Advancements in Health Research
type: channel
description: Advancements in Health Research (#AHRjournal) has the aim to become a world-leading medical journal, initially published on a quarterly basis. It accepts, with an open-access policy, studies by highly ranked scientists worldwide, providing scientific material to a large global audience, and aiming to have an impact on health. The publication of this journal was decided by the Fondazione Paolo Procacci based on a large consensus experienced by the previous editorial initiatives of the Fondazione. Our goal is to make science easily available to all those interested. The ambition of #AHRjournal is to serve and aid in a transformation of society, providing an improved and ethical approach to research on health, with a preferential focus on Pain Medicine and Quality of Life. We would be proud to publish papers that provide a crucial contribution to science and human health. #AHRjournal invites the submission of original content, as well as narrative reviews, systematic reviews, and meta-analyses, which may contribute to advances in medical science and practice.
publisher: PAGEPress Publications, Pavia, Italy
language: en
publication name: Advancements in Health Research
issn: 3035-1103
copyright: PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
items: An exploration into the efficacy of virtual reality for managing pain in hospitalized patients, with a focus on cancer pain
items: Evolving role of the Interleukin-5 antagonist mepolizumab for hypereosinophilic syndrome: pathogenesis and advances in therapy - A narrative review
items: AURICULAR ACUPUNCTURE IN THE MANAGEMENT OF TENSION-TYPE HEADACHE: A PRELIMINARY STUDY
items: COMPLAINTS OBSERVED AMONG PATIENTS AFTER INVASIVE PROCEDURES ON CORONARY ARTERIES
items: COMPARATIVE STUDY OF MENS AND TENS FOR PAIN RELIEF IN PATIENTS WITH PARTIAL ROTATOR CUFF TEAR (A ONE-YEAR FOLLOW-UP)
items: ERECTOR SPINAE PLANE BLOCK AND OZONE THERAPY: THE INNOVATIVE ALLIANCE AGAINST CHRONIC DISCOGENIC BACK PAIN
items: PAIN MANAGEMENT IN NURSE-LED EMERGENCY SERVICES: RESULTS OF A NATIONAL SURVEY
items: REDUCTION OF ANXIETY AND PROCEDURAL PAIN IN THE PAEDIATRIC PATIENT: THE ROLE OF NITROUS OXIDE IN VENOUS CANNULATION
items: PULSED RADIOFREQUENCY WITH ALGOCARE® TRANSDERMAL SYSTEM FOR BILATERAL GONALGIA DUE TO PAINFUL PROTHETICS: A CASE REPORT
items: EFFICACY AND SAFETY OF A FIXED-DOSE COMBINATION OF TRAMADOL/PARACETAMOL 75 MG/650 MG IN REDUCING PAIN INTENSITY IN PATIENTS WITH LOW BACK PAIN: A REAL-WORLD RETROSPECTIVE STUDY
items: CHRONIC VISCERAL PAIN TREATED WITH 10 khz SPINAL CORD STIMULATION: A CASE REPORT
items: A SURVEY OF NURSING ASSESSMENTS OF PAIN AND NON-PHARMACOLOGICAL MANAGEMENT METHODS FOR PATIENTS ADMITTED TO INTENSIVE CARE UNITS
items: PROCEDURAL ANALGOSEDATION WITH INTRAVENOUS KETAMINE PERFORMED BY PEDIATRICIANS IN THE PEDIATRIC EMERGENCY DEPARTMENT: THE REGINA MARGHERITA CHILDREN’S HOSPITAL EXPERIENCE
items: SHORT-WAVE DIATHERMY IN THE REHABILITATION MANAGEMENT OF TENSION-TYPE HEADACHE ASSOCIATED WITH NECK PAIN: A CASE CONTROL STUDY
items: PHYSIOTHERAPY TREATMENT OF SPINAL CORD INJURY PAIN: A SCOPING REVIEW
items: TOWARDS EARLY PERSONALIZED TREATMENT OF LUMBAR DISC HERNIATION: DEVELOPMENT OF A SUPERVISED DEEP LEARNING PREDICTIVE MODEL
items: PAIN DURING DRESSING CHANGES BASED ON THE ETIOLOGY OF SKIN ULCER
items: MUSCULOSKELETAL INFLAMMATORY PAIN MANAGEMENT WITH LOW-DOSE DICLOFENAC AND MICROPEA ASSOCIATION: TWO CASE REPORTS
items: CHALLENGING THE FLARE: CENTRAL AND PERIPHERAL NERVE BLOCK AS AN ACUTE INTERVENTION IN PEDIATRIC ERYTHROMELALGIA
items: SIGNIFICANT PAIN RELIEF AND QUALITY OF LIFE IMPROVEMENT IN REFRACTORY CHRONIC MIGRAINE PATIENT TREATED WITH HIGH-FREQUENCY SPINAL CORD STIMULATION
items: PORTABLE PERCUTANOUS ELECTRODE NERVE STIMULATION AS A HOME-BASED THERAPY FOR TRIGEMINAL NEURALGIA, A CASE REPORT
items: EFFECTIVENESS OF REIKI IN PAIN MANAGEMENT IN PEDIATRIC PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION
items: ITALIAN VALIDATION OF THE PEDIATRIC NURSES’ KNOWLEDGE AND ATTITUDES SURVEY REGARDING PAIN: A CROSS-SECTIONAL STUDY
items: USE OF COOLED RADIOFREQUENCY IN ULTRASOUND‑GUIDED NEUROABLATION OF SENSORY ARTICULAR BRANCHES OF THE SHOULDER: A PRELIMINARY STUDY
items: EFFICACY OF MULTIMODAL OZONE THERAPY IN PATIENT WITH ANKYLOSING SPONDYLITIS: CASE STUDY
items: MESOTHERAPY COMBINED WITH REGENERATIVE MEDICINE. A NEW APPROACH FOR NOCICEPTIVE PAIN TREATMENT IN PATIENTS WITH OSTEOARTHROSIS
items: EVALUATION OF PAIN IN FIBROMYALGIA PATIENTS TREATED WITH CANNABIS OIL
items: PERCUTANEOUS ELECTRICAL NERVE STIMULATION BIOWAVE PRO IN CHRONIC POST-HERPETIC NEURALGIA UNRESPONSIVE TO MEDICAL TREATMENT
items: AN ENGAGING EXPLORATION IN THE A.O. “S. CROCE E CARLE” CUNEO EMERGENCY DEPARTMENT
items: THE MOST RECENT RESEARCH SUPPORTS THE MOST ANCIENT TRADITIONS: THE EXAMPLE OF SCIATICA

An exploration into the efficacy of virtual reality for managing pain in hospitalized patients, with a focus on cancer pain
type: item
description: Cancer pain is highly complex and associated with a great global and individual burden. Due to its multifactorial nature, it must be addressed with a combination of pharmacological and non-pharmacological approaches. Many people with cancer feel their pain is inadequately managed, pointing to the critical need for new management approaches. Virtual reality (VR) is a promising management strategy for a variety of pain conditions, at the forefront of research. This study aims to explore the use of VR in the management of pain in hospitalized patients, focusing on cancer-related pain. A systematic review was carried out on all eligible articles published before July 2025, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Randomized control trials that investigated VR in the pain management of hospitalized adult patients were included. Thirty-three (33) randomized control trials were included in the systematic review following selection processes. Outcome measures such as the visual analogue scale, the numerical rating scale, and graphic rating scale, were commonly used; 79% of articles reported a significant reduction in pain when using VR. None of the studies reported any significant adverse effects. VR is a safe and feasible option for adjunctive, non-pharmacological pain management in hospitalized patients. Few studies investigate the application of VR in the management of cancer pain, however, those available reveal promising results. Future randomized control trials that employ a double-blinded study design would be of benefit.
subject: Systematic Reviews and Meta-Analysis
  topic: section
subject: Article Collection
  topic: category
subject: virtual reality
  topic: keywords
subject: pain management
  topic: keywords
subject: cancer
  topic: keywords
creator: Abigail Sayers
creator: Alkisti Giannaki
creator: Mohamed Hassouna
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-17
publication date: 2025-10-17
doi: 10.4081/ahr.2025.41

