integrating scene investigation, macroscopic autopsy findings, histopathology, and toxicology is essential to distinguish natural disease progression from accidental or iatrogenic causes in deaths occurring in water environments. This case highlights that ventricular free wall rupture can occur shortly after apparently successful PCI and underscores the importance of comprehensive forensic evaluation in water-associated deaths. Full article

Background/Objectives: The Individualized Neuromuscular Quality-of-Life Questionnaire (INQoL) is a widely used measure of quality of life in patients with various neuromuscular diseases. This study aimed to adapt and test the validity and reliability of this measure in Hungarian patients with neuromuscular disease. Methods: According to the widely accepted method of validation, we first translated the original INQoL version into Hungarian, and then a native English speaker translated it back into English to test its validity. Following a pretest procedure, the INQoL was administered to 80 patients with various muscular diseases and 30 age-matched controls. The internal consistency and test–retest reliability were assessed. Concurrent validity was measured using the 36-item Short Form Survey (SF-36) questionnaire. Results: For all INQoL subscales, Cronbach’s alpha was above 0.7, demonstrating the reliability of the subscales. The highest Cronbach alpha value was for the Weakness subscale (0.983) and the lowest for the Treatment subscale (0.794). The intraclass correlation coefficient test values ranged from 0.810 (Treatment) to 0.988 (Pain), indicating excellent test–retest reliability. There was a strong correlation between the SF-36 Physical Function and multiple INQoL subscales, including Weakness (r = 0.754, p < 0.001), Fatigue (r = 0.704, p < 0.001), Activities (r = 0.744) p < 0.001, Independence (r = 0.791 p < 0.001), Body Image (r = 0.714 p < 0.001), and overall Quality of Life (r = 0.742 p < 0.001). Conclusions: Our findings indicate that the Hungarian-language adaptation of the questionnaire possesses adequate reliability and construct validity for assessing the quality of life in patients with muscular disorders. Full article

Introduction: Low back pain (LBP) is the leading cause of disability worldwide, with substantial variation in prevalence across regions. It is associated with a wide range of biophysical, psychological, social, and lifestyle factors, as well as comorbid conditions. Given its high impact, identifying population-level correlations of LBP is essential for informing prevention strategies. This study aimed to assess demographic, socioeconomic, lifestyle, and health-related factors associated with LBP in Hungary. Methods: A repeated cross-sectional analysis was conducted using secondary data from three waves of the European Health Interview Survey (EHIS) carried out in Hungary in 2009, 2014, and 2019. Results: The prevalence of LBP increased over the study period. Female sex, higher educational attainment, normal body mass index, non-smoking status, abstaining from alcohol, and good self-perceived health were associated with lower odds of LBP. In contrast, older age (≥65 years), unfavorable financial status, residence in socioeconomically disadvantaged regions, use of over-the-counter medications, and several chronic conditions were associated with higher odds. Conclusions: Reducing the impact of low back pain requires its integration into comprehensive public health frameworks that combine chronic disease management with consideration of socioeconomic inequalities at the population level. Full article

Background and Objectives: Functional neurosurgery encompasses surgical interventions aimed at modulating the function of the central and peripheral nervous systems. Spinal cord stimulation (SCS), as a form of neuromodulation, is an established treatment for chronic pain and is increasingly utilized by both anesthesiologists and neurosurgeons. The aim of this study was to evaluate the effectiveness of SCS in patients with chronic neuropathic spinal pain. Materials and Methods: This prospective study included 42 patients who demonstrated a positive response to trial stimulation. Only patients achieving a clinically meaningful response (≥50% pain reduction) during the trial phase were included in the final analysis. Pain intensity and functional disability were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). All patients underwent a two-stage percutaneous implantation procedure using burst stimulation. A follow-up assessment was performed 3–6 months after implantation. Results: A statistically significant reduction in pain intensity was observed (p < 0.0001), with median VAS scores decreasing from 8 to 3, corresponding to a 62.5% reduction in pain intensity and exceeding the minimal clinically important difference (MCID) for VAS. Functional status improved significantly, with ODI scores decreasing from 74% to 38%, markedly surpassing the established MCID threshold. A clinically meaningful reduction in pain (≥50%) was achieved in the majority of patients. All patients requiring opioid analgesics at baseline discontinued their use following SCS implantation, and a reduction in overall analgesic consumption was observed across the cohort. Conclusions: These findings suggest that burst SCS may be an effective treatment option for carefully selected patients with chronic neuropathic spinal pain who are not candidates for conventional spine surgery. However, the results should be interpreted with caution due to the enriched study design and limited follow-up period. Full article

