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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
Thu Sep 01 2016
Journal Name
Saudi Journal Of Pathology And Microbiology
Synthesis, Characterization and Antibacterial Activities of Mixed Ligand Complexes of Symmetrical Schiff Base and 8-Hydroxyquinoline with Zn(II), Cd(II) and Hg(II)
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The current work reports a new Schiff base [N1-benzylidenebenezene-1,2-diamine(L) = C20H16N2] has been synthesized from benzaldehyde (C6H5CHO) and O- aminoaniline (O-C6H4(NH2)2. Metal mixed ligand complexes of the Schiff base were prepared from chloride salts of Zn(II), Cd(II) and Hg(II) in ethanol and 8-hydroxyquinoline(8HQ)(C9H7NO) containing sodium hydroxide. All the complexes were characterized on the basis of their; FT-IR and U.V spectra, melting point, molar conductance, and determination of the percentage of the metal in the complexes by flame (AAS). In the all complexes, (8HQ) behaves as a bidentate ligand as primary ligand through –-OH phenolic group and –N groups of pyridine group. Also, the prepared ligand (L) was bidentate i

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Publication Date
Mon Apr 08 2013
Journal Name
Chemistry And Materials Research
Synthesis, spectral and antimicrobial activity of mixed ligand complexes of Co(II), Ni(II), Cu(II) and Zn(II) with Anthranillic Acid and Tributylphosphine
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Mixed ligand complexes of bivalent metal ions, viz; Co(II), Ni(II), Cu(II) and Zn(II) of the composition [M(A)2((PBu3)2]in(1:2:2)(M:A:(PBu3). molar ratio, (where A- Anthranilate ion ,(PBu3)= tributylphosphine. M= Co(II),Ni(II),Cu(II) and Zn(II). The prepared complexes were characterized using flame atomic absorption, by FT-IR, UV/visible spectra methods as well as magnetic susceptibility and conductivity measurements. The metal complexes were tested in vitro against three types of pathogenic bacteria microorganisms: (Staphylococcus, Klebsiella SPP .and Bacillas)to assess their antimicrobial properties. Results. The study shows that all complexes have octahedral geometry; in addition, it has high activity against tested bacteria. Based on th

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Publication Date
Mon May 25 2015
Journal Name
International Journal Of Current Research
Synthesis, Spectral and Antimicrobial Activity of Mixed Ligand Complexes of Co(II),Ni(II),Cu(II) and Zn(II) with 4-aminoantipyrine and Tributylphosphine
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Complexes of Co(II),Ni(II),Cu(II)and Zn(II) with mixed ligand of 4- aminoantipyrine (4-AAP) and tributylphosphine (PBu3) were prepared in aqueous ethanol with (1:2:2) (M:L:PBu3). The prepared complexes were characterized using flame atomic absorption, FT.IR and UV-Vis spectroscopic methods as well as magnetic susceptibility and conductivity measurements. In addition biological activity of the two ligands and their complexes against three selected type of bacteria were also examined. The general compositions of the complexes are found to be [M(4-AAP)2(PBu3)2] Cl2 . Where M= Co(II),Ni(II),Cu(II)and Zn(II). Some of the complexes exhibit good bacterial activities. From the obtained data the octahedral structures have suggested for all prepare

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Publication Date
Thu Apr 01 2021
Journal Name
Biochemical & Cellular Archives
Impacts of Starvation Stress on Biofilm Formation and expression of Virulence Genes in Mono-and Mixed-species cultures of Pseudomonas Aeruginosa and Staphylococcus aureus
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Staphylococcus aureus and Pseudomonas aeruginosa are the major globally distributed pathogens, which causes chronic and recalcitrant infections due to their capacity to produce biofilms in large part. Biofilm production represents a survival strategy in these species, allowing them to endure environmental stress by altering their gene expression to match their own survival needs. In this study, we co-cultured different clinical isolates of S. aureus and P. aeruginosa as mono- and mixed-species biofilms in a full-strength Brain Heart Infusion Broth (BHI) and in a 1000-fold diluted Brain Heart Infusion Broth (BHI/1000) using Microtiter plate assay and determination of colony-forming units. Furthermore, the effect of starvation stress on the e

