Pain is an emotional experience almost experienced by almost every one of us. Since the pain can neither be seen nor measured, it poses a challenge to the patient as well as the clinician in understanding its complicated nature and the best way of managing it. There is no simple method of pain evaluation due to its subjective nature. However, comprehensive approaches for its evaluation exists, of which most common pain scale used are visual analog scale, Mc-Gills questionnaire, brief pain inventory (BPI) to name a few. We have tried to highlight the various advantages of the BPI scale over the other pain scales and to emphasize an improved instrument, which can be used as a promising modality for the assessment of orofacial pain.

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Piriformis syndrome has always remained as a diagnostic dilemma because of its varied presentation. Piriformis syndrome is myofascial dysfunction syndrome which causes pain not only because of trigger points within the muscle but also due to peripheral neuritis of the sciatic nerve. The sciatic neuritis is due to compression of the nerve as it passes through the greater sciatic foramen. The symptoms of sciatic nerve entrapment caused by the piriformis syndrome can be easily mistaken for radiculopathy as the nerve entrapment causes pain which radiates down below the knee and can go up to the foot. Electromyography (EMG) and nerve conduction velocity (NCV) studies can help differentiating these two conditions and can eliminate the need for the magnetic resonance imaging (MRI). In this paper, we have reported a case of piriformis syndrome which mimicked S ₁ radiculopathy, where diagnosis was confirmed by diagnostic piriformis injection.

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To compare the effectiveness of transforaminal epidural steroid injection (TFESI) vs Periforaminal ozone in low back pain with radiculopathy. Literature search was done from MEDLINE and PUBMED sites. Observational studies in both steroid and ozone groups clearly favouring each other whereas there was a significant difference between the RCT's in either group. 3 RCT's out of 4 favouring ozone treatment whereas only 2 out of 8 RCT's were in favour of epidural steroids. Comparison studies showed results more in favour of combined steroid and ozone. 2 RCT's and 1 observational study were in favour of combined ozone and steroid whereas 2 RCT's favoured ozone better than steroid and ozone. Currently studies have shown epidural steroids to be effective in inflammatory origin of pain as its proven by its short duration of action whereas ozone was shown to be effective in both short and long term mainly because of its anti inflammatory action which took care of the short term pain and its ability to denature the proteins of disc material and correct the underlying pathology resulting in effective long term relief. Studies have also shown cumulative effects of ozone and epidural steroids and we would recommend a careful selection of patients for ozone or steroid to increase the success rate and further studies would be needed to know their true potential in low back pain due to radiculopathy.

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Background: There is a growing trend towards opting for complementary and alternative medicine (CAM) in the therapeutic management of various medical disorders. We try to evaluate the current recommendations for CAM therapies in key neurological disorders. Materials and Methods: Sources like PubMed, Embase, UCLA libraries, USC libraries, and National Center for Complementary and Alternative Medicine (NCCAM) books were searched to gather data for this review. Results: We discuss the current recommendations for CAM therapies in headaches, neck pains, lower back pains, neuropathic pains, and cancer-related pains. The CAM therapies discussed include natural therapies, mind and body therapies, and several other modalities. Conclusion: We conclude that in spite of vast literature available on the CAM therapies for neurological disorders; there is little evidence for the most beneficial CAM remedies that target common neurological disorders. Although new CAM modalities are brought to light in addition to those that have existed for centuries, further scientific data from evidence-based studies is needed to accurately compare the CAM therapies amongst each other and allopathic treatments.

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Congenital insensitivity to pain syndrome with anhydrosis (CIPA) is a rare inherited disorder. It is characterized by loss of pain and temperature sensation, lack of sweating and mild mental retardation. This disorder belongs to hereditary sensory and autonomic neuropathy family (type IV). Because of these abnormalities, patients require special anesthetic care. They include titration of intraoperative opioids, an anesthetic to ensure co-operation and immobility and intra-operative temperature monitoring. Here we report a 7-year-old female child with CIPA posted for restoration and cementation for dental caries along with sural nerve and skin biopsy.