Background: Gymnasts are reported as a population at high risk of low back pain. The prevention and treatment of low back pain often rely on improving the effectiveness of deep stabilizer muscles through exercises that aim to reach spinal alignment and axial lengthening. However, the scientific evidence regarding the effect of the specific instructions used during exercises on the spinopelvic complex is still lacking. To address this gap of knowledge, the aim of this pilot study was to examine the effect of specific postural and breathing instructions (spine straightening, forced expiration and perineal contraction) on the sagittal alignment of the spine before and after fifteen weeks of a specific muscle strengthening program. Methods: Low-dose biplanar radiographic images were taken in neutral position and in the five specific postures before and after the program and associated skeletal 3D reconstructions were performed allowing calculation of sacral slope, pelvic tilt, lumbar lordosis and thoracic kyphosis. Results: Sixteen gymnasts completed the entire protocol and were included in the analysis. At the end of the program, most of the postures tested led to a decrease in sacral slope, an increase in pelvic tilt, a reduction in lumbar lordosis, and a decrease in thoracic kyphosis, but with varying efficiency; the condition combining spine straightening, perineal contraction and forced expiration appeared to be the most effective in influencing all parameters simultaneously. Conclusions: The results strongly encourage combining an instruction of spine straightening with instructions of both expiration and perineal contraction, which is information of interest for coaches, physiotherapists and medical professionals. Full article

Lumbosacral and thoracolumbar kinematics are key risk factors for lifting-related low back pain, yet their measurement is typically restricted to motion capture laboratories. Inertial measurement units (IMUs) offer the potential to quantify spine kinematics in more naturalistic settings, but the validity of IMU-based processing pipelines relative to optical motion capture (OMC) remains unclear. Nine healthy participants performed stoop, squat, free, and asymmetric lifting tasks while IMU and OMC data were simultaneously collected to evaluate the concurrent validity of two IMU pipelines: the proprietary MVN Analyze pipeline and an OpenSense pipeline using a validated OpenSim biomechanical model for lifting. Joint angles from both pipelines were compared against OMC-derived joint angles calculated using the same validated OpenSim model with one-way repeated-measures statistical parametric mapping (SPM) (α = 0.05), Bland–Altman analysis with Limits of Agreement (LoA) and 95% Confidence Intervals (CIs), and Concordance Correlation Coefficients (CCCs) with 95% CIs. Xsens MVN Analyze consistently overestimated flexion-extension at both spinal levels across all lift types (lumbosacral: RMSE ≤ 9.8◦, bias ≤ −14.5◦, LoA ≤ ±10◦; thoracolumbar: RMSE ≤ 5.4◦, bias ≤ −8.3◦, LoA ≤ ±5◦), with SPM confirming significant differences during the lifting and lowering phases of all lifting cycles. In contrast, processing Xsens data with OpenSense using the same biomechanical model as the OMC data yielded excellent agreement with OMC (RMSE ≤ 2.9◦, bias ≤ 3◦, LoA ≤ ±10◦). CCC was poor to moderate, specifically in lateral bending and axial rotation planes, likely reflecting limited between-participant ROM variability. These results suggest that discrepancies are driven primarily by biomechanical model differences rather than sensor or sensor fusion limitations. Ultimately, when paired with an appropriate biomechanical model, XSens sensors show promise for practical field-based assessment of lifting biomechanics, potentially requiring only sensors at the chest and pelvis. Full article