Evolving role of the Interleukin-5 antagonist mepolizumab for hypereosinophilic syndrome: pathogenesis and advances in therapy - A narrative review
type: item
description: Hypereosinophilic syndrome (HES) is a rare blood disorder characterized by hypereosinophilia greater than 1,500/μL on at least two separate occasions with some degree of associated end-organ damage and exclusion of other identifiable causes of hypereosinophilia. The systemic effects and damage seen in HES can be extensive, resulting in a variety of clinical presentations, but most commonly the affected organs include the lungs, heart, skin, and the gastrointestinal tract. After FDA-approval in 2020, mepolizumab (trade name Nucala) an interleukin-5 (IL-5) antagonist monoclonal antibody, is considered an effective treatment for HES given its ability to lower absolute eosinophil counts, improve the symptomatic burden, reduce the number of HES flares experienced, and limit the need for corticosteroids as a primary therapy. Also of benefit, Nucala has been shown to have a positive safety profile with limited adverse effects and no notable contraindications to treatment.
subject: Reviews
  topic: section
subject: Nucala
  topic: keywords
subject: mepolizumab
  topic: keywords
subject: hypereosinophilic syndrome
  topic: keywords
subject: IL-5
  topic: keywords
subject: monoclonal antibody
  topic: keywords
subject: eosinophilia
  topic: keywords
creator: Dorothy H. Askins
creator: Elena W. Bobo
creator: Benjamin J. Chacko
creator: Kasra A. Mansourian
creator: Sarah R. McDonough
creator: Carlo Jean Baptiste
creator: Jibin Mathew
creator: Vincent G. Klapper
creator: Adalyn S. De Witt
creator: Sahar Shekoohi
creator: Alan D. Kaye
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-14
publication date: 2025-10-14
doi: 10.4081/ahr.2025.29

AURICULAR ACUPUNCTURE IN THE MANAGEMENT OF TENSION-TYPE HEADACHE: A PRELIMINARY STUDY
type: item
description: INTRODUCTION Tension-type headache (TTH) is a common form of primary headache, often managed with symptomatic treatment such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. However, pharmacological approaches may lead to medication overuse and fail to address the underlying causes. Auricular acupuncture has shown promise in modulating pain pathways and muscle tension. This study aims to evaluate the efficacy and safety of auricular acupuncture in reducing the impact of TTH in adult women. METHODS A prospective observational study was conducted on 20 female patients aged 30 to 50 years with a positive history of TTH and ongoing symptomatic treatment with NSAIDs and muscle relaxants. Each participant underwent auricular acupuncture sessions using sterile, single-use needles (0.2 × 40 mm) applied bilaterally to specific auricular points: master cerebral point, thalamus point, paravertebral cervical musculature, occiput, and a muscle-relaxant point. Needles were retained for 20 minutes, followed by application of auricular plasters with embedded needles (0.15 × 0.6 mm), which were worn for 5 days and self-removed. Treatments were administered weekly during the first month and biweekly during the second month. To assess impact on quality of life and headache-related disability, patients completed the Headache-Attributed Lost Time (HALT) questionnaire: HALT-90 at baseline (T0), HALT-30 after 1 month, and again HALT-30 at 2 months. HALT-90 assesses disability over the prior 3 months, while HALT-30 evaluates the previous 30 days. RESULTS At baseline (T0), 15 patients reported moderate impact (Grade 3) and 5 reported mild impact (Grade 2) on the HALT-90 scale. After 1 month of treatment, HALT-30 scores indicated a reduction in disability: 5 patients showed moderate impact (Grade 2), and 15 showed mild impact (Grade 1). By the end of the second month, 15 patients reported mild impact (Grade 2), and 5 reported minimal impact (Grade 1). Additionally, all…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-07
publication date: 2025-10-07
doi: 10.4081/ahr.2025.126

COMPLAINTS OBSERVED AMONG PATIENTS AFTER INVASIVE PROCEDURES ON CORONARY ARTERIES
type: item
description: Procedures included in the survey which are coronary angiography - CAG and percutaneous coronary intervention PCI, are commonly available nowadays (in 2022 there were over 3960 of CAG per 1 million citizens a year and 2300 of PCI per 1 million citizens a year). During both procedures a patient’s position is the same - on their back with straight arms and legs. The duration of the procedures is various - from 15 minutes to over 2 hours. A patient, while coronary interventions, is exposed to multiple discomforts that very often are not even connected with coronary procedure sensu stricto, such as: low temperature of the environment, after effects of surgical complications, enforced position of the body and necessary body immobility during the procedures. The latter discomfort is very often connected with intensified pain in a locomotor system which is a significant problem among elderly patients. They constitute a substantial percentage of cathlab’s patients. There are no precise recommendations or guidelines about sedation and/or analgesia during the procedures. The aim of the article is to assess the patients’ complaints, especially pain components while CAG and PCI. MATERIALS AND METHODS The survey involves patients after CAG and PCI. A self created questionnaire. NRS scale, The Beck Anxiety Inventory (BAI) (A.T. Beck, R.A. Steer) RESULTS The 50 patients’ statements have been obtained. The conclusions are: a patient, during the procedure, is subject to multiple discomforts. They are dependant on the duration of the procedure itself , the temperature of the environment and coexistent health problems which might cause pain complaints of a different matter. These complaints may be intensified by enforced, uncomfortable body position and a hard bed. Other factors which intensify complaints are anxiety, feeling of embarrassment and being aware of danger of life. CONCLUSIONS During CAG and PCI procedures the patients suffer from pain complaints not always resulting from …
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-07
publication date: 2025-10-07
doi: 10.4081/ahr.2025.125

COMPARATIVE STUDY OF MENS AND TENS FOR PAIN RELIEF IN PATIENTS WITH PARTIAL ROTATOR CUFF TEAR (A ONE-YEAR FOLLOW-UP)
type: item
description: INTRODUCTION The aim of this study was to evaluate the effectiveness of a combined physiotherapy intervention (electrotherapy TENS or MENS - and kinesiotherapy) used to provide relief to patients suffering from partial thickness rotator cuff tears, and the comparison between the two alternative methods. METHODS Confirmation of partial thickness rotator cuff tears was made by ultrasound as to the category that caused the pain in patients participated in the study. A total of 42 patients were screened to ensure that they had not received recent medication that included non-steroidal anti-inflammatory drugs (NSAIDs) and were randomly assigned in two groups. First group receive TENS and kinesiotherapy, while the second received MENS and kinesiotherapy. Τhe tools used to assess pain intensity, disability and quality of life were the Shoulder Pain And Disability Index (SPADI), the numerical rating scale (NRS) and the Euro QoL questionnaire (EQ-5D: health today), respectively. The effectiveness of the intervention was evaluated with Anova repeated measurements analysis, within five time points (baseline, 1, 3, 6 and 12-months after the treatment) and between the two different groups of patients (TENS or MENS). In addition, we performed independent student's t and Mann Whitney-U tests to determine the existence of any statistically significant difference between the two methods used at each time point. Data are presented as means and standard deviation (SD). A P value <0.05 was defined as statistical significance. Statistical analyses were performed using the SPSS Statistics V.26 for Windows. RESULTS The results of the repeated measures analysis of variance showed significant improvement in the patients' pain scores, functionality and quality of life for both groups (p-values<0.001), right after the intervention. Although the MENS group had a higher improvement in pain level while the TENS group in disability and quality of life, differences between groups found no signific…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
doi: 10.4081/ahr.2025.123