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Objective: The objective was to evaluate efficacy of a novel landmark-based technique of suprascapular nerve block (SSNB) in the treatment of shoulder pain and disability. Study Design: Prospective, observational study. Materials and Methods: Forty patients with chronic shoulder pain were treated with a new technique of SSNB. Visual analog scale for pain (VAS) and shoulder pain disability index (SPADI) were assessed before giving the block and at both the follow-up visits at the end of 1 ^st and 4 ^th week. Pain relief was also assessed on Likert scale in both the follow-up visits. Results: The baseline VAS of 8.45 ± 0.87 was significantly improved to 2.80 ± 0.70 and 5.02 ± 1.02 after 1 ^st and 4 ^th week of SSNB, respectively (P = 0.000). Similarly, the baseline total SPADI was of 71.15 ± 4.96, was significantly improved to 55.22 ± 1.32 and 57.61 ± 3.50 after 1 ^st and 4 ^th week of follow-up, respectively (P = 0.000). The mean Likert scale score after 1 week was 3.68 ± 0.656 and after 4 weeks was 4.00 ± 0.679. Conclusion: This new technique of SSNB is safe, effective, and well-tolerated in treating chronic shoulder pain and disability.

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Cervical epidural steroid injection is a common procedure performed for patients with cervical radiculopathy. Cervical epidural hematoma is a rare but known complication of Intervention Pain Treatment Procedure (IPTP) in healthy patients without coagulopathy. We report a case of cervical epidural hematoma as a complication of cervical epidural steroid injection in an elderly patient with cervical radiculopathy; resulting in right upper limb motor sensory deficit. Patient responded to conservative management and surgery was not performed since symptoms progressively improved.

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Introduction: Adductor muscle strain or sportsman hernia (SH) is one of the most common disorders in cases who underwent heavy physical activity. An injection of corticosteroids is used to treat inflammation on the last step. Recently, physiotherapy (PT) considered as one of the most effective treatment for muscle strain. The aim of this study was the evaluation of the efficacy of steroid injection compared physiotherapy in adductor muscle strain. Materials and Methods: This cohort study was conducted on the patients who have presented to the physical medicine clinic of Baqiyatallah hospital with chronic groin pain definitely diagnosed SH. Other cause of unilateral groin pain was overruled, and the patients were divided into the two groups accidentally. Patients at the first group underwent 40 mg prednisolone injection and follow-up of 4 weeks later, and at the second group, the patients underwent PT containing stretching adductor muscle lasting 30 seconds 3 times per week for 2 weeks. Results: Seventy-six male patients with the mean age of 24.62 ± 3.49 including 24 athletes, 26 soldiers, and 26 martials were enrolled whom 37 of them divided into the first group and 39 into the second one. The mean ± SD of Visual Analogue Scale (VAS) before and after treatment in first group was 7.784 ± 0.492 and 3.340 ± 0.836, respectively and in second group equals to 8.008 ± 0.457 and 3.370 ± 0.297, respectively. These differences between and within groups were statistically significant. (P < 0.05). Conclusion: Both therapeutic protocols were effectively repressed the pain scores (VAS) although PT protocol was more effective than prednisolone injection. We suggest PT protocol as the first choice of SH treatment.

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Background: Postoperative pain management is based on assessment of severity of pain. Adult patients can express their pain accurately but difficulty occurs in paediatric population. Children between 2 and 7 years of age may give biased response to any scale of pain assessment as they belong to the preoperational stage of cognitive development. Objectives: To establish the agreement between two pain scale, namely Faces Pain Scale-Revised (FPS-R) and Face, Legs, Activity, Cry, Consolability scale (FLACC) regarding assessment of severity of postoperative pain and to find out true negative in terms of specificity of combination of scale for assessment of postoperative pain. Settings and Design: Postoperative recovery unit, cross-sectional analytical study. Materials and Methods: Four hours after short surgical procedure 95 children were assessed by two pain scale and by two observers simultaneously and data submitted to analyser. Statistical Analysis: IBM SPSS (Version 20.0). P < 0.05 was considered as statistically significant. Results: Combination of these two scales show high odds ratio (39%) and kappa coefficient (0.76) suggesting excellent agreement. Specificity of combination of these scales is very high (95.1%) than individual (FPS-R-17.85%, FLACC-2.2%). Spearman's correlation coefficient (ρ) was computed to ascertain the correlation between two scales and a significant positive correlation was found (ρ = 0.727, P = 0.00). Conclusion: FPS-R and FLACC scale has excellent agreement to diagnose the severity of postoperative pain in 2-7 years of age group and combination of these two scales has high specificity to assess the severity of postoperative pain than individual.

