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Opioid use is extensively linked to adverse bone health outcomes, including increased risks of fractures, impaired bone repair, and diminished bone mineral density (BMD). Opioids such as morphine and dilaudid inhibit bone formation, leading to bone loss, while chronic opioid use exacerbates bone turnover and suppresses bone formation. These effects, observed in both males and females, frequently result in osteoporosis. Opioid-induced endocrinopathies, including hypogonadism and testosterone deficiency, significantly contribute to decreased bone density and heightened fracture risk. Observational studies report a higher prevalence of hip fractures among chronic opioid users, emphasising the necessity of routine BMD screening, particularly in high-risk populations. The interaction between opioid use and bone health mandates comprehensive monitoring and risk assessment strategies for long-term opioid users.

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Eucalyptus globulus (Myrtaceae family) is the only recognized medicinal species of the Eucalyptus genus, by Commission E, and its leaves are used to extract essential oil with minimum content of 60% 1,8-cineole content. Eucalyptus essential oil is traditionally used to treat rheumatoid arthritis, muscle joint pains, and inflammation. The purpose of this review is to evaluate the effectiveness of Eucalyptus globulus essential oil in the management of pain and inflammation. The analgesic and anti-inflammatory effects of eucalyptus essential oil were confirmed in some pharmacological and clinical studies of pain. Eucalyptus essential oil reduced the pain and inflammation, which is antagonized by naloxone, suggesting the participation of μ-opioid receptors in its analgesic effects. The analgesic effects of eucalyptus essential oil are related to its 1,8-cineole content as its main component, which inhibits the production or synthesis of pro-inflammatory cytokines, by attenuation of TREM pathway surface receptor (TREM-1) and MKP-1 phosphatase. Eucalyptus essential oil and 1,8-cineole are the activators of hTRPM8, the antagonist of hTRPA1, and the inhibitor of the P2X3 receptor, which reduces pain and inflammation. The role of other components in eucalyptus essential oil in pain is confirmed. Eucalyptus essential oil or 1,8-cineole can be used as an alternative treatment in topical pain preparation, but it is better to be evaluated in well-designed clinical trials of pain and inflammation.

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Epidural steroid injection (ESI) is one of most popularly used conservative treatments for spinal pain. But concern or fear for adverse effects associated with steroid frequently prevents the patients from being treated by injection, consequently leading them to chronic pain condition or unnecessary extensive treatment. Thus, understanding of not only innate characteristics of steroids but also their utilizations in practice is necessary to decide appropriate method of epidural injection. This article is to review properties of steroids and therapeutic strategies of epidural steroid injection such as dose, repetition, or intervals on the basis of literatures that have been published. Non-particulate steroid is preferred to particulate because of their advantage for prevention of systemic and local adverse effects as well as of their non-inferior clinical efficacy to particulate. High dose, short interval between injections, and large number of injections may be regarded to increase steroid accumulation and consequently risk of systemic side effects. Although conclusive evidence or guideline does not exist, no more than 3 injections within 6 months, maximum 6 injections per year, three weeks interval between injections, especially in case of using particulate steroid are recommended. High dose of steroid is not recommended because no evidence is found that high dose has the ability to promote better outcomes in comparison with low dose. When only partial response is obtained by first injection, repeat injections at appropriate intervals are required to fulfill more complete and prolonged clinical effects by accumulating treatment effects without concerns of overtreatment or abuse.

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Background: This study aims to measure patients’ POP to understand the status of patients after surgery and to identify factors, which can influence POPM.
Methods: This cross-sectional survey involved a convenience sample of 105 patients with abdominal surgery. The response rate was 70%. The American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was used for data collection. Data analysis was done using Statistical Package for Social Sciences (SPSS), version 26 software. The pain was measured by using the Numerical Rating Scale (NRS) at 2, 12, and 24 hours post-operatively.
Results: Libyan patients, who had undergone abdominal surgeries showed higher barriers to effective POPM than patients in other countries, as very few Libyan patients (8.6%), received strong opioids for POPM, and 19.0% of them had weak opioids for their POPM. This finding could mean that Libyan patients received inadequate POPM compared to patients in other countries, as few patients had opioids for POPM. Multiple regression results revealed only significant differences with the type of medications for Post-Operative Pain Management (POPM) (B = –0.0330, P < 0.05).
Conclusions: Our results showed that Libyan patients received inadequate POPM compared to patients in other countries, as view Libyan patients received opioids for POPM. The Author subscribes to the necessity for further implementation of POPM and teaching about POPM of HCPs and patients concerning acute POP in Libya.