ERECTOR SPINAE PLANE BLOCK AND OZONE THERAPY: THE INNOVATIVE ALLIANCE AGAINST CHRONIC DISCOGENIC BACK PAIN
type: item
description: INTRODUCTION The Erector Spinae Plane (ESP) block is a relatively recent locoregional anesthesia technique, increasingly used not only in postoperative spine surgery but also in the management of various acute and chronic pain conditions. Its mechanism of action is still under investigation, but most hypotheses suggest an interfascial spread affecting the dorsal rami of spinal nerves, with possible anterior diffusion into the paravertebral space. Simultaneously, ozone therapy has long been applied in the treatment of chronic discogenic low back pain (DLBP), thanks to its anti-inflammatory, antioxidant, anti-edema, and analgesic effects. However, the integration of ozone into ultrasound-guided locoregional techniques is still rarely documented. Combining ESP block and ozone may offer a novel, minimally invasive approach for patients unresponsive to conventional treatments. METHODS We describe the case of a patient with a history of chronic DLBP and acute onset of left-sided lumbosciatica (NRS 8–9). MRI revealed a median-paramedian L4-L5 disc herniation and an extruded L5-S1 disc in the left preforaminal space, with caudal migration. Initial treatment with oral methylprednisolone led to only partial improvement. After a subsequent relapse, pain was successfully managed with slow-release diclofenac (NRS 0), but recurred after discontinuation (NRS 4–5) with sciatica-like features extending from the left gluteal region to the foot, worsened by movement and positive Lasègue sign. As the patient refused epidural corticosteroid injections and was unsuitable for long-term NSAID therapy, we proposed an ultrasound-guided ESP block combined with ozone. A convex probe and a 50 mm needle were used to perform a left L4-L5 ESP block, injecting 20 ml of ozone at a concentration of 40 mcg/ml. RESULTS In the two days following the first ESP block, the patient experienced significant pain relief (NRS 2–3). This was followed by a transient increase in symptoms (NRS 4–5), but further gra…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.106

PAIN MANAGEMENT IN NURSE-LED EMERGENCY SERVICES: RESULTS OF A NATIONAL SURVEY
type: item
description: INTRODUCTION Acute pain effective management in a pre-hospital setting enables better care for patients in emergency situations. In Italy decision-making algorithms and operating protocols have been issued by the relevant authorities, such as 118 Emergency Medical Dispatch Centers (EMDC) and department or regional bodies. These tools regulate pain management procedures, even when carried out independently by emergency nurses. This study aimed to describe drugs used to treat acute pain in patients managed by nurse-led emergency services in Italy. A further objective was to determine the extent to which nurses can autonomously assess and treat acute pain during patient management. METHODS In April and May 2025, a questionnaire was sent to each Italian region's 118 EMDC. The questionnaire consisted of approximately ten closed and open-ended questions. The questionnaire investigated nursing algorithms for assessing and managing pain in adults and children. The questionnaire was completed online using Google Forms. RESULTS Out of a total of 21 118 EMDC to which the questionnaire was sent, 90.5% (n=19) responded. 89% (n=17) have decision-making algorithms in place for nurse-led emergency vehicles. In 12 of these centres, nurses can independently administer drugs in specific cases defined by the algorithms during emergency management. Of the 17 operational centres, 13 (76.4%) have specific nursing algorithms for managing pain in adults, and 12 (70.5%) have algorithms for managing pain in children. Twelve operational centres (70.5%) use nursing algorithms that include validated pain measurement scales such as the NRS (Numerical Rating Scale), VAS (Visual Analogue Scale), PAINAD (Pain Assessment in Advanced Dementia) and FACES. Nurses can independently administer the following drugs without authorisation from the 118 EMDC: paracetamol in eight cases, NSAIDs in three cases, morphine in four cases, fentanyl in four cases, ketamine in one case, and tramadol in one case. However…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.104

REDUCTION OF ANXIETY AND PROCEDURAL PAIN IN THE PAEDIATRIC PATIENT: THE ROLE OF NITROUS OXIDE IN VENOUS CANNULATION
type: item
description: BACKGROUND Procedural pain, often underestimated, is a type of pain caused by invasive diagnostic and therapeutic procedures, accompanied by emotional reactions such as anxiety, stress, and fear; it is a predictable pain that can therefore be pretreated1-2. Despite past beliefs, the perception of pain in children, especially the youngest, is high. Moreover, emotions play a pivotal role, hence healthcare professionals should prevent and control them accordingly3-4. The use of nitrous oxide (N2O), considered a possible form of analgosedation, allows to relieve pain and to reduce the procedure-related anxiety5-8. The purpose of this thesis is to test whether nitrous oxide is effective in reducing pain and procedural anxiety during peripheral venous access placement compared to standard placement in the pediatric patient (1 to 18 years old). MATERIALS A literature review was conducted in the databases PubMed, Cochrane Library, CINAHL, Embase, and TripDatabase between March and April 2024. Thirteen studies were selected, applying studies of pediatric patients undergoing minor painful procedures using N2O as inclusion criteria. RESULTS All selected studies confirm the efficacy and safety of N2O in reducing pain and anxiety in pediatric procedural settings, improving cooperation during the procedure and reducing the overall duration of the procedure5-9. N₂O is an easily manageable gas with rapid onset (1-5 minutes) and recovery (within 5 minutes of cessation of inhalation), making it suitable for its use also in the ambulatory setting. N2O administration via face mask appears to be simple and well tolerated6-7. Reported side effects are rare, mild, and transitory (e.g., nausea, dizziness, euphoria). Several studies showed that the combination of non-pharmacological (audiovisual distraction) and pharmacological techniques (local anesthetics, midazolam) further enhances its effectiveness6-8. The administered gas concentrations may vary, but the equimolar mixture (50% N₂O and…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.103

PULSED RADIOFREQUENCY WITH ALGOCARE® TRANSDERMAL SYSTEM FOR BILATERAL GONALGIA DUE TO PAINFUL PROTHETICS: A CASE REPORT
type: item
description: BACKGROUND AlgoCare® is a non-invasive, single-use device that modulates cellular processes involved in inflammation and edema via Pulsed Electromagnetic Field (PEMF) therapy. The electromagnetic field induces a low-intensity current (no heat), penetrating tissue up to 5–7 cm, disrupting pro-inflammatory molecule synthesis. Widely used in orthopedics, plastic, and general surgery, it can be applied with one or two antennas depending on the area treated. Therapy duration is typically 100 hours over two weeks. CASE DESCRIPTION A 91-year-old woman with osteoporosis and bilateral knee arthroplasties (right 1983, left 2016) experienced persistent pain in her left knee. Bone scan and CT exclude infection or loosening. A genicular nerve block gave >50% relief. In December 2024, conventional radiofrequency denervation (RFD) was performed, yielding only temporary benefit. Three months later, RFD was repeated using transdermal ALGOCARE®, with full pain relief but residual stiffness. As pain worsened in the right knee, bilateral ALGOCARE® RFD was performed (20 min, 1.4 A, 50 V, 30 Ohm). After one month, the pain score dropped from 8 to 2, with QoL stable at 30%. MATERIALS AND METHODS Between June 2023 and June 2024, a double-blind randomized trial was conducted in Western Rajasthan, India, enrolling 180 patients (mean age 57) with knee osteoarthritis (ACR criteria, KL grades 2–4) and chronic pain >3 months. The study compared standard 3-nerve RFD (SMGN, SLGN, IMGN) to an extended 5-nerve protocol that added the infrapatellar saphenous nerve (IPBSN) and recurrent fibular nerve (RFN). RESULTS Pain (NRS), function (TUG), and QoL (KOOS subscale) were measured at baseline, 1 and 3 months. No significant differences emerged between groups, though both showed clinical improvement. The 5-nerve group had greater QoL gains at 3 months, suggesting possible long-term benefit. DISCUSSION PEMF use reduces pain, analgesic need, and anxiety, supporting faster recovery and lower costs. Broader…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.99

