Search Results (1,042)

The amygdala is composed of several nuclei, including the lateral nucleus which is the main receiving area for the input from cortical and subcortical brain regions. It mediates fear, anxiety, stress, and pain across species. Evidence suggests that the endocannabinoid system may be a promising target for modulating these processes. Cannabinoid and cannabinoid-related receptors have been identified in the amygdala of rodents, carnivores, and humans, but not in horses. This study aimed to investigate the gene expression of cannabinoid receptors 1 (CB1R) and 2 (CB2R), transient receptor potential vanilloid 1 (TRPV1), and peroxisome proliferator-activated receptor gamma (PPARγ) within the lateral nucleus of six equine amygdalae collected post mortem from an abattoir using quantitative real-time PCR, cellular distribution, and immunofluorescence. mRNA expression of CB1R and CB2R, but not TRPV1 or PPARγ, was detected. The percentage of immunoreactivity (IR) was calculated using ImageJ software. Cannabinoid receptor 1 immunoreactivity was absent in the somata but was strongly detected in the surrounding neuropil and varicosities and CB2R-IR was observed in the varicosities; TRPV1-IR showed moderate expression in the cytoplasm of somata and processes, while PPARγ-IR was weak-to-moderate in the neuronal nuclei. These findings demonstrate endocannabinoid system components in the equine amygdala and may support future studies on Cannabis spp. molecules acting on these receptors. Full article

Chronic musculoskeletal pain negatively affects patients’ quality of life, and pain perceptions may significantly influence rehabilitation outcomes. This study investigated the relationships among pain intensity, pain perceptions, and kinesiophobia in individuals with chronic musculoskeletal pain. No previous studies have examined these variables in combination. A cross-sectional observational study was conducted with 37 participants with non-specific chronic musculoskeletal pain for at least 6 months, affecting the neck (n = 8), lower back (n = 18), upper limbs (n = 5), lower limbs (n = 5), or shoulder (n = 1). The following validated tools were used: (a) Pain Beliefs and Perceptions Inventory (PBPI), (b) the Tampa Scale for Kinesiophobia (TSK), and (c) the Short-Form McGill Pain Questionnaire (SF-MPQ). Spearman r correlation analyses were performed. Total kinesiophobia scores were positively correlated with (a) total pain intensity (McGill score) (r = 0.37, p = 0.022), (b) present pain intensity (PPI) (r = 0.52, p = 0.001), (c) pain duration (r = 0.51, p = 0.001), (d) the “mystery” factor of pain perception (r = 0.41, p = 0.013), and (e) the Visual Analogue Scale (VAS) (r = 0.42, p = 0.009). The total pain perception scores were positively associated with the “fear of injury” factor of kinesiophobia (r = 0.36, p = 0.028). The McGill pain scores were strongly correlated with both PPI (r = 0.63, p = 0.001) and VAS (r = 0.51, p = 0.001). There is a significant relationship between pain perception and kinesiophobia levels in patients with chronic musculoskeletal pain. Limitations of the study include a small and heterogeneous sample regarding pain localization. Further research is required using larger, more homogeneous populations to confirm the present findings. Full article

Aim: To compare diabetic polyneuropathy (DPN) and cardiac autonomic neuropathy (CAN) between T1DM and T2DM patients. Methods: This study enrolled 66 T1DM and 79 T2DM patients. DPN was evaluated using three different methods: clinical examination, using neuropathy symptom score (NSS) and neuropathy disability score (NDS), current perception threshold (CPT) using Neurometer, and nerve conduction studies (NCSs). CAN was assessed by cardiovascular autonomic reflex tests (CARTs). Results: The prevalence of DPN did not differ between T1DM and T2DM (p > 0.05 for all), however, the proportion of DPN depended on the method used and was highest with CPT (53.0% vs. 46.8%), followed by NCSs (44.1% vs. 41.2%) and clinical examination (25.8% vs. 31.6%). T2DM vs. T1DM patients were more often diagnosed with painful DPN (51.9% vs. 27.3%, p = 0.004), reduced perception of vibration (72.2% vs. 48.5%, p = 0.006), and autonomic neuropathy (59.5% vs. 32.3%, p = 0.001), while NCSs revealed more prevalent motor nerve dysfunction in T1DM compared to T2DM (41.2% vs. 19.6%). Multivariate regression analysis showed increased DPN risk with age and CAN risk with worsening of eGFR in T1DM. No significant associations remained after multivariate adjustment for T2DM. Conclusions: The prevalence of DPN is highly varied and depends on the diagnostic method used. T2DM patients more often had symptoms and signs of diabetic neuropathy. However, stronger associations with risk factors were observed in T1DM. Full article