Current scientific reports on pain pharmacotherapy focus on the side effects of opioid medications related to dysregulation of the oxidative–antioxidant balance and immunomodulation. Initial observations concerned the use of opioids in the treatment of acute postoperative and cancer pain. Little is known about oxidative stress modulation in multi-modal opioid-based analgesia for chronic non-cancer pain. The aim of this study was to describe oxidative stress using plasma total antioxidant capacity (TAC) and total oxidative capacity (TOC), to assess whether these metrics are dependent on pain intensity and the scheme of analgesia. The study group consisted of patients with chronic low back pain, who were divided under the following treatments: multi-modal opioid-based therapy (n = 42), monotherapy with opioids (n = 28), and the control group (n = 11). A significantly lower TAC was observed in the study group compared to the monotherapy and control groups (220 µmol/L vs. 295 µmol/L, p = 0.02 vs. 399 µmol/L, p = 0.01). TOC was significantly lower in the polytherapy group compared to the monotherapy group (594 µmol/L vs. 723 µmol/L, p = 0.0002). A significantly lower TAC was observed in the typical analgesia scheme compared to the adjuvant analgesia model (260 µmol/L vs. 339 µmol/L, p = 0.01). The TAC in the severe pain classification was significantly lower than in the moderate group (p = 0.03). Multi-modal therapy with opioids significantly reduced oxidative activity compared to monotherapy but did not improve antioxidant capacity. Opioid-based pain therapy combined with adjuvant analgesics produced better antioxidant properties, and the antioxidant capacity was lower in severe pain scores. Full article

Furuncular myiasis is rarely reported in Southeast/Eastern Europe and may be underrecognized or misdiagnosed in non-endemic settings. We described two imported furuncular myiasis cases diagnosed in Romania following travel to Peru and confirmed the etiologic agent by larval morphology and mitochondrial cytochrome c oxidase subunit I (COI) sequencing. We also conducted a narrative review of published case reports/series from Southeast/Eastern Europe (1900–2025) and summarized case characteristics. A previously healthy 31-year-old woman and 32-year-old man presented with painful furuncle-like lesions on the upper back near the shoulder and the posterolateral upper arm, respectively, associated with pruritus and a sensation of movement. Each lesion had a central punctum with intermittent air bubbles. Occlusion of the breathing pore with petroleum jelly facilitated mechanical extraction of one barrel-shaped larva per lesion. Microscopy showed features consistent with second-instar Dermatobia hominis larvae, and COI sequencing demonstrated 97.14–99.33% identity with reference D. hominis sequences. Literature review identified 25 travel-associated cases, with D. hominis involved mostly after travel to Central/South America. These cases highlight the value of travel history and key diagnostic clues for D. hominis myiasis in travelers that may enable timely diagnosis and minimally invasive management. Greater awareness and reporting are needed to better define epidemiology. Full article

Background/Objectives: Adolescent lumbar disc herniation (ALDH) is rare. Evidence on long-term surgical outcomes remains limited. The objective of this study was to evaluate mid- and long-term clinical outcomes following lumbar microdiscectomy in adolescents with lumbar disc herniation (LDH). Methods: A single-institution retrospective cohort study of patients under 19 years who underwent lumbar microdiscectomy over a ten-year period. Baseline clinical and radiological data were obtained from electronic patient records (EPR) and Magnetic Resonance Imaging (MRI). Patient-reported outcomes were collected at follow-up using the Oswestry Disability Index (ODI) as the primary outcome and Numeric Rating Scales (NRS) for back and leg pain and Global Perceived Effect (GPE) as secondary outcomes. Descriptive statistics were used to summarize results. Results: Seventeen of 27 patients (63%) participated. Mean age at surgery was 16.9 years, and mean symptom duration prior to surgery was 11.3 months. All patients underwent disc-preserving microdiscectomy. At a mean follow-up of 67.7 months, mean ODI was 9.5, mean NRS back pain was 2.8, and mean NRS leg pain was 2.3. Fourteen patients (82%) reported being completely recovered or much improved. Conclusions: Lumbar microdiscectomy in adolescents with LDH showed acceptable mid- to long-term outcomes, low disability, and low pain levels at more than five years of follow-up. Clinical and imaging findings resembled those seen in adults, though symptom duration before surgery was prolonged. Full article