EFFICACY AND SAFETY OF A FIXED-DOSE COMBINATION OF TRAMADOL/PARACETAMOL 75 MG/650 MG IN REDUCING PAIN INTENSITY IN PATIENTS WITH LOW BACK PAIN: A REAL-WORLD RETROSPECTIVE STUDY
type: item
description: INTRODUCTION Low back pain (LBP) is a complex and multifactorial condition affecting a substantial portion of the population.1 Prevalence estimates suggest that up to 80% of adults will experience at least one episode of LBP during their lifetime.2 One promising approach for LBP management is the use of combination therapies, which allow for lower dosages of each active ingredient, potentially reducing the risk of side effects.3 Tramadol/paracetamol combinations have been used in clinical practice to manage various pain conditions.4-6 The multimodal action of tramadol, combining opioid and monoaminergic mechanisms, and paracetamol, an analgesic with minimal cyclooxygenase inhibitory activity, results in a comprehensive effect on pain by targeting both nociceptive and neuropathic components.7 This study aimed to assess the effectiveness and safety of a fixed-dose tramadol/paracetamol combination (75 mg/650 mg) for LBP management. METHODS In this real-world retrospective study, 100 adults with moderate-to-severe LBP were treated with tramadol/paracetamol over 15 days. Pain intensity through the NRS (Numeric Rating Scale), disability level through the ODI (Oswestry Disability Index) and patient satisfaction through a 4-point Likert scale, alongside the frequency and types of adverse events and dropout rate, were assessed. RESULTS A significant reduction in pain intensity, as measured by the NRS, was observed at T1 (day 7), with mean scores decreasing from 6.76 at baseline to 2.66 (p ≤ 0.05). This reduction was maintained at T2 (day 15), with a mean score of 2.35 (p ≤ 0.05) (Figure 1). The ODI improved from 37.5 at baseline to 4.06 at T2 (day 15) (p≤0.05) (Figure 1). Patient satisfaction on day 15 was moderate, with a score of 1.96 on a 4-point Likert scale. Adverse events, primarily nausea and constipation, were reported by 5% of patients. The dropout rate was also 5%, and in all cases, it was due to adverse events and not treatment inefficacy. CONCLUSIONS Tramadol/par…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.102

CHRONIC VISCERAL PAIN TREATED WITH 10 khz SPINAL CORD STIMULATION: A CASE REPORT
type: item
description: INTRODUCTION Visceral pain originates from thoracic, abdominal, or pelvic organs. It is typically diffuse, poorly localized, and described as cramping, pressure-like, or deep aching1. Pathophysiology involves activation of unmyelinated C fibers due to mechanical distension, ischemia, or inflammation. Signals are transmitted via autonomic pathways to the CNS. A key feature is spinal convergence of visceral and somatic afferents, resulting in referred pain. Autonomic symptoms (e.g., nausea, sweating, tachycardia) and strong emotional components are also common, due to limbic system involvement. Diagnosis and management are often complex, requiring multimodal approaches. CASE PRESENTATION A male patient was referred for chronic right hypochondrial pain. History included benign prostatic hyperplasia, right radiculopathy, and left coxalgia, previously treated with infiltrations. The patient reported 10 kg weight loss due to pain. Ongoing medications included buprenorphine patch (52 mcg/h), oxycodone/naloxone (20 mg TID), pregabalin (75 mg BID), duloxetine (30 mg daily), and vaporized high-THC cannabis (four times/day). Pain began eight years earlier, described as constant stabbing in the right hypochondrium, alleviated by walking and worsened by sitting. Flares improved with intramuscular diclofenac. MRI revealed right renal inflammatory changes; PET showed somatostatin receptor uptake in the duodenopancreatic area. Lumbar MRI was normal. Given the diagnosis of drug-resistant chronic visceral pain, the patient underwent two-stage high-frequency spinal cord stimulator (SCS 10 kHz) implantation between May and June 2024, without complications. Leads were placed between T3–T6 in a right median-paramedian position. RESULTS At 1, 3, 6, and 12-month follow-ups, the patient reported substantial pain relief (NRS reduced from 9/10 to 2/10), improved quality of life (EQ-5D-5L from 0,130 to 0,758), and decreased use of analgesics. The patient is currently receiving transdermal bupr…
subject: Abstracts
  topic: section
subject: Newsletter
  topic: category
subject: Article Collection
  topic: category
subject: Abstract(s)
  topic: keywords
rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.100

A SURVEY OF NURSING ASSESSMENTS OF PAIN AND NON-PHARMACOLOGICAL MANAGEMENT METHODS FOR PATIENTS ADMITTED TO INTENSIVE CARE UNITS
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description: INTRODUCTION Pain assessment and management for patients admitted to intensive care is a complex healthcare issue. The Behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (C-CPOT) are recommended by guidelines as suitable tools for adequately assessing pain in such patients. When it comes to pain management, it may be more beneficial to use pharmacological and non-pharmacological methods synergistically. This study aimed to investigate nurses' approach to pain when caring for critically ill patients who require sedation and/or mechanical ventilation, and who are unable to communicate about pain. METHODS Between August and October 2022, a questionnaire was administered to 260 nurses working in intensive care units in the Sardinia region. The questionnaire consisted of 32 closed and open-ended questions. It investigated the tools used to measure patients' pain, such as behavioural and quantitative scales, and the care interventions used to manage it. The questionnaire was completed anonymously via an online form. Data analysis was performed using Excel®. RESULTS A total of 136 nurses (52.3%) responded to the questionnaire. Of these, 95 were female (69.9%), mainly aged up to 40 years (61.7%), and had worked in intensive care for between two and five years (41.2%). The nurses believed that sedated patients admitted to intensive care experienced pain only sometimes (M = 3.27; 1-5 = Never-Always) and reported that they could recognise patients' pain only sometimes (M = 3.80; 1-5 = Never-Always). Of the nurses, 41.9% (n = 57) stated that they use pain assessment scales during care. However, only 25% of the entire sample (n = 34) reported using the BPS, C-CPOT, or both scales (28 nurses use the BPS, and 11 use the C-CPOT). The remaining 23 nurses only use quantitative scales (VAS - Visual Analogue Scale and NRS - Numerical Rating Scale). Other tools associated with the above include the VRS (Verbal Rating Scale), vital sign monitoring, and observation o…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.97

PROCEDURAL ANALGOSEDATION WITH INTRAVENOUS KETAMINE PERFORMED BY PEDIATRICIANS IN THE PEDIATRIC EMERGENCY DEPARTMENT: THE REGINA MARGHERITA CHILDREN’S HOSPITAL EXPERIENCE
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description: INTRODUCTION Recognizing and managing pain is a key objective in every pediatric Emergency Department (ED). Preventing pain during procedures is equally important, and procedural analgosedation (PAS) is an effective mean of achieving this. Among the drugs used for moderate to deep PAS, ketamine stands out due to its analgesic, sedative, and dissociative properties, while maintaining cardiovascular and respiratory stability. These characteristics make it suitable for use by non-anesthesiologist medical staff, provided they receive appropriate training in its administration and in managing potential side effects1. The aims of this retrospective study are: 1. To describe the training completed by ED pediatricians at the Regina Margherita Children’s Hospital (OIRM) in Turin for the administration of intravenous (IV) ketamine for PAS 2. To analyze the use of ketamine in the pediatric ED in order to identify potential areas for improvement. METHODS The study was conducted in the pediatric ED of OIRM, which treats approximately 40,000 patients annually. Pediatricians at the OIRM ED underwent a structured training program consisting of three 4-hour theoretical and practical sessions, held within the hospital and supervised by an anesthesiologist experienced in PAS. Key topics included drug interactions, monitoring systems, and the assessment of vital function recovery following PAS. During training, pediatricians were mentored by anesthesiologists and progressively gained autonomy in performing IV ketamine PAS. Upon successfully completing a final assessment, they were authorized to independently administer IV ketamine for PAS in the ED, in accordance with the regional protocol “Management of acute and procedural pain in children in out-of-hospital settings, emergency departments, and pediatric units of Piedmont hospitals”. RESULTS Between July 1, 2023, and April 30, 2025, 7 pediatricians completed the training. The training focused on identifying suitable candidates for PA…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.96