Background: Postoperative pain management after a cesarean section remains a significant challenge, as inadequate control can delay maternal recovery and hinder early bonding and breastfeeding. While multimodal analgesia is the standard approach, non–pharmacological strategies like immediate skin–to–skin contact (SSC) are often underused despite their potential benefits in reducing pain, improving uterine contractions, and increasing maternal satisfaction. Objective: To evaluate the effects of immediate SSC on postoperative pain perception, uterine contraction quality, and maternal satisfaction, and to explore ways to incorporate SSC into routine post–cesarean care to promote recovery and humanized care. Method: A randomized clinical trial was conducted with 80 women undergoing elective cesarean sections, divided into two groups: SSC (40 women) and control (40 women). Postoperative pain was measured using the Visual Analog Scale (VAS) at various intervals, while uterine contraction quality and maternal satisfaction were assessed through clinical observation and a Likert scale, respectively. Results: We found that women in the SSC group experienced significantly lower pain scores (VAS2 and VAS3, p < 0.001), stronger infraumbilical uterine contractions (92.5%, p < 0.001), and higher satisfaction levels (average 9.98 vs. 6.50, p < 0.001). An inverse correlation was observed between pain intensity and satisfaction, indicating that SSC enhances both physiological and psychological recovery. Conclusions: Immediate SSC after cesarean is an effective, humanizing intervention that reduces pain, supports uterine contractions, and boosts maternal satisfaction. These findings advocate for integrating SSC into standard postoperative care, aligning with ethical principles of beneficence and autonomy. Further research with larger samples is necessary to confirm these benefits and facilitate widespread adoption in maternity protocols. Full article

Disruption of circadian rhythms by abnormal light exposure and reduced melatonin secretion has been linked to heightened pain sensitivity and opioid tolerance. This study evaluated how environmental light manipulation and exogenous melatonin supplementation influence pain perception and morphine tolerance in a rat model of neuropathic pain induced by partial sciatic nerve transection (PSNT). Rats were exposed to constant darkness, constant light, or a 12 h/12 h light–dark cycle for one week before PSNT surgery. Behavioral assays and continuous intrathecal (i.t.) infusion of morphine, melatonin, or their combination were conducted over a 7-day period beginning immediately after PSNT. On Day 7, after discontinued drugs infusion, an acute intrathecal morphine challenge (15 µg, i.t.) was administered to assess tolerance expression. Constant light suppressed melatonin levels, exacerbated pain behaviors, and accelerated morphine tolerance. In contrast, circadian-aligned lighting preserved melatonin rhythms and mitigated these effects. Melatonin co-infusion attenuated morphine tolerance and enhanced morphine analgesia. Reduced pro-inflammatory cytokine expression and increase anti-inflammatory cytokine IL-10 level and suppressed astrocyte activation were also observed by melatonin co-infusion during morphine tolerance induction. These findings highlight the potential of melatonin and circadian regulation in improving opioid efficacy and reduced morphine tolerance in managing neuropathic pain. Full article

