Search Results (196)

Abdominal pain is the cardinal symptom of irritable bowel syndrome (IBS) and the primary determinant of disease burden and healthcare utilization. Despite its diagnostic centrality and high prevalence across all IBS subtypes, effective management remains a clinical challenge. This narrative review explores the pathophysiological mechanisms underlying IBS-related pain, emphasizing the role of visceral hypersensitivity, altered brain–gut communication, and luminal factors such as gas and distension. We examine current guideline recommendations, real-world treatment patterns, and evidence supporting both pharmacological and non-pharmacological interventions. Particular focus is placed on the fixed-dose combination of alverine citrate/simeticone, which targets both motor and sensory pathways. Mechanistic studies demonstrate its smooth muscle relaxant, antinociceptive, and anti-inflammatory actions. Clinical trials support its efficacy in reducing pain, improving quality of life, and lowering healthcare resource use. Despite these advances, several unmet needs remain, including subtype-specific treatment strategies, mechanistic biomarkers, and broader access to integrated care. The review concludes with a call for more personalized, mechanism-based approaches to pain management in IBS, with alverine citrate/simeticone offering a pragmatic option within this evolving therapeutic framework. Full article

Background: Wound healing contributes to restoring skin integrity. However, scars affect soft tissue in all its layers, including the superficial and deep fascia; moreover, it has been demonstrated that the fibroblasts leading the scarring process develop from progenitors located in the superficial fascia. In the past, research into scar etiology has focused primarily on the dermal and epidermal layers, leaving the role of the fasciae largely overlooked. Many patients presenting with surgical or traumatic scars complain of the increased stiffness and thickness of the scar, reduced extensibility of the area surrounding it, and chronic pain persisting even after the healing process has been completed. The purpose of this systematic review is to investigate the non-invasive tools and methods employed for the objective evaluation of scars that involve fascial layers. Methods: A systematic literature search was conducted on PubMed and WOS. Registration DOI: 10.17605/OSF.IO/SDR3Q. Results: A total of 11 articles were selected; the etiologies of scars were surgical, traumatic, and other (keloids). The investigations were conducted using ultrasound, magnetic resonance imaging, strain elastography, and shear wave elastography on the visceral fasciae, superficial fascia, hypodermis, and musculoskeletal fasciae. Sliding of fasciae was assessed by ultrasound; thickness of fasciae was assessed by ultrasound and magnetic resonance imaging; stiffness was assessed by shear wave elastography and strain elastography; and the qualitative assessment was performed via ultrasound. Conclusions: Our literature review showed that ultrasound, magnetic resonance imaging, strain elastography, and shear wave elastography are currently adopted for investigating the sliding, thickness, stiffness, and qualitative features of scars involving fascial layers. Moreover, our research showed the existence of a gap in the scientific literature on this topic. Full article

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, altered motility, and visceral hypersensitivity. Emerging evidence implicates G protein-coupled receptors (GPCRs) as key integrators of microbial, immune, endocrine, and neural signals in IBS pathophysiology. This review summarizes recent advances in understanding how GPCRs mediate gut immune regulation, microbiota–host crosstalk, metabolic signaling, and pain processing in IBS. Recent studies show that microbial metabolites (e.g., short-chain fatty acids, biogenic amines, and lipid mediators) signal through GPCRs on immune cells, epithelia, and neurons to influence intestinal homeostasis. On immune cells and neurons, GPCRs also mediate signals from external substances (such as fats, sugars, histamine, etc.) to regulate immune and neural functions. And there are challenges and future directions in targeting GPCRs for IBS, including patient heterogeneity and the complexity of host–microbiome interactions. This review provides a mechanistic framework for GPCR-based therapies in IBS. Full article