SHORT-WAVE DIATHERMY IN THE REHABILITATION MANAGEMENT OF TENSION-TYPE HEADACHE ASSOCIATED WITH NECK PAIN: A CASE CONTROL STUDY
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description: INTRODUCTION Tension-type headache is the most common neurological disorder worldwide and is often associated with neck pain. Cervical musculoskeletal dysfunctions are frequently observed in this patients, suggesting a potential role for physical rehabilitation. Short-wave diathermy (SWD) is a deep-heating technique known to raise pain thresholds, reduce muscle spasms, and improve soft tissue flexibility. This single-center retrospective case-control study aims to evaluate the effectiveness of SWD as an adjunct to conventional rehabilitation in adults with tension-type headache and neck pain. MATERIALS AND METHODS The study was conducted at the Neurorehabilitation Unit of the University of Verona. The study population consisted of 42 adults with persistent tension-type headache and neck pain. Participants were divided into two groups. SWD was administered using the ProNexibus Plus® device (focusMED srl, Montegrotto Terme, Italy). The case group received 20 minutes of short-wave diathermy and 20 minutes of myofascial release (pompage), while the control group underwent 20 minutes of pompage followed by 20 minutes of therapeutic neck exercises. Both groups completed a total of 10 rehabilitation sessions, each lasting 45 minutes, for 5 weeks. Inclusion criteria were: age ≥18 years; persistent headache associated with neck pain for more than 8 weeks at the time of inclusion; pain intensity ≥2 on the Numerical Pain Rating Scale (NPRS); and stable pharmacological treatment. Exclusion criteria included: participation in other clinical trials; diagnosed specific causes of headache or cervical pain (e.g., trauma, rheumatic or systemic disorders); presence of central or peripheral neurological signs; cognitive impairment; prior cervical spine surgery; and known or suspected disorders affecting sensory or vascular pathways (e.g., migraine, hypertension). Patients were evaluated at two time points: before treatment (T0) and one week after the completion of the intervention (T1)…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.95

PHYSIOTHERAPY TREATMENT OF SPINAL CORD INJURY PAIN: A SCOPING REVIEW
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description: INTRODUCTION Pain - whether nociceptive, neuropathic, or nociplastic - is a key clinical concern in physiotherapy and a major challenge in the management of individuals with spinal cord injury (SCI). In this population, pain may present in diverse forms: neuropathic, reflex, below-level, above-level, as well as paradoxical and dysreflexic responses to nociceptive stimuli. These complex patterns often compromise rehabilitation outcomes and quality of life. Non-pharmacological strategies, particularly physiotherapy, are central in SCI pain management. Physiotherapists play a crucial role within multidisciplinary and interprofessional teams, offering personalized and evidence-based interventions such as therapeutic exercise, neuromodulation, electrotherapy, neurodynamic techniques, hydrotherapy, and manual therapy. Mapping these approaches is essential to guide clinical decision-making and ensure equitable access to effective treatments. This scoping review aims to systematically explore and describe the range, characteristics, and extent of physiotherapy interventions for SCI-related pain, identify gaps in knowledge, and support integrated non-pharmacological pain management strategies. MATERIALS AND METHODS The review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A structured search strategy based on the PIO (Population, Intervention, Outcome) framework was applied. The databases consulted were PubMed, PEDro, and the Cochrane Library. Inclusion criteria comprised studies addressing physiotherapy interventions for pain management in SCI, regardless of study design. Two independent reviewers performed screening and data charting. RESULTS Screening and extraction are ongoing. Preliminary data reveal a wide use of physiotherapy modalities, with therapeutic exercise being the most frequently studied and evidence-supported. Other interventions include electrostimulati…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.60

TOWARDS EARLY PERSONALIZED TREATMENT OF LUMBAR DISC HERNIATION: DEVELOPMENT OF A SUPERVISED DEEP LEARNING PREDICTIVE MODEL
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description: BACKGROUND Aside from severe neurological deficits, choosing surgery versus conservative care for lumbar disc herniation (LDH) is poorly supported by current evidence. Randomized trials exclude early-surgery patients, require 6–8 weeks of conservative therapy before enrollment, and suffer high dropout/crossover rates, limiting applicability. Moreover, “conservative treatment” lacks standardization and often conflates acute and chronic presentations. As a result, guidelines defer surgery until 6 weeks–4 months of failed conservative care—potentially extending work disability, raising costs, and heightening pain chronification. PURPOSE To develop and validate a supervised deep learning model that leverages easily obtainable anamnesis data to predict the 6-month clinical outcomes of conservative treatment in patients with lumbar disc herniation. The ultimate goal is to support early clinical decision-making by identifying, at the first evaluation, patients most likely to benefit from conservative management. METHODS Patients with lumbar disc herniation are being prospectively enrolled at the Hospital of Trento, with detailed anamnesis and clinical data collected at baseline. Six months after either conservative treatment or surgery, patients are re-evaluated to determine the Oswestry Disability Index (ODI), which serves as the primary outcome. A supervised deep learning model is constructed using a compact neural network architecture, trained using stratified tenfold cross-validation with cyclical learning rates. Model performance is evaluated both as a continuous ODI prediction and within clinically meaningful score ranges. RESULTS Although data collection is ongoing, the study is designed to evaluate model performance both as a continuous ODI prediction and as a categorical prediction within 5–6 clinically meaningful score ranges. This classification approach aims to enhance interpretability and better reflect real-world decision-making thresholds. Additionally, the …
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subject: Abstract(s)
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.58

PAIN DURING DRESSING CHANGES BASED ON THE ETIOLOGY OF SKIN ULCER
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description: INTRODUCTION Pain associated with chronic skin ulcers, particularly during dressing changes, remains an underestimated issue. In recent decades, medical research has primarily focused on wound healing with the aim of improving the effectiveness of dressings and treatments and reducing the healing time. However, other important patient concerns, such as pain during treatment, have been largely overlooked. The 2004 EWMA Position Document was specifically developed to provide guidelines on how to assess and manage pain during dressing changes for chronic wounds. OBJECTIVE This master's thesis project aims to identify and compare the scientific evidence available in databases regarding this topic and to propose a training program for healthcare personnel, as well as the collection of clinical case data in the future within the Internal Medicine Department of the AOU San Luigi of Orbassano. RESULTS Patients with venous, arterial, mixed vascular lesions, and burns experience the most pain during dressing removal. Surgical wounds, on the other hand, tend to be the least painful. Pain-inducing procedures during dressing changes include touching the wound, cleaning the wound, applying a new dressing, and the waiting time before the procedure begins, which may trigger anticipatory psychological distress due to negative and painful memories of previous dressing changes. DISCUSSION The literature does not contain articles that clearly and significantly differentiate the level of pain between skin lesions of different etiologies. A few articles, although of little statistical value, indicate which types of skin lesions are more painful during dressing removal—findings that have been confirmed in the small clinical data collection conducted on Internal Medicine patients. CONCLUSIONS Nursing staff must be professionally competent, well-trained, and motivated to act in the patient's best interest. Currently, there is a large amount of information, methods, techniques, and materials…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.57

