Fetal pain is one of the most controversial topics in medicine because of the disagreement between people whether the fetus can perceive pain or not and the absence of any direct objective method for the assessment of fetal pain. Although fetus is incapable of declaring pain, various studies have shown that the mere experience of pain without the aptitude of self-contemplation is worth paying attention to, and that the pain in fetus need not be comparable to that of a mature adult to matter. Furthermore, refusing to acknowledge fetal pain in late preterm fetuses would jeopardize the advances in neonatal care because it would question the use of analgesia in neonates of similar gestational age. This systematic review article examines the neuroanatomical and physiological evidence of nociception in the fetus and its implications, which compel the need for its alleviation. It looks into the adequacy of International Association for the Study of Pain definition of pain to define fetal pain. The article also provides a brief overview of the existing literature on whether safe analgesia and anesthesia techniques exist for abortions and therapeutic fetal procedures. We performed a literature search for English-language articles using the electronic database with keywords: controversy in fetal pain, fetal anaesthesia, fetal analgesia, fetal pain, fetus, neuroanatomy of fetal pain, neurophysiology of fetal pain, nociception, and recent advances in understanding of fetal pain

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Introduction: Headache is one of the most common conditions troubling nearly 68% of the world's population. Tension-type headache (TTH) & migraine are the most common forms of classical headaches, which is nowadays mostly neglected, associated with frequent, severe pain and significant functional impairment. Transcranial direct current stimulation (tDCS), is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain. Various studies demonstrated tDCS as a valued device to treat neuropsychiatric conditions such as chronic headache & associated anxiodepressive condition. Objective: The aim of this the current review was to evaluate the effectiveness of tDCS in the management of TTH and Migraine. Results generated from various studies for the effectiveness of tDCS in TTH & Migraine. Methods: We programmed our search strategy, to identify studies pertaining to use of tDCS and pain management in TTH & migraine, within the Database of the Cochrane Library of Systematic Reviews, & various author manuscripts in PMC, MEDLINE, EMBASE, NLM, PsycINFO, Other indexed citations from inception to December 2021 and potentially relevant studies. Outcomes: The outcomes of interest include: Effective pain management, in terms of headache intensity, frequency, its episodes, associated depression, anxiety, in target population prioritised by the individual reviews. The evidences were mapped and synthesised with appropriate health problem, patient subgroups, intervention type, context and outcome.Conclusions: We found a significant reduction of pain intensity in patients receiving tDCS treatment, also the pain intensity and duration were significantly improved from baseline after tDCS treatment and during a follow-up period. There was a significant reduction of pain intensity by both anodal and cathodal stimulation conditions, with noteworthy decrease in episodic headaches equally by both 1mA and 2mA current intensities. The aforementioned works support the utility of tDCS in the pain management of TTH and migraine offering a hope for patients with this debilitating disease. However, the review shows promising results in the pain management by tDCS, but the included studies must be analysed critically since most of them were pilot studies, with some having adapted an open-label design.

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Context: Landmark-guided fascia iliaca compartment block (FICB) has been used in operation theater to facilitate patient position before administration of subarachnoid block, but its utilization is yet to be explored in the accident and emergency department for acute pain relief in patients with femoral fractures. Aims: The study aims to compare dexmedetomidine and dexamethasone as adjuvants to ropivacaine for FICB for onset and duration of analgesia. Settings and Designs: This was a prospective randomized controlled study performed in Mahatma Gandhi Memorial Medical College, Indore. Subjects and Methods: Ninety patients with femoral factures were allocated into three groups, and each group received 15 ml of study drug; (i) ropivacaine with dexmedetomidine (RD) group (0.2% ropivacaine with 50 μg dexmedetomidine), (ii) ropivacaine with dexamethasone (RM) group (0.2% ropivacaine with 4 mg dexamethasone), and (iii) ropivacaine alone (RP) group (0.2% ropivacaine). Patients were assessed for onset, duration of analgesia, and need for rescue analgesic. Severity of pain was assessed using Numerical Rating Scale (NRS) score. Statistical Analysis Used: Comparison of means of three groups was done using One-Way ANOVA and pair-wise comparisons using post hoc Tukey's test. Results: The onset of analgesia was earlier in Group RD at 4.38 min followed by Group RM at 4.45 min and Group RP at 7.86 min, whereas the duration of analgesia was longer in Group RD at 725 min followed by Group RM at 594 min and Group RP at 275 min. NRS Score was comparable before application of FICB. After the block, the mean NRS score in Group RD was 3.83, in Group RM was 5.30, and in Group RP was 7.93. Conclusions: FICB is an effective alternative to intravenous opioids and nonsteroidal anti-inflammatory drugs for acute pain relief in patients with femoral fractures, and dexmedetomidine and dexamethasone can be used as adjuvants to ropivacaine as they both enhance quality of block.