Laser acupuncture (LA) integrates principles of traditional acupuncture with photobiomodulation (PBM) and has gained increasing attention as a non-invasive modality for pain management. PBM-based integrative LA in medicine refers to the application of low-level laser irradiation to acupuncture points, combining contemporary biomedical mechanisms with holistic, system-oriented therapeutic principles. This narrative review aimed to critically assess the scientific evidence on the efficacy of LA for pain management within the framework of the Principles of Clinical Integration of Photobiomodulation (PCIPBM) in LA, summarizing frequently used laser parameters and clinical indications. LA involves special protocols in standardized acupoints, using defined parameters of wavelength, irradiation, and energy density, consistent with PBM dosing principles. Therapeutic effects are mediated through point-specific neuromodulation and photobiological mechanisms, including modulation of peripheral and central nociceptive processing, reduction in pro-inflammatory mediators, improvement of microcirculation, and mitochondrial activation via cytochrome c oxidase-dependent adenosine triphosphate (ATP) synthesis. Clinical studies report statistically and clinically significant analgesic effects, particularly in chronic musculoskeletal pain, osteoarthritis, low back and neck pain, temporomandibular disorders, neuropathic pain, and selected postoperative pain conditions, when appropriate laser parameters are applied. Reported adverse effects are minimal, and tolerability is high. LA represents a safe, non-invasive therapeutic option and patient-friendly approach with clinically relevant efficacy in pain management. When applied according to PCIPBM, including evidence-based PBM parameters, it may serve as an effective adjunct or alternative to conventional pharmacologic and interventional approaches. Further standardization and high-quality randomized controlled trials are still required. Full article

Chronic pain is increasingly understood as a neuroimmune disorder rather than a purely neuronal condition, in which immune mediators and immune-like signaling within the nervous system regulate nociceptive gain across peripheral tissues, dorsal root ganglia (DRG), spinal cord, and supraspinal networks. Seminal and recent syntheses show that microglia, macrophages, cytokines/chemokines, and innate immune sensors can initiate and maintain maladaptive plasticity and central sensitization, helping explain the frequent clinical dissociation between structural pathology, systemic inflammatory markers, and pain severity. However, immune biology is bidirectional: alongside pronociceptive pathways, a growing literature describes active “pain-resolving” programs that terminate sensitization and restore homeostasis, including regulatory T cell (Treg)–IL-10 signaling and specialized pro-resolving mediators (SPMs). A structured search of PubMed/MEDLINE, supplemented by Europe PMC and PubMed Central, was performed, and citation chasing through broad scholarly indices was used to identify high-impact reviews, meta-analyses, and translational mechanistic studies. Systematic biomarker syntheses in low back pain, neck pain, and fibromyalgia indicate modest and heterogeneous systemic inflammatory signals, underscoring the need for mechanistic endotyping and stage-specific interventions. Based on this evidence, a clinically oriented framework is presented that distinguishes immune-driven pain amplification from impaired resolution and outlines practical implications for assessment, biomarker interpretation, and precision-oriented trial design. Full article