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Background: Pain relief is the right of every patient undergoing surgery and more so of any parturient post cesarean delivery because she has to take care of her baby also. So this multimodal analgesia technique of linea semilunaris block with intrathecal buprenorphine was studied to see its efficacy for post cesarean section analgesia.
Methods: A prospective randomized comparative study conducted in 60 ASA grade 2 and 3 pregnant women aged 20-40 years requiring LSCS under spinal anesthesia - divided into 2 groups of 30 patients each. Intervention groups: Group 1 – bilateral open surgical linea-semilunaris block with injection 0.2% ropivacaine 20 ml with 1 ml normal saline on either side of abdomen, Group 2 – bilateral open surgical linea-semilunaris block with injection 0.2% ropivacaine 20 ml with dexamethasone 4 mg on either side of abdomen.
Results: The duration of analgesia, demand for first rescue analgesia was prolonged in both the groups. The total demand of postoperative analgesics and nausea and vomiting was reduced significantly, postoperative mobilization was very fast in both the groups.
Conclusions: Linea semilunaris block with intrathecal opioid is an effective multimodal analgesia combination for post LSCS pain. It is an open surgical technique, easy and safe to perform under vision, does not require any costly gadgets, very cost effective, opioid sparing and reduces the consumption of postoperative analgesics with fast recovery, early mobilization and high patient satisfaction. We recommend this multimodal analgesia technique for post caesarean section and lower abdominal surgeries.

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Pseudoseptic arthritis is a rare complication mimicking septic arthritis following intra-articular injections. While hyaluronic acid (HA) has been the primary agent linked to such reactions, we report a case of pseudoseptic arthritis after polydeoxyribonucleotide (PDRN) injection in an 81-year-old male with bilateral ankle osteoarthritis. Severe left ankle pain, swelling, and fever developed seven days after the second PDRN injection, with elevated inflammatory markers. Synovial fluid analysis revealed no infectious organisms or crystals, and septic arthritis was ruled out through synovial fluid cultures. Pseudoseptic arthritis was diagnosed. This case suggests that pseudoseptic arthritis may arise not only with HA but also with PDRN, emphasizing the need to be aware of this complication with other injection agents.

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The 2024 fall conference of the Korean Pain Research Society (KPRS) took place on October 13 at Samsung Medical Center's Cancer Hospital in Seoul, South Korea. Founded as the Korean chapter of the International Association for the Study of Pain (IASP), KPRS serves as a multidisciplinary hub for advancing pain research and treatment strategies. The conference featured a comprehensive array of presentations, covering various aspects of pain diagnosis, management, and rehabilitation. Key topics included lumbar spinal pain, its mechanisms, and both surgical and non-surgical treatments. Experts discussed innovative surgical techniques such as endoscopic spine decompression and minimally invasive procedures, alongside the importance of evidence-based postoperative rehabilitation approaches. Advancements in neuropathic pain were highlighted, focusing on cellular mechanisms, drug delivery systems, and neuroregenerative strategies. The conference also explored non-surgical interventions, such as epidural and nerve block procedures, emphasizing safe and effective pain management techniques. Furthermore, experts examined the connection between spinal disorders and abdominal or pelvic pain, presenting differential diagnostic and interventional strategies. The event underscored the significance of a multidisciplinary approach, promoting collaboration among specialists in neurosurgery, anesthesiology, pain medicine, rehabilitation medicine, and basic sciences. The KPRS remains dedicated to fostering academic exchange and innovation to advance the field of pain management and research.

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Cervical epidural steroid injection (CESI) is conducted to treat the patient with neck or upper limb pain from various cervical pathologies. Despite its clinical usefulness that have been supported by numerous literatures, concerns for serious complication associated with its technical and relevant anatomical properties give up its application at clinical setting to target non-specific treatment, medication, as compared with lumbosacral correspondence. But it is desirable as pain physician to conduct disease specific treatment by overcoming the barriers. This review is to explore the technical consideration of CESI to stress the clinical importance of CESI as target-specific conservative treatment for pain from cervical diseases. This describes technical consideration of transforaminal and interlaminar approach and the topic of ultrasound guided injection as replacement with non-radiation exposure to C arm guided injection. In conclusion, appropriate procedural application based on exact knowledge of relevant technical considerations promotes clinical usefulness of CESI, which leads CESI to valuable treatment option of the patients with cervical diseases.