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Thoracic outlet syndrome (TOS) remains one of the underdiagnosed conditions due to the unavailability of specific tests. The pain of TOS may mimic shoulder pain and or cervical radicular pain. Understanding the pathology and type of TOS is the key to successful management. Although surgery remains the final permanent solution in a conformed case of TOS, conservative therapies do provide great relief from pain. Botox remains one of the modalities in managing TOS pain by relieving the spasm of the scalene group of muscles and thereby alleviating the compression symptoms.

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Background: Literature suggests that non-pharmacological treatments like non-invasive brain stimulation and cognitive behavioural therapy (CBT) may be used as augments in the management of Tension-Type Headache (TTH). Aims and Objectives: To assess the efficacy of Transcranial Direct Current Stimulation (tDCS) and Cognitive Behavioral Therapy (CBT) compared to treatment as usual (TAU) on headache-related disability and the psychological impact of headache on life of patients suffering from TTH. Materials and Methods: Thirty right-handed TTH patients HDI (headache disability index) > 30 were randomly allocated to group A (tDCS + TAU), group B (CBT + TAU), and group C (TAU). While the primary outcome measure was headache related disability (Headache Disability Index(HDI)), somatic symptoms (Somatic Symptom Severity (SSS-8)), anxiety & depression (Hospital Anxiety and Depression Scale (HADS)) and sleep quality (Pittsburgh Sleep Quality Index (PSQI). Assessments were done at baseline, end of the third and sixth month. Results: We found a statistically significant reduction in HDI (F=12.419, p <0.001), SSS-8 (F=4.587, p=0.010), and HADS-anxiety (F=4.810, p=0.002). tDCS showed better efficacy than CBT, while these two were significantly better than TAU on HDI and SSS-8. On HADS-A also both tDCS and CBT were better than TAU, but showed no significant difference between them. Conclusion: Supplementing non-pharmacological techniques like tDCS and CBT will be effective in reducing headache-related disability and associated psychological symptoms.

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We report here to draw attention to an uncommon complication that could arise from routinely performed procedure in pain practice such as percutaneous trigeminal radiofrequency ablation (RFA). We report a case of a 53-year-old female who underwent trigeminal nerve RFA for trigeminal neuralgia. RFA after adequate assessment with sensory and motor stimulation is performed as a routine procedure followed by 0.2 ml 1% lignocaine for dense sensory block at the target, following which the patient developed giddiness, nausea, vomiting, and nystagmus. After 2 h of rest and gaze fixation, her symptoms improved, with a decline in the severity of nystagmus. Symptoms gradually resolved over a period of 3 h. Proximity of the membranous part of the auditory tube to the foramen ovale might lead to such mishaps. Direct administration of 1% lignocaine into the middle ear via the auditory tube might be the most likely reason for her condition.