Background: Hormone receptor-positive (HR+), Human Epidermal growth factor Receptor 2 (HER2-negative) metastatic breast cancer (MBC) represents a substantial proportion of breast cancer cases in Saudi Arabia. Despite the established efficacy of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, particularly Palbociclib, in randomized control trials, real-world data from local institutions in Saudi Arabia remain limited. Objectives: This study aimed to evaluate progression-free survival (PFS), overall survival (OS), and toxicity profile among HR+, HER2-negative MBC female patients treated with Palbociclib at King Fahad Medical City (KFMC). Methods: A retrospective study was conducted on female patients with HR+/HER2-negative MBC treated with oral palbociclib combined with endocrine therapy (ET) at KFMC between January 2021 and September 2024. Data were collected from electronic health records. Descriptive statistics were conducted using mean for continuous variables and frequency for categorical variables. Survival analyses were conducted using Cox regression, log-rank tests and Kaplan–Meier analysis. Results: A total of 169 female patients with HR+/HER2− MBC were included. In the first-line setting, the median PFS was 20.14 months (95% CI: 14.65–30.49), compared with 11.3 months (95% CI: 7.98–not estimable) in the second-line setting. For OS, the median OS values were 53.1 months (95% CI: 41.2–not estimable) in the first-line group and 23.7 months (95% CI: 18.5–not estimable) in the second-line group. Significant predictors of shorter PFS included age, Body Mass Index (BMI), type of ET, cancer type, line of therapy, family history of cancer, and history of VTE. Visceral metastasis (HR = 3.087; p = 0.0229) and ECOG performance status of 4 (HR = 13.86; p = 0.0156) were associated with significantly shorter OS. The most common hematological adverse events (AEs) were neutropenia (45.6%), followed by anemia (5.9%), leukopenia (5.3%), and back pain (5.3%). Most toxicities were managed with dose reduction, holding treatment, or supportive care. Conclusions: Palbociclib demonstrated favorable survival outcomes and a manageable safety profile, with neutropenia being the most common AE. This study provides region-specific real-world evidence supporting the use of Palbociclib in HR+/HER2− MBC. These findings align with global trial data and highlight the importance of individualized treatment in clinical practice. Full article

Background and Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is frequently associated with intervertebral disc degeneration (IVDD). Current therapeutic strategies are primarily symptomatic and do not restore native disc biology, largely due to the avascular nature of the intervertebral disc and the hostile inflammatory and mechanical microenvironment that characterizes degeneration. The aim of this study is to provide an updated and clinically oriented overview of the pathophysiology of IVDD and to evaluate the current evidence on mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP)-based therapies. Materials and Methods: A focused narrative literature review was performed to evaluate current evidence on MSC- and PRP-based therapies for intervertebral disc degeneration (IVDD). The search was conducted in PubMed. Only studies in English were considered eligible. Results: Mesenchymal stem cells (MSCs) demonstrated regenerative and immunomodulatory effects primarily through paracrine mechanisms, enhancing extracellular matrix synthesis and reducing inflammation and apoptosis. MSC-derived extracellular vesicles emerged as a promising cell-free alternative, potentially overcoming limitations related to cell survival and safety. Platelet-rich plasma (PRP) showed anabolic and anti-inflammatory properties, promoting disc cell proliferation and matrix production, particularly in early-stage degeneration. Clinical studies, including randomized trials, reported significant improvements in pain and function for both MSC and PRP therapies, with favourable safety profiles. However, heterogeneity in treatment protocols and limited long-term data remain significant limitations. Orthobiologic therapies represent a minimally invasive option for patients with discogenic low back pain refractory to conservative treatment. Patient selection is crucial and should consider degeneration stage, disc viability, and clinical presentation. PRP is primarily indicated in early-stage degeneration (Pfirrmann II–III), whereas MSC-based therapies may be considered in selected patients with more advanced but still viable discs. Based on current evidence, a stepwise approach is proposed, progressing from conservative management to PRP, MSCs, and ultimately surgery. Orthobiologics should be integrated within a multimodal strategy including rehabilitation. Conclusions: MSCs and PRP represent a promising and, eventually, complementary orthobiologic therapies for IVDD. PRP is primarily effective in early degenerative stages as a biologic stimulator, whereas MSCs may provide regenerative benefits in more advanced but still viable discs. Further studies are necessary to standardize protocols and confirm long-term efficacy and safety. Full article