Background and Objectives: Effective pain control after laparoscopic colorectal surgery is crucial for Enhanced Recovery After Surgery (ERAS) protocols. The transversus abdominis plane block (TAPB) provides somatic analgesia but lacks visceral coverage. The quadratus lumborum block (QLB) has emerged as an alternative, potentially offering both somatic and visceral blockade, but its superiority is debated. This systematic review and meta-analysis aimed to compare the analgesic efficacy of QLB versus TAPB in this setting. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for randomized controlled trials (RCTs) up to November 2025. Primary outcomes were 24 h postoperative and intraoperative opioid consumption. Secondary outcomes included pain scores, length of hospital stay (LoS), surgery duration, and adverse events. Standardized mean differences (SMD) and risk ratios (RR) were pooled. Results: Five RCTs involving 520 patients were included. No significant difference was found in 24 h postoperative opioid consumption (SMD: −1.62, 95% CI [−3.45, 0.20]; p = 0.08) or intraoperative opioid consumption (SMD: 0.38, 95% CI [−0.36, 1.12]; p = 0.31). QLB provided better, transient pain relief at rest at 12 h (SMD: −0.30, 95% CI [−0.52, −0.07]; p = 0.01) and during movement at 6 h (SMD: −0.20, 95% CI [−0.49, −0.09]; p = 0.01). No other time points for pain showed significant differences. QLB was associated with a shorter surgery duration (MD: −5.61 min, 95% CI [−10.38, −0.85]; p = 0.02), but not LoS (p = 0.53) or rates of PONV (p = 0.24) or dizziness (p = 0.32). Conclusions: With uncertain evidence, QLB and TAPB showed no significant difference in opioid consumption. QLB demonstrated a statistically significant but transient early analgesic advantage. This heterogeneity may be due to different QLB techniques, warranting further investigation. Full article

The global obesity pandemic has unveiled adipose tissue as a pivotal, active modulator of neurological health, intricately linking metabolic dysfunction to chronic pain and cognitive decline. This review synthesizes current evidence to propose a unified “neuro-metabo-inflammatory” model of the adipose-central nervous system (CNS) axis. We articulate a framework where, in pathological states such as obesity, dysfunctional adipose tissue releases a milieu of factors—including adipokines, lipids, and extracellular vesicles—that propagate peripheral and central neuroinflammation, disrupt blood–brain barrier integrity, and impair synaptic plasticity. These processes converge to drive pain sensitization and cognitive deficits. Critically, we evaluate the clinical evidence linking visceral adiposity to multisite chronic pain and accelerated cognitive impairment, while highlighting sexually dimorphic pathways. The review moves beyond cataloging findings to prioritize the most robust mechanisms, assess evidence quality, and identify key translational gaps. We conclude by discussing emerging therapeutic strategies targeting this axis and proposing precise directions for future research to disentangle the complex temporal and spatial dynamics of adipose–CNS communication. Full article

Irritable bowel syndrome (IBS) is a disorder of gut–brain interaction characterized by recurrent abdominal pain associated with a change in the frequency and/or form of stools. Approximately one in three patients with quiescent inflammatory bowel disease (IBD), defined as the absence of endoscopic evidence of active inflammation, experience IBS-type symptoms. These symptoms are associated with reduced quality of life and increased psychological burden, and can complicate clinical assessment by mimicking conditions such as small intestinal bacterial overgrowth, bile acid malabsorption, or post-inflammatory complications. This up-to-date narrative review examines the mechanisms, diagnostic challenges, and management of IBS-type symptoms in quiescent IBD. Evidence suggests that these symptoms arise from a complex “matrimony” of functional and organic processes, including low-grade residual inflammation, altered intestinal permeability, microbiota dysbiosis, visceral hypersensitivity, and psychosocial impairment. Diagnosing IBS-type symptoms in IBD requires a “positive”, symptom-focused approach while carefully excluding active inflammation. Management should adopt a biopsychosocial approach, integrating dietary strategies (e.g., low-FODMAP diet), brain–gut behavioral therapy, biofeedback therapy, and/or pharmacological treatments such as antispasmodics, antidiarrheals, laxatives, and neuromodulators to address both physiological and psychological factors. Future research should integrate sensitive biomarkers and longitudinal follow-up to enhance diagnostic precision and guide personalized therapy. Understanding and addressing the overlap between IBS and IBD is essential to reduce the multidimensional burden on physical health, psychological well-being, and daily functioning. Full article