MUSCULOSKELETAL INFLAMMATORY PAIN MANAGEMENT WITH LOW-DOSE DICLOFENAC AND MICROPEA ASSOCIATION: TWO CASE REPORTS
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description: INTRODUCTION Inflammatory pain management is a common problem representing a clinical challenge. While non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, are widely used, their long-term or high-dose use should be limited due to the risk of dose-dependent side effects1. Protracted pain can lead to exhaustion of palmitoylethanolamide (PEA), an endogenous molecule with anti-inflammatory, analgesic and neuroprotective properties attributable to its ability to modulate mast cells and microglia. Then, PEA administration becomes essential to restore its endogenous levels and body homeostasis2. The association of diclofenac and PEA, particularly in its micronized and ultramicronized (m/umPEA) formulations (microPEA), could represent an innovative strategy for pain relief, combining efficacy and safety. Preliminary preclinical evidence demonstrated that combining microPEA with diclofenac enhanced the analgesic effect of the latter, allowing a reduction of its effective dose3. Here we reported the cases of two patients with musculoskeletal inflammatory pain, treated with the aforementioned association. METHODS A 32-year-old man (case 1) and a 55-year-old woman (case 2) suffering from pain associated with previous shoulder dislocation and tendinopathy respectively, were treated with mPEA 300 mg + umPEA 600 mg (Normast® MPS microgranules) 2 sachets/day in combination with diclofenac prolonged-release tablets, at the low dose of 75 mg/day for 10 days. MicroPEA treatment was then prolonged at the same dosage for another 20 days. Throughout the treatment period, patient 1 was also managed with conservative physical rehabilitation (FKT every other day for 10 sessions) and magnetotherapy, while patient 2 performed exercises independently at home. Pain severity (Numeric Rating Scale, NRS) and blood pressure were self-monitored by patients daily. Patients’ subjective impression and clinician’s opinion about patient’s global improvement were assessed at the end of the…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.55

CHALLENGING THE FLARE: CENTRAL AND PERIPHERAL NERVE BLOCK AS AN ACUTE INTERVENTION IN PEDIATRIC ERYTHROMELALGIA
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description: Erythromelalgia (EM) is a rare and debilitating syndrome characterized by episodes of burning pain, erythema, and warmth, affecting the distal extremities. Attacks are precipitated by heat or exertion and relieved by cooling. EM may be classified as primary, most often linked to SCN9A mutations, or secondary to systemic conditions, mostly myeloproliferative diseases. The pathophysiology involves hyperexcitable nociceptive neurons and vasomotor dysregulation due to sympathetic hypoactivity. Diagnosis is clinical, based on the characteristic symptoms. Treatment remains challenging: there is no curative approach, and pharmacologic therapies yield inconsistent results. In particular, acute episodes resistant to conventional pain management demand alternative strategies. Despite the pathophysiological rationale, there is scarce literature addressing procedural interventions like central and peripheral nerve blocks (PNBs), especially in the pediatric population. Nerve blocks directly inhibit nociceptor transmission and can interrupt the pain-autonomic feedback loop contributing to symptom perpetuation. We present the case of a 17-year-old boy with first-onset primary EM, unresponsive to standard analgesia and adjuvant medications. His clinical course was marked by progressive, unremitting pain in all four limbs, associated with cutaneous hyperemia, edema over the course of forty days. Diagnostic investigations were unremarkable, and multiple therapeutic attempts failed, therefore he was subsequently referred to our center. The patient arrived to our attention in disabling conditions, unable to walk, with a significant degree of weight loss (10 kg), in profound psychological distress, including insomnia and anti-conservative ideation. He was already in therapy with tapentadol, gabapentin and mexiletine. Given the severity and refractoriness of symptoms, an early procedural approach was adopted. Bilateral upper limb PNBs (median, ulnar, radial nerves) with perineural cathet…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.54

SIGNIFICANT PAIN RELIEF AND QUALITY OF LIFE IMPROVEMENT IN REFRACTORY CHRONIC MIGRAINE PATIENT TREATED WITH HIGH-FREQUENCY SPINAL CORD STIMULATION
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description: INTRODUCTION A significant number of chronic migraine patients fail conventional medical treatment, becoming highly disabled. High-Frequency 10 kHz Spinal Cord Stimulation (10kHz SCS) have been used as a physical therapy for refractory migraine in a limited number of patients, showing promising results1-4. We report the case study of a young patient with a long history of severe and invalidating migraine treated with cervical 10kHz SCS. METHODS The subject underwent a 2 weeks cervical HF10 SCS trial followed by a permanent system implant as subjective pain reduction was reported during the trial. Two leads were placed at the C1-C2 level. Stimulation parameters included 10-kHz frequency, 30-μs pulse width delivered via bipole, and amplitude range of 0.5 to 3.5 mA. Optimal bipole location and amplitude were adjusted per patient feedback. At permanent implantation, a second program was added for neck and shoulder pain and patient was instructed to activate it as needed. RESULTS The patient is a 43 years old woman with a familiarity for headache and chronic migraine since the age of 8. Migraine was diagnosed as without aura but episodes with aura were present as the condition progressed in recent years. The subject had undergone several multi pharmacological conventional treatments with limited relief, and Greater Occipital and Peripheral Occipital Nerve Block, Greater Occipital and Peripheral Bilateral Pulsed Radiofrequency with no benefit. At the time of SCS implantation, the patient was treated with monoclonal antibody galcanezumab, therapeutic cannabis, venlafaxine, pregabalin, delorazepam, estrogen-progestin, and ibuprofen. Pain manifested daily as a continuous pain, flaking frequently as invalidating events (up to 14 per month) with pulsing unilateral periorbital or occipital-nape pain associated with photophobia, phonophobia, nausea, vomit, tinnitus, and vertigo. After a month of neurostimulation with 10kHz SCS, the patient self-reports a 50% pain relief with no …
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.53

PORTABLE PERCUTANOUS ELECTRODE NERVE STIMULATION AS A HOME-BASED THERAPY FOR TRIGEMINAL NEURALGIA, A CASE REPORT
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description: INTRODUCTION Trigeminal neuralgia is a painful condition characterized by intense and recurrent episodes of facial pain. Various therapeutic options have been explored, including Percutaneous Electrical Nerve Stimulation (PENS) at the emergence points of the affected branches of the trigeminal nerve. The possibility of performing the treatment at home using PENS devices allows for long-term, non-invasive pain management with few or no side effects. MATERIALS AND METHODS A 67-year-old woman presented for consultation due to a severe neuralgia experienced in the second and third branches of the trigeminal nerve scoring her pain as a NRS 6/10. Her medical history includes depression under treatment with mirtazapine 15 mg/day. In 2006, she underwent extraction of an impacted upper right third molar and one month after she developed neuralgia in the maxillary and mandibula branches on the right side. In 2016, she underwent microvascular decompression for marked neurovascular conflict, which resolved the symptoms but left a burning sensation exacerbated by chewing, oral hygiene, and speech. Maxillofacial evaluation did not reveal any pathological conditions explaining this symptomatology. Pharmacological management attempts over the years were unsuccessful due to persistence of symptoms or significant side effects from medications (pregabalin, carbamazepine, duloxetine). Two trials of pulsed radiofrequency (PRF) on the emergence of the trigeminal nerve were carried out (2020 and 2023) achieving about 60% of pain relief each time but symptoms gradually recurred in the following months. An adjunctive therapy was prescribed, including B-group vitamins, alpha-lipoic acid, and Palmitoylethanolamide (PEA). In January 2025 follow-up visit, patient reported persistent neuropathy and difficulties with speech and chewing, despite the absence of pain paroxysms. Medical therapy with duloxetine 30 mg was started, and the patient underwent a PENS session with percutaneous electrode arr…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.49

EFFECTIVENESS OF REIKI IN PAIN MANAGEMENT IN PEDIATRIC PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION
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description: BACKGROUND Reiki, recognized by the WHO among complementary treatments, supports and integrates conventional therapy in various hospital settings. Studies have confirmed the positive results produced by Reiki in terms of psychophysical well-being in adult patients suffering from oncological pathologies, while the literature regarding the pediatric oncology population is currently scarce. OBJECTIVES This study intends to evaluate the feasibility and effectiveness of Reiki in providing pain relief among pediatric patients undergoing hematopoietic stem cell transplant hospitalized in the Pediatric Oncohematology Department. METHODS This pilot study enrolled pediatric patients undergoing hematopoietic stem cell transplantation to examine the impact of Reiki on pain. The changes in pain at different times were analyzed: during the Reiki session, before and after the session, and on the day of the session compared to a day of rest. RESULTS The pilot study analyzed 88 Reiki sessions conducted with nine patients. The results indicate a significant decrease in pain in the short and medium term with a sustained effect in the long term. CONCLUSIONS This study investigates the application of Reiki as a supportive intervention for pediatric patients during hematopoietic stem cell transplantation. Preliminary results suggest that the integration of Reiki into clinical practice, administered by trained pediatric nurses, may promote well-being and alleviate suffering in children with cancer.
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.50