Objective: To compare the effect of different bone augmentation procedures, namely, autogenous bone blocks (ABBs) versus guided bone regeneration (GBR), on patient-reported outcomes (PROMs). Methods: This systematic review was conducted according to the PRISMA guidelines. A MEDLINE, Embase, and Web of Science search was conducted by two independent reviewers in combination with a free-hand search in relevant journals until June 2025. Outcomes were PROMs to enhance our understanding of the evolution of these procedures. Results: The electronic search yielded 6291 articles. After title screening, 67 articles were further analyzed for abstract review, which resulted in 14 articles eligible for full-text reading. Six articles were finally included based on the exclusion and inclusion criteria with a total of 295 patients. The overall study quality was low, since only two RCTs could be included. One study demonstrated a high risk of bias. Different PROMs were examined and compared such as pain, edema, neurosensory disturbance, Patient-Reported Predominant Symptom, OHIP-14, postoperative analgesic usage, willingness to repeat, and likelihood to recommend. Meta-analysis was not achievable due to a lack of direct comparisons and heterogeneity in terms of PROMs. Evaluation points varied between pretreatment and up to nearly 10-years of follow-up. Conclusions: Despite significant heterogeneity and reporting, this systematic review concluded that ABB and GBR are well-tolerated procedures. Trends such as transient postoperative pain and swelling with a minor occurring of neurosensory disturbances were reported in a few studies. Overall, a good perception of postoperative recovery was reported for both treatment modalities. Good quality of life was noted related to GBR procedures. Patient-reported outcomes were only analyzed for patients who completed the entire follow-up period. This may introduce bias, as patients who dropped out and were more likely to experience complications were not represented, potentially resulting in a more favorable portrayal of the outcomes. Further well-conducted prospective studies with a long follow-up are needed for an evidence-based evaluation and comparison of PROMs for these procedures. Full article

Background and Objectives: Gender disparities in pain management persist, with women frequently receiving inadequate analgesia despite reporting similar or higher pain levels compared with men. This issue is particularly evident across various medical and gynecological procedures. Materials and Methods: This integrative literature review synthesizes recent empirical studies examining gender biases in pain perception and management, focusing specifically on procedural pain in women. It includes an analysis of clinical research, patient-reported outcomes, and healthcare provider behaviors. Results: The findings indicate that unconscious biases, a lack of gender-specific clinical protocols, and prevailing cultural stereotypes contribute to the undertreatment of pain in women during procedures such as intrauterine device insertion and diagnostic hysteroscopy. Additionally, communication gaps between patients and healthcare providers exacerbate these disparities. Conclusions: Addressing gender disparities in pain management necessitates systemic reforms, including the implementation of gender-sensitive clinical guidelines, enhanced provider education, and targeted policy changes. Personalized, gender-informed approaches are essential to improving equity and quality of care in pain treatment. Full article

Background: Sarcopenic obesity, characterized by reduced skeletal muscle mass and excess adiposity, is strongly associated with chronic pain and functional decline in older adults. Objective: This prospective controlled trial without randomization investigated the effects of a structured, three-phase rehabilitation program on physical performance, pain, and sarcopenia-specific quality of life in elderly patients with sarcopenic obesity and chronic pain. Methods: In this study, 82 participants were enrolled and allocated to a study group (SG, n = 40), receiving supervised rehabilitation, nutritional counseling, and supplementation, or to a control group (CG, n = 42), which did not receive rehabilitation. The final analysis included 35 patients in SG and 36 in CG. Outcomes were assessed at baseline and six months using the Sarcopenia Quality of Life Questionnaire (SarQoL), Short Physical Performance Battery (SPPB), Numeric Rating Scale (NRS), and Pressure Pain Threshold (PPT). Results: The SG showed significant improvements in all outcomes: SarQoL increased from 57.02 to 63.98, SPPB increased from 7.14 to 8.4, PPT increased from 69.31 to 78.05, and NRS decreased from 6.94 to 4.65 (all p < 0.001). The CG showed no significant changes. Conclusions: The implementation of a structured, three-phase rehabilitation program resulted in clinically and statistically significant improvements in physical performance, pain perception, and sarcopenia-related quality of life in older adults with sarcopenic obesity and chronic pain. Full article