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Objective: To evaluate the efficacy of Meloxicam mucoadhesive patches in dental pain reduction. Study Design: It was a hospital-based study. Fifty-five patients of either sex diagnosed with dental pain were included in the study. Meloxicam patches were applied on the area of chief complaint about half an hour and pain scores were recorded. Statistical analysis was done using repeated measure ANOVA (Parametric test) with P ≤ 0.05. Result: There was a significant drop in the pain scores from baseline to the score recorded after 30 min. The pain reduction was noted to be maximum in the first 20 min. Conclusion: The result of the present study revealed significant decrease in dental pain using mucoadhesive patches with no side effects and suggests that meloxicam administered in this mucoadhesive patch may present a potential therapeutic use as a strong anti-inflammatory and analgesic agent giving further scope to carry out studies for noninvasive faster pain relief.

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Background: The efficacy of glucocorticoids like dexamethasone in reducing postoperative pain has been investigated and showed that a single dose of dexamethasone significantly analgesia has advantages in terms of reduction in pain intensity, opioid requirements, rescue analgesia, and did not increase the incidence of infection and impaired wound healing. The aim of this study was to evaluate the effects of preoperative single dose of intravenous dexamethasone to the dynamics of pro- and anti-inflammatory cytokine in orthopedic surgery perioperative period. Materials and Methods: Thirty patients were studied and randomly into two groups: 15 patients received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and patient-controlled analgesia (PCA) morphine (dexamethasone group) and 15 patients received perioperative analgesia paracetamol and PCA morphine only (control group). Blood samples were taken at the time before anesthesia, immediately postsurgery, 4 h and 24 h after surgery to measure plasma levels of interleukin 6 (IL-6) and IL-10. We recorded the pain intensity and morphine requirement in 4 h and 24 h after surgery. Results: IL-6 levels in the dexamethasone group did not increased from immediately after surgery to 24 h after surgery but increased in the control group (P < 0.05). There is no difference of IL-10 levels in both groups at all measurement time. Rest and moving pain intensity from time to time in the two groups did not differ except the rest pain at 24 h postoperative (P < 0.05). Morphine requirement in the dexamethasone group was lower in the 24 h after surgery than the control group. Conclusion: The addition of dexamethasone preoperatively on the combination of paracetamol and morphine did not change plasma levels of IL-6 and IL-10 cytokines Dexamethasone provides sufficient analgesia and decrease postoperative opioid requirement.

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Background: Allopurinol and febuxostat are xanthine oxidase inhibitors which are used in the treatment of hyperuricemia and gout. Pain is one of the important symptoms in gout patients. The present study was to evaluate the analgesic activity of allopurinol and febuxostat in two analgesic models in mice. Materials and Methods: The analgesic activity of allopurinol (39 mg/kg) and febuxostat (15.6 mg/kg) was evaluated using central analgesic model of Eddy's hot plate and peripheral analgesic model of acetic acid induced writhing. Both drugs were compared with the positive control, pentazocine for a hot plate method and aspirin for the writhing method. Furthermore, both allopurinol and febuxostat were compared with each other. Results: Both allopurinol and febuxostat showed significant increase in reaction time at various time periods in hot plate method and also showed significant delay in onset of writhing as well as decrease in number of writhes in writhing method. As compared to positive control result, allopurinol and febuxostat result were lower. Febuxostat shows better analgesic activity as compared to that of allopurinol. Conclusion: Allopurinol and febuxostat exhibited analgesic activity in both central and peripheral models of pain.

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