ITALIAN VALIDATION OF THE PEDIATRIC NURSES’ KNOWLEDGE AND ATTITUDES SURVEY REGARDING PAIN: A CROSS-SECTIONAL STUDY
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description: INTRODUCTION Pediatric pain management remains a critical issue in clinical practice, with underassessment and suboptimal management frequently reported, often due to healthcare providers' limited knowledge and cultural misconceptions. This leads to long-term physical, emotional, and psychological consequences. In Italy, no validated tool currently exists to systematically assess nurses’ knowledge and attitudes regarding pediatric pain. This study aimed to translate, culturally adapt and validate the Italian version of the PNKAS, revised by Riemann et al. (2007), applicable to nurses who care for pediatric patients not only in the oncology setting. METHODS The study followed ISPOR guidelines (Wild et al., 2005) for the linguistic and cultural validation process. A cross-sectional multicenter validation study was then conducted with a convenience sample of 298 Italian registered nurses working in pediatric settings. Psychometric analyses included item difficulty, internal consistency, Confirmatory Factor Analysis (CFA), and test-retest reliability using Intraclass Correlation Coefficients (ICC). RESULTS The Italian version PNKAS demonstrated good psychometric properties. Internal consistency reached a satisfactory level (Cronbach’s α = 0.728) and test-retest reliability showed high stability (r = 0.712; ICC = 0.801). CFA supported a three-factor model (assessment, treatment, epidemiology), with strong fit indices (CFI = 0.92; TLI = 0.91; RMSEA = 0.06). The scale demonstrated good item coherence (Infit/Outfit MnSq between 0.85–1.35) with difficulty ranging from −2.64 to 2.51. Despite this, the proportion of correct answers was 59.8%, with no respondent scoring ≥80%. Items related to pharmacology and pain assessment were particularly challenging. Notably, pediatric specialization was associated with higher scores compared to general nursing education or years of experience alone. CONCLUSIONS The Italian PNKAS is a valid and reliable tool to evaluate pediatric pain mana…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.48

USE OF COOLED RADIOFREQUENCY IN ULTRASOUND‑GUIDED NEUROABLATION OF SENSORY ARTICULAR BRANCHES OF THE SHOULDER: A PRELIMINARY STUDY
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description: INTRODUCTION Pulsed and/or thermal radiofrequency (RF) is used to treat chronic shoulder pain, with results that are sometimes inconsistent1. Recent anatomical studies have determined the precise location of the articular branches of the main nerves innervating the joint capsule: suprascapular, lateral pectoral, and axillary nerves. Cooled radiofrequency is a neuroablative treatment modality that has proven effective in various anatomical sites. Targeting these nerves, combined with the larger lesion size, may lead to a longer-lasting pain relief2. The aim of this study is to evaluate the effectiveness of ultrasound-guided cooled radiofrequency for the treatment of chronic shoulder pain. METHODS We conducted a retrospective study. All patients aged between 18 and 90 who provided informed consent, underwent a positive diagnostic block, and subsequently received cooled radiofrequency treatment of the suprascapular, lateral pectoral, and axillary nerves under ultrasound guidance for chronic shoulder pain. The treatments were performed between 04/2024 and 11/ 2024 at Bellaria Hospital in Bologna. Demographic data were collected, and pain and quality of life were assessed using the Numerical Rating Scale (NRS) and the Brief Pain Inventory (BPI) questionnaire, respectively, at baseline (T0) and at 1, 3, and 6 months post-procedure. Quantitative variables were expressed as mean and standard deviation after checking for normal distribution using the Shapiro-Wilk test. A Linear Mixed Model for repeated measures was used to evaluate the trend of the outcomes over time, as well as the change in outcomes. In each model, the timepoints were considered fixed effects, while the patients were treated as random effects. RESULTS Eight patients were included in the study group. The mean age was 76 ± 6.3 years, and 87.5% of the participants were female. Table 1 describes the trends of mean NRS, BPI Pain, and BPI Quality of Life over time. The Linear Mixed Model for repeated measures sh…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.46

EFFICACY OF MULTIMODAL OZONE THERAPY IN PATIENT WITH ANKYLOSING SPONDYLITIS: CASE STUDY
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description: INTRODUCTION Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the sacroiliac joints and the spine, leading to stiffness, pain, and functional limitation. The rationale for multimodal ozone therapy includes: GAET, topical application of a rechargeable biodynamic and transdermal tape with gradual release of Ozoile (stable ozonides), and infiltrative ozone therapy. The protocol is proposed to modulate inflammation, control pain, and improve quality of life. Case Presentation: A 48-year-old patient with ankylosing spondylitis came to our for poorly controlled pain, insomnia, confusional state, and hallucinations. The patient had been on Methotrexate and Fentanyl TTS 50 µg/h for 2 years. Due to insufficient analgesic response and adverse effects, an integrated treatment plan was initiated with multimodal ozone therapy and equianalgesic transdermal buprenorphine (70 µg/h). The objective of this study is to highlight the specific analgesic action of multimodal ozone therapy, considering the high baseline pain levels and disease impact1. MATERIALS AND METHODS Outcomes evaluated: Pain (VAS), physical function (BASFY index), sleep quality and side effects were monitored through structured clinical interviews. Clinical controls were evaluated weekly for 60 days. Treatment protocol: • GAET: 1 session/week, 100 ml of ozone at 25 µg/ml in 100 ml of blood (1st session), 30 µg/ml (subsequent sessions); • Transdermal tape: 2 applications/week of rechargeable taping with microcells for gradual release of Ozoile; • Ozone infiltrations: 1 infiltration/week in the lumbosacral region (12 µg) RESULTS VAS score dropped from 8 to 6 after the first session, and progressively to 2. Insomnia, confusion, and hallucinations resolved. BASFI improved from 120 to 50. CONCLUSIONS Improvements in reduction of pain, sleep quality, and resolution of the confusional state and hallucinations, occurred in close temporal correlation with the start of treatment. GAET decreased…
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.47

MESOTHERAPY COMBINED WITH REGENERATIVE MEDICINE. A NEW APPROACH FOR NOCICEPTIVE PAIN TREATMENT IN PATIENTS WITH OSTEOARTHROSIS
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description: Regenerative medicine focuses on repairing or restoring damaged tissues by promoting the biological activity of cells at the target site. This goal is achieved through the in vivo stimulation of cellular mechanisms responsible for tissue regeneration, often mediated by the administration of biofunctional molecules.1 The drug Placentex (Mastelli S.r.l., Italy), based on polydeoxyribonucleotide (PDRN), was used in the present study. In musculoskeletal disorders such as arthritis, pain often results from peripheral tissue inflammation (nociceptive pain) and may be accompanied by nerve damage or dysfunction (neuropathic pain). These pain types often coexist. No universally accepted standard of care exists due to the multiple pain mechanisms involved and the wide range of therapeutic options for chronic pain. The high incidence of adverse events associated with nonsteroidal anti-inflammatory drugs has led to increased interest in alternative treatments. If effective and well-tolerated, local pharmacological therapy is a viable alternative to systemic NSAIDs.2 Our study included patients with nociceptive pain of arthritic origin, localized in the hand and wrist joints. The group consisted of ten patients—nine women and one man—who were able to independently complete the DASH questionnaire we administered, all reporting pain with an NRS score > 7. One patient was diagnosed with Charcot-Marie-Tooth disease, nine had fibromyalgia, seven had shoulder osteoarthritis, and eight suffered from anxiety-depressive syndrome. The follow-up period ranged from 3 to 12 months. At baseline (T0), the DASH-FS scores indicated high levels of disability (90.35, 88.17-94.35). Following treatment (T1), scores significantly improved (57.65, 47.02 - 61.50). The difference in scores between T0 and T1 showed a consistent reduction (-35.00, -27.65 - -39.85). The Wilcoxon signed-rank test confirmed a statistically significant improvement in upper limb function (p = 0.0059). Our findings demonstrate …
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.44

