Mixed pain, defined by the concurrent involvement of nociceptive, neuropathic, and sometimes nociplastic mechanisms, poses a significant diagnostic and therapeutic challenge within modern pain medicine. This complex pain phenotype is increasingly recognized as a prevalent and burdensome clinical entity, yet it remains substantially underdiagnosed and sub-optimally managed across diverse healthcare settings. Epidemiological data indicate that mixed pain affects a substantial proportion of patients with chronic pain syndromes and is consistently associated with more severe symptomatology, prolonged pain duration, functional impairment, diminished quality of life, and escalated healthcare resource utilization compared to pain of a single mechanism. In response to this unmet clinical need, the present recommendations aim to provide a structured, evidence-informed framework for the diagnosis and management of mixed pain. Developed through a rigorous process involving systematic literature review and multidisciplinary expert consensus, this document emphasizes the importance of mechanism-based therapeutic strategies tailored to the individual patient’s pain profile. Central to the approach is the implementation of multimodal and interdisciplinary care models that address the biological, psychological, and functional dimensions of mixed pain. These recommendations are intended for a broad spectrum of healthcare professionals, including primary care physicians, pain specialists, neurologists, oncologists, physiatrists, nurses, pharmacists, physical and occupational therapists, and clinical psychologists. The target population encompasses patients affected by mixed pain conditions such as chronic low back pain with radiculopathy, cancer-related pain, persistent post-surgical pain, and osteoarthritis complicated by central sensitization. By facilitating accurate diagnosis and integrated treatment planning, these recommendations seek to advance clinical practice, reduce the burden of mixed pain, and enhance patient-centered outcomes. This guidance aims to transform mixed pain care by promoting mechanism-based, multidisciplinary strategies with direct clinical applicability.
In this study, tin oxide (SnO2) and mixed with cadmium oxide (CdO) with concentration ratio of (5, 10, 15, 20)% films were deposited by spray pyrolysis technique onto glass substrates at 300ºC temperature. The structure of the SnO2:CdO mixed films have polycrystalline structure with (110) and (101) preferential orientations. Atomic force microscopy (AFM) show the films are displayed granular structure. It was found that the grain size increases with increasing of mixed concentration ratio. The transmittance in visible and NIR region was estimated for SnO2:CdO mixed films. Direct optical band gap was estimated for SnO2 and SnO2 mixed CdO and show a decrease in the energy gap with increasing mixing ratio. From Hall measurement, it was fou
... Show MoreSteady natural and mixed convection flow in a square vented enclosure filled with water-saturated aluminum metal foam is numerically investigated. The left vertical wall is kept at constant temperature and the remaining walls are thermally insulated. Forced convection is imposed by providing an inlet at cavity bottom surface, and a vent at the top surface. Natural convection takes place due to the temperature difference inside the enclosure. Darcy-Brinkman-Forchheimer model for fluid flow and the two-equation of the local thermal non-equilibrium model for heat flow was adopted to describe the flow characteristics within the porous cavity. Numerical results are obtained for a wide range of width of the inlet as a fraction
... Show MoreVolterra – Fredholm integral equations (VFIEs) have a massive interest from researchers recently. The current study suggests a collocation method for the mixed Volterra - Fredholm integral equations (MVFIEs)."A point interpolation collocation method is considered by combining the radial and polynomial basis functions using collocation points". The main purpose of the radial and polynomial basis functions is to overcome the singularity that could associate with the collocation methods. The obtained interpolation function passes through all Scattered Point in a domain and therefore, the Delta function property is the shape of the functions. The exact solution of selective solutions was compared with the results obtained
... Show MoreThe steady state laminar mixed convection and radiation through inclined rectangular duct with an interior circular tube is investigated numerically for a thermally and hydrodynamicaly fully developed flow. The two heat transfer mechanisms of convection and radiation are treated independently and simultaneously. The governing equations which used are continuity, momentum and energy equations. These equations are normalized and solved using the Vorticity-Stream function and the Body Fitted Coordinates (B.F.C) methods. The finite difference approach with the Line Successive Over-Relaxation (LSOR) method is used to obtain all the computational results. The (B.F.C) method is used to generate the grid of the problem. A computer program (Fortran
... Show MoreThe purpose of this research is to implement the orthogonal polynomials associated with operational matrices to get the approximate solutions for solving two-dimensional elliptic partial differential equations (E-PDEs) with mixed boundary conditions. The orthogonal polynomials are based on the Standard polynomial (
This research presents the kinetics of the saponification reaction using mixed fats of olein and stearin [in the ratio (3:1)] with NaOH solution. In this reaction, excess solution of NaOH was used to ensure the reaction being irreversible. Three parameters were varied to show their effects on the reaction rate .They are: percentage excess of NaOH solution (10 % - 100 %) , temperature (100-150)oC , and stirring speed (400-1100) rpm. It was noticed that increasing the percentage excess of NaOH solution enhances the rate of reaction while increasing temperature decreases the reaction rate since it is exothermic reaction. Increasing stirring speed also improves the reaction rate because it is mass transfer controlled .Calcu
... Show MoreBackground: Routine supplementation of vitamin D to infants is justifiable since vitamin D deficiency, and its consequences are highly prevalent not only in developing countries but worldwide. Maintaining a normal level of vitamin D is crucial in order to have a normal skeletal, as well as, extra-skeletal health. Knowledge of mothers regarding importance of vitamin D supplementation affect the health of their babies in a positive manner if accompanied by appropriate practice.
Objective: To determine the level of knowledge, attitude and practice of Iraqi mothers of under or equal 12 months old infants in Baghdad, AL-Rusafa, regarding vitamin D supplementation for their infants.
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... Show MoreDue to the increasing interest in the quality of auditing by writers, researchers and regulators of the auditing profession. The matter necessitated a statement of the extent to which the auditor practices professional skepticism, because of its significant impact in discovering errors and material misrepresentations contained in the financial statements in order to give the financial community confidence in them and the success of the audit process. The research aims to clarify the concept and importance of the practice of professional skepticism and its effect on the quality of the auditor's performance in Iraq. To achieve the research objectives, the two re
... Show MoreBackground: Most primary Health Care Centers (PHCCs) in Iraq have a referral system records; however, this mechanism does not function well because of the lack of other requirements for an efficient referral system.
Objective: To assess the practice & opinion of doctors in PHCs toward the referral system, and to determine the doctors in PHC's commitment to referral system instructions and guidelines.
Subjects and methods: A cross-sectional study with analytic elements was conducted in nine health directorates in Iraq, from the 1st October 2018 – 30th June 2019.One PHC was selected randomly form each sector in every governorate, A questionnaire was used to collect the required information.
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