Recent scientific advances point towards an important role for oral and gastrointestinal health in people with chronic pain. Poor oral health (e.g., periodontitis, tooth loss) is observed in subgroups of the chronic pain population, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. In addition to poor oral health, studies have also revealed altered intestinal microbiota compositions in various types of chronic pain, including people with chronic low back pain, knee osteoarthritis, visceral pain, fibromyalgia, tinnitus, and migraine. While overweight/obesity contributes to the likelihood of gut dysbiosis, normal-weight individuals with chronic pain also more often present with poor gut health. Both gastrointestinal and oral health problems (e.g., periodontitis, tooth loss) are increasingly recognized across multiple chronic pain conditions, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. This perspective paper provides an overview of the requirements for integrating oral and gastrointestinal health in chronic pain management. First and foremost, oral and gastrointestinal health issues need to be recognized as common chronic pain comorbidities that require tailored treatment. Next to recognition of the issue, individuals seeking care for chronic pain need to be screened routinely for these oral and gastrointestinal comorbidities. In terms of management, the following options are suggested: (1) providing oral and gastrointestinal health science education; (2) considering the possible interplay between the gut microbiome and drug treatment (including polypharmacy); (3) expanding the importance of dietary interventions; and (4) considering the potential interplay with other lifestyle factors (e.g., chronic insomnia, overweight/obesity, depression and anxiety). To inform the implementation of these suggestions, longitudinal cohort studies investigating the role of oral and gastrointestinal health in people with chronic pain, as well as studies exploring possible (modifiable) factors that affect the oral and/or gut microbiome, are needed. This includes the bidirectional interplay between the gut microbiome and drugs commonly prescribed to patients with chronic pain. Likewise, adequately powered and controlled clinical trials evaluating the effectiveness of possible treatments for oral and/or gastrointestinal comorbidities in people with chronic pain represent another research priority. Such randomized clinical trials can not only examine the possible causal link between poor oral/gut health and treatment outcomes, but also inform the development of new, innovative ways to improve care for people with chronic pain. Full article

Type B aortic dissection (TBAD) requires management tailored to the disease phase and clinical presentation, with the subacute period representing a favorable window for endovascular intervention due to improved procedural safety and remodeling potential. We report the case of a 38-year-old male with hypertension, dyslipidemia, and bicuspid aortic valve disease who presented one month after symptom onset with persistent chest pain and progressive bilateral lower-limb numbness. Clinical examination suggested early spinal cord ischemia, while laboratory tests demonstrated acute hepatic and renal dysfunction. CT angiography revealed a subacute TBAD with a markedly expanded false lumen and near-complete compression of the true lumen, resulting in visceral, renal, and potential spinal malperfusion. Given the high-risk anatomy and evolving organ dysfunction, a staged hybrid strategy was undertaken. A left carotid–subclavian bypass was performed to secure proximal landing for endovascular repair, followed the next day by thoracic endovascular aortic repair (TEVAR) using two thoracic stent grafts. Postoperative recovery was favorable, with rapid resolution of neurological symptoms and normalization of hepatic and renal parameters, allowing discharge on postoperative day seven. This case underscores the importance of early recognition of malperfusion and timely hybrid intervention in subacute TBAD with severely compressed true lumen, demonstrating excellent early clinical outcomes. Full article

Acute inflammatory visceral pain (AIVP) is a prevalent yet challenging clinical condition associated with inflammatory diseases, characterized by diffuse pain that often escalates into nausea, vomiting, and systemic autonomic disturbances. The absence of effective and patient-centered therapies remains a significant clinical challenge. While dexmedetomidine (Dex) has demonstrated promising analgesic effects, its conventional intravenous administration involves slow infusion, heightening risks of infection and compromising patient comfort and compliance. Here, we present a breakthrough strategy using a hyaluronic acid (HA) hydrogel and microneedle-based transdermal system for Dex delivery to enhance clinical practicality. We successfully fabricated Dex-loaded HA hydrogel microneedles (MN/Dex), enabling efficient skin penetration and controlled drug release. Comprehensive biosafety evaluations, including skin irritation, cytotoxicity, and hemolysis assays, confirmed the excellent biocompatibility of the HA hydrogel microneedle system (HA-MN). In the acetic-acid-induced AIVP model, MN/Dex not only produced significant and sustained reduction in visceral and somatic hyperalgesia but also maintained normal physiological activity, avoiding sedation burden, preserving feeding behavior, and supporting natural mobility. MN/Dex offers a minimally invasive, easy-to-administer, and well-tolerated alternative to intravenous therapy, with the potential to transform outpatient management and improve quality of life for patients suffering from AIVP. This advanced delivery platform bridges a critical translational gap in pain management, combining efficacy with outstanding clinical adaptability. Full article