Background and Objectives: Orthodontic treatment aims to enhance dental aesthetics and function, yet many patients report dissatisfaction. This study was designed with the following objectives: To assess overall patient satisfaction during active orthodontic treatment; to identify key psychosocial and clinical predictors of satisfaction, including self-confidence, social experiences, and cost perception; to evaluate the impact of orthodontist–patient communication on satisfaction and perceived treatment outcomes; to explore the relationship between aesthetic improvement and willingness to undergo treatment again. Materials and Methods: A cross-sectional survey was conducted using structured questionnaires to assess satisfaction, pain perception, treatment expectations, and communication quality. Statistical analyses, including correlations and regression models, were used to identify predictors of satisfaction. The study included 450 orthodontic patients from the north-eastern region of Romania, undergoing active treatment at the time of data collection. Results: The strongest predictor of satisfaction was improved self-confidence and smile aesthetics (r = 0.62). Effective communication with orthodontists significantly increased satisfaction (r = 0.58, p = 0.002), while perceived high costs had a negative impact (r = −0.41). Pain and discomfort were common, with 90% of patients experiencing treatment-related pain, leading to reduced compliance. Social embarrassment due to braces also contributed to dissatisfaction (r = −0.47). Conclusions: Patient satisfaction with orthodontic treatment is primarily influenced by aesthetic improvements and effective communication. While enhanced smile perception boosts confidence, financial concerns and social discomfort may negatively affect the overall experience. Improving accessibility to treatment and providing comprehensive patient support are essential for optimizing patient satisfaction. Full article

Background: Ginger contains gingerols, shagaols, paradols, gingerdiones, and terpenes, which have been shown to display anti-inflammatory properties and inhibit pain receptors. For this reason, ginger has been marketed as a natural analgesic. This study examined whether a specialized ginger extract obtained through supercritical CO₂ extraction and subsequent fermentation affects pain perception, functional capacity, and markers of inflammation. Methods: Thirty men and women (56.0 ± 9.0 years, 164.4 ± 14 cm, 86.5 ± 20.9 kg, 31.0 ± 7.5 kg/m²) with a history of mild to severe joint and muscle pain as well as inflammation participated in a placebo-controlled, randomized, parallel-arm study. Participants donated fasting blood, completed questionnaires, rated pain in the thighs to standardized pressure, and then completed squats/deep knee bends, while holding 30% of body mass, for 3 sets of 10 repetitions on days 0, 30, and 56 of supplementation. Participants repeated tests after 2 days of recovery following each testing session. Participants were matched by demographics and randomized to ingest 125 mg/d of a placebo or ginger (standardized to contain 10% total gingerols and no more than 3% total shogaols) for 58 days. Data were analyzed by a general linear model (GLM) analysis of variance with repeated measures, mean changes from the baseline with 95% confidence intervals, and chi-squared analysis. Results: There was evidence that ginger supplementation attenuated perceptions of muscle pain in the vastus medialis; improved ratings of pain, stiffness, and functional capacity; and affected several inflammatory markers (e.g., IL-6, INF-ϒ, TNF-α, and C-Reactive Protein concentrations), particularly following two days of recovery from resistance exercise. There was also evidence that ginger supplementation increased eosinophils and was associated with less frequent but not significantly different use of over-the-counter analgesics. Conclusions: Ginger supplementation (125 mg/d, providing 12.5 mg/d of gingerols) appears to have some favorable effects on perceptions of pain, functional capacity, and inflammatory markers in men and women experiencing mild to moderate muscle and joint pain. Registered clinical trial #ISRCTN74292348. Full article