EVALUATION OF PAIN IN FIBROMYALGIA PATIENTS TREATED WITH CANNABIS OIL
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description: INTRODUCTION Fibromyalgia is a chronic condition characterized by widespread pain and a significant reduction in quality of life. The use of cannabis oil has recently been proposed as an alternative treatment for pain control, although clinical trials are still limited. This study aims to evaluate the efficacy and tolerability of cannabis oil in patients with fibromyalgia. OBJECTIVE The main objective of this study was to evaluate the reduction in perceived pain, measured by the NRS, and the tolerability of cannabis oil in a sample of patients with fibromyalgia. In addition, the study explored the influence of pre-existing comorbidities on treatment response and patient adherence to therapy. MATERIALS AND METHODS A retrospective study was conducted, with prior consent to data processing for research and publication purposes, on 65 patients with fibromyalgia treated with cannabis oil. Data were collected over a period of 6±1 months, analyzing NRS scores at the start of treatment (T0), at T1: 3±1 month of treatment and T2: 6±1 month of treatment. A segmented analysis was performed by age, sex and Charlson Comorbidity Index (CCI), and patient-reported side effects were monitored. RESULTS The results indicate a reduction in NRS scores in the overall sample, with a more marked improvement in young patients with low comorbidities (CCI 0-2). However, seven patients, all women, dropped out of treatment due to side effects, such as cognitive changes, hypotension and somnolence. Patients with higher CCI showed less pain reduction, except for a few isolated cases that responded favorably to the therapy. DISCUSSIONS AND CONCLUSIONS Treatment with cannabis oil has shown promising potential in pain management in patients with fibromyalgia, especially in those with few comorbidities. However, tolerability of treatment remains a critical issue, with side effects that may impact adherence to therapy. Larger prospective studies will be needed to confirm these results and to evaluate …
subject: Abstracts
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subject: Newsletter
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subject: Article Collection
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.105

PERCUTANEOUS ELECTRICAL NERVE STIMULATION BIOWAVE PRO IN CHRONIC POST-HERPETIC NEURALGIA UNRESPONSIVE TO MEDICAL TREATMENT
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description: INTRODUCTION Percutaneous Electrical Nerve Stimulation (PENS) is a minimally invasive neuromodulation technique used to manage chronic pain, especially in patients unresponsive to pharmacologic therapies. PENS typically uses biphasic pulsed current with low or mixed frequencies while the BioWave PRO system uses a new technology that delivers two alternating high-frequency pulses through transcutaneous microneedle-electrodes. The passage of the current to the underlying tissue generates a low-frequency electric field that inhibits the propagation of the action potential and blocks the transmission of pain to higher centers. Current indications include Post- Herpetic Neuralgia. METHODS This study is a preliminary observational study. All patients provided informed consent prior to undergoing treatment with the BioWave PRO device. B-SET electrodes (each 6 cm in diameter) were placed over the area of pain. Patients were instructed to gradually increase the power output of the device during the 30-minute session until they experienced mild discomfort Inclusion criteria were: age over 18 years; chronic high-performance neuralgia unresponsive to medical therapy; pain intensity greater than 4 out of 10 on the Numeric Rating Scale (NRS). Exclusion criteria included: presence of a pacemaker or implantable cardioverter-defibrillator; epilepsy; pregnancy. Primary endpoints were i) a reduction in pain of at least 50% compared to the initial NRS score following treatment and ii) a subjective sense of well-being lasting at least 24 hours post-treatment. RESULTS The study population consisted of five patients (3 females, 2 males) diagnosed with chronic Post-Herpetic Neuralgia that had been unresponsive to conventional medical therapy for a minimum of six months. The mean age of participants was 72 years. Neuropathic pain was confirmed in all cases by a DN4 questionnaire score ≥4. The primary sites of treatment were thoracic (4 patients) and cervical (1 patient). Baseline pain inten…
subject: Abstracts
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subject: Newsletter
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subject: Article Collection
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subject: Abstract(s)
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.101

AN ENGAGING EXPLORATION IN THE A.O. “S. CROCE E CARLE” CUNEO EMERGENCY DEPARTMENT
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description: BACKGROUND Non-traumatic abdominal pain is a common symptom in the Emergency Department (ED). Proper triage color coding is essential for timely treatment of patients at risk of worsening conditions. Effective assessment tools are necessary during the Triage phase. OBJECTIVE This study aims to compare the multidimensional Manchester Pain Ruler Scale (MPRS) with the unidimensional Numeric Pain Rating Scale (NRS) regarding their predictive ability for analgesic needs, care duration, and outcomes in patients with non-traumatic abdominal pain at the Emergency Department of A.O. S. Croce e Carle in Cuneo. METHODS A cohort of patients with non-traumatic abdominal pain who met the study criteria was selected. Data were categorized into pain levels (0-3; 4-6; 7-10) and types of analgesia used (Paracetamol, NSAIDs, opioids) for both MPRS and NRS. Results were analyzed using descriptive and inferential statistics. Feedback from Triage operators was also collected through a questionnaire administered by a nurse prior to the study (November 2023). RESULTS In 2024, the Emergency Department of the "Santa Croce" Hospital in Cuneo recorded 40,042 visits, with 2,933 for non-traumatic abdominal pain from May to November. Out of these, 599 cases met the inclusion criteria. The sample comprised 55.1% females, with 88.1% arriving independently. Most patients received a green triage code, while 34% were classified as orange. The MPRS assigned lower scores than the NRS, with a 64% discrepancy. However, MPRS showed better predictive ability for opioid needs and hospitalization, indicating greater objectivity in risk assessment. Implementing MPRS could improve pain management in the ED, but further studies are necessary to evaluate its practical impact.ù CONCLUSIONS The findings confirm that abdominal pain is a leading cause of ED visits. MPRS is a promising tool for assessing non-traumatic abdominal pain and enhancing risk stratification and pain management in Triage. Further studies compa…
subject: Abstracts
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subject: Newsletter
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subject: Article Collection
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subject: Abstract(s)
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.98

THE MOST RECENT RESEARCH SUPPORTS THE MOST ANCIENT TRADITIONS: THE EXAMPLE OF SCIATICA
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description: Before the anatomical understanding of nerves and the issues related to compression and/or physiological alterations, classifications of radiculopathies were empirical and based on the distinction between “hot” and “cold” syndromes. Some studies now demonstrate the involvement of autonomic function, echoing this traditional differentiation between hot and cold. Similarly, some therapies used in ancient times to treat these conditions may have seemed like mere superstition, but recent scientific evidence is beginning to clarify their mechanisms of action. For example, moxibustion—a technique from traditional Chinese medicine—involves burning mugwort cones on specific points of the body, producing a varying sensation of heat depending on the condition. A recent systematic review has identified therapies that activate TRPV1 ion channels—cellular channels sensitive to various stimuli, including heat—as among the few effective treatments for reducing pain in chronic low back pain and sciatica. In recent years, many studies have highlighted the important role of the body’s outer layer. In particular, the study of heat receptors (TRPV) and pressure receptors (Piezo), combined with new insights into the physiology of the superficial fascia and its connection to the autonomic nervous system, help us better understand the ancient belief that treating the body’s surface can influence deeper systems. Investigating the mechanisms behind certain techniques and understanding the rationale of traditional practices enables us to bridge different perspectives, integrate therapies, and ultimately enrich and improve the effectiveness of our treatments.
subject: Abstracts
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subject: Newsletter
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subject: Article Collection
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subject: Abstract(s)
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rights: Copyright (c) 2025 the Author(s) https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ahr.2025.93