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Mixed pain: clinical practice recommendations
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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.

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Publication Date
Sat Jan 01 2022
Journal Name
Journal Of Stomatology
The effectiveness of limited flap design in surgical removal of fully impacted lower third molars: a comparative clinical study
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Introduction: Surgical removal of impacted lower wisdom teeth is one of the most commonly performed proce- dures in oral and maxillofacial surgery. Objectives: This study aimed to compare the operative and post-operative outcomes of 2 flap designs (limited vs. extended 2-sided flap) in surgical extractions of lower third molars (M3) regarding fully impacted teeth. Material and methods: A prospective, randomized, controlled split-mouth trial was designed, and included 27 patients with bilateral (symmetrically positioned) impacted M3. Limited 2-sided flap was performed on one side (group 1) and extended 2-sided flap on the other side (group 2). The effect of flap design on intra-operative (visibility, accessibility, and duration of surgery) a

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Publication Date
Tue Jul 01 2025
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Clinical Diagnostic Value of Stromelysin-2 and Highly Sensitive-Cardiac Troponin I in the Severity of Coronary Artery Obstruction
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Background: Coronary artery disease is a leading cause of death worldwide. Troponin is released into blood from patients with reversible myocardial ischemia. Stromelysin-2 is also involved in the development and progression of atherosclerosis by tissue remodeling and degradation of extracellular matrix proteins.Objectives: To investigate the role of serum high-sensitive cardiac troponin I (hs-cTn I) and Stromelysin-2 (Str-2) in the diagnosis and determination of the severity of coronary artery obstruction.Methods: This cross-sectional study was conducted on 125 subjects undergoing coronary angiography for suspicion of coronary artery disease in Baghdad Teaching Hospital/ Medical City complex/ Baghdad/ Iraq by the Department of Bioch

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Publication Date
Tue May 05 2026
Journal Name
Journal Of Pioneering Medical Sciences
Clinical and Biochemical Indicators Associated with Impaired Kidney Function in Children with Type 1 Diabetes: A Case-Control Study.
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Background: Kidney failure is the leading cause of early death for diabetic patients and is regarded as the most dangerous consequence of the disease. This can only be reversed through early detection and intervention. The incidence of type 1 diabetes, which comprises 5-10 per cent of all diabetic diseases, is rising across the globe with a rate of 15 per 100,000 people per year. Methods: 90 samples were collected and used in this study. Thirty healthy children served as controls (aged 5-15 years), 30 patients with Type 1 Diabetes Mellitus (T1DM, aged 5-15 years) and 30 patients with type 1 diabetic nephropathy (DN), aged 5-20 years). Results: highly significant increase in Urea and Creatinine levels when compared control with DN al

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Publication Date
Wed Nov 23 2022
Journal Name
Dental Hypotheses
Remineralization of Dentine Caries Using Moringa Oleifera Based Nano-Silver Fluoride: A Single-Blinded, Randomized, Active-Controlled Clinical Trial
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Publication Date
Sun Sep 15 2024
Journal Name
Journal Of Baghdad College Of Dentistry
The reliability of insertion torque as an indicator for primary stability in immediate dental implant: A prospective clinical study
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Background: The primary stability of the dental implant is a crucial factor determining the ability to initiate temporary implant-supported prosthesis and for subsequent successful osseointegration, especially in the maxillary non-molar sites. This study assessed the reliability of the insertion torque of dental implants by relating it to the implant stability quotient values measured by the Osstell device. Material and methods: This study included healthy, non-smoker patients with no history of diabetes or other metabolic, or debilitating diseases that may affect bone healing, having non-restorable fractured teeth and retained roots in the maxillary non-molar sites. Primary dental implant stability was evaluated using a torque ratc

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Publication Date
Tue Apr 01 2025
Journal Name
Georgian Medical News
THE EFFECT OF SOFT ROBOTIC GLOVE ON THE FLEXION AND EXTENSION OF HAND FOR STROKE PATIENTS: A CLINICAL TRIAL
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Background: Stroke defined by diminished cerebral blood flow, results in brain damage and neurological impairments. It often leads to considerable difficulties, such as limited mobility and compromised hand function, usually manifesting as a weakening in the ability to open and shut the hand. Objective: The study evaluates the differences between opening and closing hands when utilizing a soft robot. Methods: The study was conducted in the Mosul Specialist Rehabilitation Center which involved 68 participants, all over 20 years old, with visual impairments. The Iranian Clinical Trials Registry and Ministry of Planning approved the study, The Fugl-Meyer Assessment for Upper Extremity Action Research Arm Test, and Arm Motor Ability Test were

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Publication Date
Sun Dec 10 2017
Journal Name
Research Journal Of Pharmaceutical, Biological And Chemical Sciences
Preparation, Spectral studies and Biological Efficiency of Metal (II) Mixed Ligand Complexes Schiff Base derived from (Benzaldehyde and O-Aminoaniline) with 8-Hydroxyquinoline.
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A novel Schiff base ligand [N1-benzylidenebenezene-1,2-diamine(L) = C20H16N2] was prepared through intensification of benzaldehyde (C6H5CHO) and O- amino aniline O-C6H4(NH2)2 in ethanol with 8-Hydroxyquinoline (8HQ) . Formed compounds were acquired of 1:1:2 molar proportion reactions for metal ions and ligands (L) and 2(8HQ) during reaction for MCl2 .nH2O salt products complexes conformable into the forms [M(L)(8HQ)2] ,where M = Mn(II),Co(II) and Ni(II). Whole the compounds were identified during the basis of their; FT-IR and U.V spectrum, melting point, molar conduct, identify of the percentage from the metal at the complexes via flame (AAS), C, H and N content of the Schiff base (L) and metal complexes were analysis and magnetic susceptib

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Publication Date
Thu Jan 01 2026
Journal Name
Bulletin Of The Chemical Society Of Ethiopia
Synthesis, characterization, thermal study, and evaluation of mixed ligand complexes of (malonic acid, nicotinic acid, and 2-aminopyridine) with some transition metal ions
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Six mixed ligand complexes were prepared from malonic acid (MA), nicotinic acid (NA), and 2-aminopyridine (AP) in a (1:1:1:1) molar ratio (M: MA: NA: AP.), using aqueous ethanol as a reaction medium. The prepared compounds were analyzed by flame atomic absorption, (C.H.N.) analysis, and FTIR, UV-Vis, and mass spectroscopy, as well as conductivity measurement and magnetic susceptibility studies. Based on the combined analytical data, the prepared complexes were proposed to adopt an octahedral geometry.   A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract.   The emergence of antibiotic-resistant bacteria and fungi has led to poor patient outcomes and limited treatment options, prompting int

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Publication Date
Thu Aug 11 2022
Journal Name
Chemical Papers
Surface tensiometry study of the interfacial phenomena in the mixed surfactant solutions of sodium di-2-ethylhexylsulfosuccinate (AOT) and hexadecyl benzylammonium chloride (HDBAC)
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Publication Date
Thu Mar 08 2018
Journal Name
Iosr Journal Of Applied Chemistry
synthesis, Composition, Spectral, Geometry and Antibacterial Applications ofMn(||),Ni(||),Co(||),Cu(||) and Hg(||) schiff Base complexes of N2O2 mixed donor with 1,10-phenanthroline
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synthesis, Composition, Spectral, Geometry and Antibacterial Applications ofMn(||),Ni(||),Co(||),Cu(||) and Hg(||) schiff Base complexes of N2O2 mixed donor with 1,10-phenanthroline