Background/Objectives: Obesity among university students is a growing concern, often influenced by biological, psychological, and social factors. Few studies in Saudi Arabia have addressed this issue using a comprehensive framework. This study aims to examine the prevalence of obesity and its biopsychosocial predictors among university students, as well as their perceptions, behaviors, and comorbidities. Methods: A cross-sectional study was conducted at Jazan University during the 2024–2025 academic year. A total of 819 undergraduate students completed a structured, self-administered Arabic questionnaire. The tool assessed sociodemographic variables, body mass index (BMI) (calculated from self-reported height and weight), biological and psychological factors, social influences, lifestyle behaviors, and comorbidities. Bivariate associations were tested using chi-square analyses, and multivariate logistic regression was used to identify independent predictors of obesity. Results: The prevalence of obesity was 19.6%, and 22.6% of students were overweight. Obesity was significantly more prevalent among males (26.7%) than females (9.6%, p < 0.001) and among students aged 24 years and above (24.0%, p = 0.024). Independent predictors of obesity included being overweight in childhood (AOR = 5.23, 95% CI: 3.47–7.90), belief in a genetic predisposition (AOR = 4.66), emotional eating (AOR = 2.57), academic or personal stress (AOR = 5.36), and social pressures related to body image (AOR = 2.96). Comorbidities significantly associated with obesity included high cholesterol (AOR = 5.40), sleep disorders (AOR = 2.99), and joint pain (AOR = 1.96). More than 80% of students with obesity reported current or past weight loss attempts, and nearly 60% received medical advice to lose weight. Conclusions: Obesity among Jazan University students is significantly associated with male gender, early-life weight history, emotional and academic stress, and social pressures. Students with obesity also experience a higher burden of comorbid conditions, even at a young age. These findings highlight the need for integrated, student-centered interventions that address both the psychological and social dimensions of weight management in university settings. Full article

Background/Objectives: The main purpose of the present scoping review was to map and explore the efficacy of computer-controlled intraosseous anesthesia (CCIA) in comparison with conventional dental anesthesia in pediatric dental patients. Secondarily, this study aimed to compare the acceptance and preference factors between CCIA and conventional dental anesthesia in children. Given the limited and heterogeneous nature of the available literature, this review aimed to identify gaps and scope the extent of research conducted in this area, providing a foundation for future, more targeted studies. Methods: The search was conducted in 19 electronic databases, and the appropriate studies were identified according to PRISMA-ScR guidelines. Only split-mouth randomized controlled clinical trials that reported on the clinical outcomes of CCIA in children were included. Two reviewers worked independently on the screening and selection of the studies. The same two reviewers carried out the data extraction and the risk of bias assessment, using the Cochrane risk of bias tool. Due to the exploratory nature, this review focused on mapping the characteristics, outcomes, and research trends rather than synthesizing effect sizes. Results: Out of 841 papers, 2 randomized clinical trials were ultimately included in the scoping review. The outcomes were categorized as primary (including results that answered the focus question) and secondary (relating to additional quality characteristics). Regarding the primary outcomes, in both studies, intraosseous anesthesia was efficacious in achieving the adequate level of anesthesia. One of the secondary outcomes was the acceptance and preference of CCIA in comparison with conventional dental anesthesia in children. The limited number and the high risk of bias in existing studies highlight the necessity for more comprehensive and high-quality research. Conclusions: The selected studies support the assertion that CCIA is a promising technique since it results in less pain perception and is preferred by patients compared to conventional local anesthesia. However, the existing literature is limited and at high risk of bias. Thus, further targeted investigations are needed to evaluate and yield more definitive results regarding the superiority of CCIA. Full article

Background and Objectives: Orthodontic treatment, whether fixed or removable, offers several benefits, including improved aesthetics, enhanced oral function, and increased self-confidence. However, it may also cause discomfort and pain, particularly following adjustment visits. This study aimed to assess pain characteristics (latency and continuity), food impairment, weight loss, and analgesic use in relation to treatment duration and appliance type. Methods: This observational study included 160 orthodontic patients who completed a structured questionnaire comprising 13 single-choice items. The questionnaire assessed age, gender, residential environment, educational status, type and duration of orthodontic treatment, pain characteristics (duration, latency, continuity), food impairment, and analgesic use. Inclusion criteria specified patients with moderate anterior crowding undergoing fixed orthodontic treatment or treatment with clear aligners on both arches, for at least one month. All fixed appliance cases involved 0.022-inch-slot Roth prescription brackets. Results: Patients undergoing fixed orthodontic treatment reported a higher frequency of pain (91.4%), greater need for analgesics (95.2%), and more food impairment compared to those with clear aligners. Patients treated for less than 6 months more frequently reported pain lasting 1 week (57.1%), while those treated for 1–2 years more commonly reported pain lasting several days (43.8%). Conclusions: Fixed orthodontic appliances are associated with greater discomfort, longer pain latency, more frequent analgesic use, and higher dietary impact compared to clear aligners. These findings emphasize the importance of personalized patient counseling and proactive pain management to improve compliance, enhance quality of life, and support informed decision-making in orthodontic care. Full article