Instant Cascara (IC), a beverage obtained from dried coffee cherry pulp, represents a sustainable hydration option rich in bioactive phytochemicals, such as caffeine, chlorogenic acids, and melanoidins, which may provide effects beyond basic nutrition. This study evaluated the impact of three weeks of IC consumption on somatic and visceral sensitivity, and on neural and immune markers in the colon of male and female healthy Wistar rats. Behavioral tests showed that IC increased locomotor activity and somatic sensitivity in females (p < 0.05). Although control females were more sensitive to visceral pain than males (p < 0.05), IC intake did not significantly alter pain sensitivity in either sex. Histological and immunohistochemical analyses in the colonic myenteric plexus revealed higher enteric glial cell density and glia-to-neuron ratio (p < 0.01), but lower calcitonin gene-related peptide (CGRP)-positive fiber density (p < 0.001) in IC-treated compared to control females. Macrophages decreased in IC-treated compared with control males in the colon wall (p < 0.05), whereas their number increased in IC-treated females compared to IC-treated males (p > 0.0001). Visceral pain responses are associated with complex sex-dependent neuroimmune changes in the colon. Interestingly, IC effects appear mild under healthy conditions, possibly due to compensatory mechanisms exerted by its different phytochemicals. Further investigation is needed to determine the effects of IC in pathological situations involving visceral hypersensitivity, such as brain–gut axis disorders. Full article

Visceral pain in Irritable Bowel Syndrome (IBS) is difficult to evaluate objectively due to its complex physiological nature and lack of reliable biomarkers. Given the complexity of IBS, a multimodal physiological monitoring approach, combining electrodermal activity (EDA), electrocardiogram (ECG), and surface electromyography (sEMG), offers a promising approach to capture the autonomic and muscular responses linked to visceral pain. However, no existing wearable device supports simultaneous EDA, ECG, and sEMG acquisition from the abdomen in a format suitable for long-term, real-world use. This study presents the development and validation of a novel wearable belt for concurrent ECG, sEMG, and EDA monitoring, with EDA measured at both the torso and wrist. The system was built using modified BITalino platforms with custom-fabricated reusable electrodes and Bluetooth connectivity for real-time smartphone display. Signal quality was validated against laboratory-grade systems in 20 healthy participants during a four-stage protocol involving cognitive, orthostatic, muscular, and combined stress tasks. Time and frequency-domain analyses showed high correlations and comparable spectral features across all modalities. The belt maintained stable skin contact even during movement-intensive tasks. By enabling anatomically targeted, multimodal data acquisition, this wearable system supports real-world visceral pain assessment in IBS and is ready for deployment in ambulatory and home-based monitoring scenarios. Full article

Background/Objectives: This study investigates the pharmacological potential of 1,4-dihydropyridine derivatives, functionalized with an imidazo[2,1-b]thiazole scaffold, as selective modulators of intestinal motility. Given their structural similarity to both L-type calcium channel blockers and spasmolytics such as Otilonium Bromide (OB), we explored their repurposing for the treatment of gut motility disorders. Methods: A focused library of 83 1,4-dihydropyridine derivatives was screened for spasmolytic activity on potassium (80 mM)-induced depolarization in isolated guinea pig ileal and colonic tissues. Compounds showing pharmacodynamic profiles similar to OB and nifedipine were further evaluated for their effects on the spontaneous contractility of longitudinal and circular smooth muscle layers. Additional functional assays assessed intestinal transit, visceral nociception, and mixing/fragmentation efficiency. Microbiota safety was preliminarily tested on mixed cultures of Bifidobacterium and Lactobacillus species. Results: Compounds 62 and 65 selectively relaxed intestinal smooth muscle, primarily targeting the longitudinal layer without affecting vascular contractility. Ex vivo testing highlights that compounds 62 and 65 could both modulate gut transit and mixing without causing functional constipation or pain. Microbiota analyses showed no detrimental effects on “good” bacterial species Bifidobacterium and Lactobacillus spp. Conclusions: The favorable gastrointestinal and microbiological profiles of compounds 62 and 65, combined with their structural versatility, support their potential repurposing for functional bowel disorders. Their selective activity suggests a promising role in therapies targeting intestinal motility while preserving microbiota homeostasis, supporting the need for extended pharmacological characterization. Full article