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Background: We conducted this study to assess the efficacy and safety of PF-72 (TGel Bio Co. Ltd., Seoul, Korea) combined with 0.75% ropivacaine hydrochloride in relieving the postoperative pain in patients undergoing single-level lumbar discectomy.
Methods: A total of 95 eligible patients were randomized to either the trial group (n = 47; PF-72 combined with 0.75% ropivacaine hydrochloride) or the control group (n = 48; ramosetron hydrochloride 0.3 mg). The patients were monitored at 3, 6, 24, 48 and 72 hours postoperatively, for which the cumulative area under the curve (AUC_0-72) of NRS pain scores was plotted and the amount of rescue analgesics used at 6, 24, 48 and 72 hours or 24, 48 and 72 hours postoperatively. Moreover, incidences of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) were analyzed.
Results: The amount of analgesics used and the AUC_0-72 of the NRS pain scores was significantly smaller and the NRS pain scores were significantly lower in the trial group as compared with the control group (P < 0.05). In addition, there was no significant difference in the number of the patients presenting with no pain (NRS pain scores ≤ 3) between the two groups at 48 and 72 hours postoperatively (P > 0.05). There were no significant differences in the incidences of TEAEs and SAEs between the two groups (P > 0.05).
Conclusions: PF-72 combined with 0.75% ropivacaine hydrochloride is an effective, safe drug delivery system.

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Background: PF-72 (TGel Bio Co. Ltd., Seoul, Republic of Korea) is a type of temperature-responsive hydrogel.
Methods: The eligible patients (n = 72) were randomized to either the trial group (n = 35; PF-72 mixed with 0.75% ropivacaine hydrochloride) or the control group (n = 37; patient-controlled anesthesia). We compared the amount of used rescue analgesics, numeric rating scale (NRS) pain scores, the cumulative area under the curve (AUC_0-72) of NRS pain scores and incidences of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). We estimated time-to-events (TTEs).
Results: There were significant differences in the amount of used analgesics and NRS pain scores between the two groups at 3, 6, 24, 48 and 72 hours postoperatively (P = 0.000). There were also significant differences in AUC_0-6, AUC_0-24, AUC_0-48 and AUC_0-72 of NRS pain scores between the two groups (P = 0.000). There was a significant difference in the proportion of the patients presenting with no pain between the two groups at 3, 6 and 24 hours postoperatively (P = 0.000). There were no significant differences in the incidences of TEAEs and SAEs between the two groups (P > 0.05). TTEs are estimated at 7.486 ± 2.758 (95% confidence interval [CI] 2.081 ± 12.890) hr in the trial group and 9.324 ± 2.488 (95% CI 4.448 ± 14.200) hr in the control group.
Conclusions: PF-72 mixed with 0.75% ropivacaine hydrochloride is an effective, safe modality in alleviating pain in the patients undergoing elective arthroscopic shoulder surgery.

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Background: Mesenchymal stem cells (MSCs) are undifferentiated cells that give rise to the mesodermal lineage. Adipose-derived MSCs are an easy and widely used source for MSCs isolation. In this study, adipose tissue was isolated and processed for MSCs isolation. MSCs’ proliferation, surface marker expression, in vitro differentiation potential, and polymerase chain reaction (PCR) results were evaluated by subculturing.
Methods: Adipose tissue collected from a patient during spinal cord injury surgery was stored in PBS without shaking. First, the connective tissue was removed and the fat tissue was secured. Thereafter, the fat tissue was digested with collagenase type 1 at 37°C and 140 rpm for 1 h. After centrifugation, the remaining cell pellet was resuspended and filtered. Cells were cultured in Dulbecco’s modified Eagle’s medium supplemented with 10% FBS, fibroblast growth factor, and platelet-derived growth factor. Characterization analyses were performed to assess trilineage differentiation and marker expression using PCR and fluorescence-activated cell sorting.
Results: Our results confirm that adipose-derived MSCs have a high proliferation rate. Additionally, marker gene expressions were confirmed by PCR. Evaluation of the surface marker expression of MSCs revealed positive expressions of CD73, CD90, and CD105, and negative expressions of CD14, CD34, and CD45. The MSCs showed differentiation potential into adipocytes, chondrocytes, and osteocytes in differentiation medium.
Conclusions: MSCs can be isolated from the adipose tissue. Adipose-derived MSCs have adipose, chondrogenic, and osteogenic differentiation potential. The characterization and differentiation potential of MSCs are useful for evaluating their potential applications in various field of basic research, including pain research.

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The goal of rehabilitating individuals with chronic pain is to assist them in reclaiming control over their pain management and channeling their focus towards well-being and improving function. By providing rational information that helps patients understand their pain, their distress can be alleviated, resulting in positive changes in both their emotional and behavioral responses. Practitioners can assist patients in comprehending their pain and developing an effective management plan by employing a case formulation model. Within the cognitive behavioral model of chronic pain, event-meaning coupling can be emphasized in case formulation, allowing for a greater focus on the patient’s internal cognitive processes, helping them gaining insight into their pain. This model also considers potential biopsychosocial factors that could afford the patient’s ability to make new meaning from events. By assessing and promoting positive event-meaning couplings, patients can be empowered to interact more effectively with their biopsychosocial arena, which in turn can foster a virtuous cycle for self-expansion for successful rehabilitation.