Background and objectives: Duloxetine is widely used for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and various types of neuropathic pain. While its efficacy is well documented in clinical trials, less is known about how it is perceived and utilized in routine psychiatric practice. To address this knowledge gap, we conducted a cross-sectional observational study involving 80 psychiatrists from Spain to assess real-world clinical attitudes toward duloxetine. Methods: Participants completed a 20-item multiple-choice questionnaire that examined familiarity, perceived efficacy in multiple conditions (MDD, GAD, neuropathic pain, somatization, and quality of life), and perspectives on tolerability, safety, adherence, and overall satisfaction. Results: Survey results indicated that a large majority of psychiatrists frequently prescribe duloxetine, particularly for patients with MDD and comorbid chronic pain. Notably, 94% rated it as either “more effective” or “much more effective” for diabetic peripheral neuropathic pain. Psychiatrists reported a high perceived efficacy of duloxetine: 94% rated it as “more effective” or “much more effective” for diabetic peripheral neuropathy, and 93% gave similarly positive ratings for general neuropathic pain. For somatization, 70% found it “effective” or “very effective”, and 83% observed improvements in quality of life for many of their patients. Psychiatrists generally reported favorable perceptions of duloxetine’s tolerability profile: 97.5% rated it as the antidepressant associated with the least weight gain, and 82.5% perceived fewer sexual side effects compared to other options. Sedation and gastrointestinal side effects were generally considered mild or less severe. In terms of treatment adherence, 69% rated it as “better” or “much better” than other antidepressants, and 80% found its combination with other antidepressants to be “favorable” or “very favorable”. Overall satisfaction was high, with 99% of psychiatrists reporting being either “satisfied” or “very satisfied” with its use. The side effect profile was generally viewed as manageable, with low perceived rates of weight gain, sedation, and sexual dysfunction. Furthermore, 96% of respondents expressed a willingness to recommend duloxetine to their colleagues. Conclusions: Psychiatrists reported highly favorable attitudes toward duloxetine, viewing it as a flexible treatment option in routine care. However, these findings reflect clinicians’ subjective perceptions rather than objective clinical outcomes and should be interpreted accordingly. Full article

Background/Objectives: Chronic Pelvic Pain (CPP) is a multifactorial condition that affects in many ways the daily life of patients suffering from it. Different psychological factors demonstrated to be associated with the genesis and maintenance of CPP. Less is known about the role of the Psychological Flexibility (PF) model. Thus, the aim of this study is to explore the relationship between the PF domains, psychological distress, pain, and quality of life in patients with chronic pelvic pain. Methods: A total of 114 women with a diagnosis of chronic pelvic pain were included in this study. Participants completed online self-report measures to assess psychological distress (anxiety, depression, stress), Psychological Flexibility, Pain interference, and Quality of life. Results: Psychological distress and Psychological Flexibility showed significant association with pain interference. Other PF dimensions related to pain interference were as follows: self as context, defusion, and values. Physical Quality of life showed significant association with Experiential avoidance and Lack of values clarity, while Mental Quality of life was associated with Psychological Inflexibility and Self as content. Conclusions: Psychological distress and Psychological Flexibility have a role in pain perception and its interference with a patient’s daily life, affecting also physical and mental quality of life of CPP patients. Full article