Background and Objectives: Cancer pain continues to be a major clinical problem nowadays. This study aims to evaluate the World Health Organization (WHO) analgesic ladder effectiveness in patients with colorectal cancer and develop machine learning models to predict treatment response for precision pain management. Materials and Methods: In a retrospective observational study, a total of 107 oncological patients were analyzed, with a detailed subgroup analysis of 42 patients with colorectal cancer, hospitalized between July and September in 2022. The pain assessment used numerical rating scales at baseline and 2–3 weeks follow-up. Clinical variables included demographics, disease staging, metastatic patterns, analgesic progression, and medication usage. Machine learning algorithms (e.g., Random Forest, CatBoost, XGBoost, and Neural Network) were used to predict pain reduction outcomes. The UMAP dimensionality reduction and clustering identified the patient phenotypes. Results: Statistical analyses included descriptive methods, Chi-square and Mann–Whitney tests, and the models’ performance was evaluated by AUC. Among patients with colorectal cancer, 73.8% achieved clinically pain improvement, with a mean reduction of 2.62 points and median improvement of 3.00 points. The metastatic site significantly affected outcomes: visceral metastases patients showed median improvement of 3.00 points with high variability, patients with bone metastases demonstrated heterogeneous responses (range: −2.00 to +8.00 points), while non-metastatic patients exhibited consistent improvement. Random Forest achieved optimal predictive performance (AUC: 0.9167), identifying the baseline pain score, bone metastases, Fentanyl usage, anticonvulsants, and antispasmodics as key predictive features. The clustering analysis revealed two distinct phenotypes, requiring different analgesic intensities. Conclusions: This study validates the WHO analgesic ladder effectiveness while demonstrating superior outcomes in patients with colorectal cancer. The machine learning models successfully predict the treatment response with excellent discriminative ability, supporting precision medicine implementation in cancer pain management. Full article

Complete detachment of a cardiac myxoma represents an exceptionally rare but potentially catastrophic complication. This case report describes a young female patient who developed acute abdominal pain following vigorous physical exertion, with rapid progression to visceral ischemia and bilateral lower limb ischemia within an extremely short timeframe. Comprehensive diagnostic imaging and postoperative pathological examination confirmed this as a remarkably rare case of complete cardiac myxoma detachment. This condition has been reported in only a handful of cases in the existing medical literature. Full article

Background/Objectives: This secondary analysis aimed to compare the effects of time-restricted eating (TRE) versus calorie restriction (CR) and controls on mood and quality of life in adults with type 2 diabetes (T2D). Methods: Adults with T2D (n = 69) were randomly assigned to one of three interventions for 6 months: 8 h TRE (eating only between 12 and 8 pm daily); CR (25% energy restriction daily); or a no-intervention control group. At baseline and 6 months, mood was assessed using the Beck Depression Inventory-II (BDI-II) and the Profile of Mood States (POMS) questionnaires, while quality of life was assessed using the Rand 36-Item Short Form (SF-36). Results: Body weight significantly decreased in the TRE group (−3.38%; 95% CI, −6.04 to −0.71%, p = 0.008), but not in the CR group (−1.80%, 95% CI, −4.50 to 0.91%, p = 0.32) versus controls by month 6. Fat mass, lean mass, and visceral fat mass remained unchanged in TRE and CR groups, versus controls, from baseline to month 6. No changes were observed in depression scores (BDI-II), total mood disturbance, or any POMS subscales (tension, depression, anger, fatigue, confusion, or vigor) in either the TRE or CR groups compared to controls. Similarly, there were no significant changes in the quality-of-life SF-36 constructs of vitality, bodily pain, mental health, and general physical health in the TRE or CR group versus controls. By month 6, there were no associations between changes in body weight, quality of life, and mood outcomes in any group. Conclusions: In conclusion, our findings suggest that TRE and CR do not have any effect on mood or quality of life in adults with T2D, relative to controls. However, the participants’ baseline mood and quality of life were generally within healthy ranges, and only minimal weight loss was achieved (3.5%, TRE only), which may explain the lack of observed effects. Full article