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Background: The administration of local anesthetics into the wound before the incision (preemptive analgesia) has been demonstrated to reduce postoperative pain. Aims: The aim of this study was to determine the quality of postoperative analgesia in abdominal hysterectomy by visual analog scale (VAS) in the group of 0.125% bupivacaine 15 ml with dexmedetomidine 1 μg/kg and in the group of 0.125% bupivacaine 15 ml alone. Settings and Design: A prospective observational analytical study was conducted in a tertiary care government hospital including 80 patients undergoing hysterectomy divided into two groups of 40 each. Subjects and Methods: Group A included those patients who received 0.125% bupivacaine 15 ml with dexmedetomidine 1 μg/kg and Group B patients received bupivacaine 15 ml alone. The pain was assessed by VAS. Rescue analgesia was given with diclofenac sodium 75 mg intramuscular on demand or whenever the VAS score was ≥4. The level of sedation was assessed using the four-point Sedation Scale. Nausea and vomiting were assessed by four-point categorical scales. Statistical Analysis: Mean and standard deviation were used to depict quantitative data, and paired t-test was used to compare the groups. Results: The combination of bupivacaine with dexmedetomidine has a better and longer anesthetic effect than bupivacaine alone (P < 0.001). The total diclofenac consumption in Group A was less (95.63 [±33.92] mg) than in Group B (150 [±0.0] mg), P < 0.01. Group A rescue analgesia was required after 2 h in only one (2.5%) patient, whereas in Group B, rescue analgesia was required immediately at 0 h in six (15%) patients (P < 0.001). Conclusions: The duration of analgesia was longer, and number of doses of rescue analgesia during the first 24 h after operation was significantly less in the group who received bupivacaine with dexmedetomidine when compared with bupivacaine alone.

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Background: Chronic pain is a silent pandemic with a prevalence varying from 15% to 30% globally. Yet there is widespread ignorance among health professionals as well as society. We conducted this institution-based study among chronic pain patients with the aim to know their awareness and knowledge about chronic pain and pain physicians. The gist of this study can help us in future to bridge the gap and create mindfulness among the masses regarding chronic pain. Materials and Methods: Two hundred and seventy-three people with chronic pain were questioned about their knowledge and awareness of chronic pain through a questionnaire comprising eight questions. Results: Out of 273 participants, 84.62% took treatment for chronic pain. Yet only 2% consulted pain physicians. 62.64% and 73.63% had no idea about chronic pain being a disease in itself and pain physicians, respectively. All the illiterate participants were unaware of the presence of pain specialists and 89.47% of them were ignorant of the sound effects of physical activities in treating chronic pain conditions. Conclusion: The majority of the participants were not aware that chronic pain can be a disease in itself and that there are pain physicians who specialize in treating this condition. However, most of them had an idea about the beneficial effects of performing daily physical activities. Furthermore, the level of education had an impact with illiterates having the least insight about the participants. These lacunae can be improved by educating people, creating more awareness, and further encouraging pain services.

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Shoulder pathology occurs most commonly in food service workers, who repetitively perform motions of the upper limbs. About 85% of patients who visit pain clinics complain of nonarticular musculoskeletal impairments. Myofascial pain syndrome is one of the common, painful musculoskeletal disorders characterized by the presence of trigger points in muscles at discrete places. Here is a case presenting with symptoms of myofascial pain of the upper trapezius; on clinical examination, ultrasonographic findings were diagnosed with a rotator cuff injury delaying her recovery. This also highlights the importance of clinical examination of ipsilateral shoulder joint whenever the patient presents with myofascial pain involving upper back.

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This manuscript aims to report the successful treatment of a patient with fibromyalgia using a novel approach to vagus nerve (VN) stimulation. The patient reported significant pain relief and improved performance after almost 3 months of follow-up. VN stimulation has been Food and Drug Administration approved for epilepsy and depression, but recent studies have shown its usefulness for pain management. Our novel approach is minimally-invasive compared to surgical techniques; it provides long-lasting analgesia within a single session and is cheaper than current methods. This technique should be evaluated in clinical trials to clarify the optimal parameters and treatment intervals.

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