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Publication Date
Thu Dec 01 2016
Journal Name
Ibn Al-haitham Jour. For Pure & Appl. Sci.
Co(II) and Cd(II) Mixed-Ligands Complexes Prepared From N'-(4-methylsulfanyl-benzoyl)-hydrazine Carbodithioic Acid Methyl Ester; Synthesis and Physico-Chemical Characterisation
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This work is based on the synthesis of Cobalt(II) and Cadmium(II) mixed-ligands compounds obtained from the reaction of N'-(4-methylsulfanyl-benzoyl)-hydrazine carbodithioic acid methyl ester as a ligand and using ethylendiamine (en), 2,2'-bipyridine (bipy) or 1,10-phenanthroline (phen) as a co-ligand. The synthesis of ligand (HL) was based on multi-steps synthetic procedure. The reaction of 4-methylsulfanyl-benzoyl chloride with hydrazine gave 4-methylsulfanyl-benzoic acid hydrazide. This compound was reacted with carbon disulfide and potassium hydroxide in methanol to yield N'-(4-methylsulfanylbenzoyl)-hydrazine potassium thiocarbamate, which upon reaction with methyl iodide resulted in the formation of the ligand. A range of physico-chem

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Publication Date
Tue Apr 21 2026
Journal Name
Microbes And Infectious Diseases
Mixed-ligand metal complexes of a p Hydroxybenzaldehyde – 4-Aminoantipyrine Schiff Base with 2,2′-Bipyridine: Synthesis, characterization, antibacterial evaluation, molecular docking and ADME studies
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Background/aim: The rising challenge of microbial resistance necessitates the development of novel therapeutic agents. This study aims to synthesize, characterize, and evaluate the antimicrobial potential of a new series of mixed-ligand metal complexes (ZnII, CuII, NiII, and MnII) derived from a p-hydroxybenzaldehyde-4-aminoantipyrine Schiff base and 2,2′-bipyridine, in addition to assessing the binding affinity and pharmacokinetic properties of the synthesized free Schiff base ligand through molecular docking and ADME profiling. Methods: The Schiff base ligand and its transition metal complexes were synthesized and subsequently characterized using single-crystal X-ray diffraction, elemental analysis, FTIR, UV–Vis spectroscopy, NMR, mag

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Publication Date
Sun Mar 01 2015
Journal Name
Baghdad Science Journal
Synthesis of Mixed Ligand Complexes of M(II) Dithiocarbamato Derivative and 2,2'-bipyridyl and Study their Cytotoxic Effect Against HepG2 Cell Line in vitro
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Mixed ligand of Co and Ni (II) complexes were prepared from [5-(p-nitrophenyl)-4/-phenyl-1,2,4-triazole-3-dithiocarbamato hydrazide](TRZ.DTC) as primary ligand and 2,2'-bipyridyl (bipy) as a co-ligand with metal salts. These complexes were analytically and spectroscopically characterized in solid state by elemental analyses, flame atomic absorption, magnetic susceptibility and molar conductance measurements, as well as by UV–Vis and FTIR spectroscopy. Infrared, ultra violet spectra reveal a bidentate coordination of the two ligands with metal ions 1:1:1 mole ratio. Room temperature magnetic moments and solid reflectance spectra data indicate paramagnetic complexes with five-coordinate square pyramidal geometry for nickel (II) comple

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Publication Date
Thu Sep 26 2013
Journal Name
Chemistry And Materials Research
Synthesis, spectral and antimicrobial activity of mixed ligand complexes of Co(II), Ni(II), Cu(II) and Zn(II) with Anthranillic Acid and Tributylphosphine
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Mixed ligand complexes of bivalent metal ions, viz; Co(II), Ni(II), Cu(II) and Zn(II) of the composition [M(A)2((PBu3)2]in(1:2:2)(M:A:(PBu3). molar ratio, (where A- Anthranilate ion ,(PBu3)= tributylphosphine. M= Co(II),Ni(II),Cu(II) and Zn(II). The prepared complexes were characterized using flame atomic absorption, by FT-IR, UV/visible spectra methods as well as magnetic susceptibility and conductivity measurements. The metal complexes were tested in vitro against three types of pathogenic bacteria microorganisms: (Staphylococcus, Klebsiella SPP .and Bacillas)to assess their antimicrobial properties. Results. The study shows that all complexes have octahedral geometry; in addition, it has high activity against tested bacteria. Based on th

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Publication Date
Wed Aug 01 2018
Journal Name
Collegian
Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial
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Publication Date
Mon Aug 29 2022
Journal Name
Indonesian Journal Of Chemistry
Synthesis, DFT Calculations, DNA Interaction, and Antimicrobial Studies of Some Mixed Ligand Complexes of Oxalic Acid and Schiff Base Trimethoprim with Various Metal Ions
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Mixed ligand metal complexes are synthesized from oxalic acid with Schiff base, and the Schiff base was obtained from trimethoprim and acetylacetone. The synthesized complexes were of the type [M(L1)(L2)], where the metal, M, is Ni(II), Cu(II), Cr(III), and Zn(II), L1 corresponds to the trimethoprim ((Z)-4-((4-amino-5-(3,4,5-trimethoxybenzyl)pyrimidine-2-yl)imino)pentane-2-one) as the first ligand and L2 represent the oxalate anion ( ) as a second ligand. Characterization of the prepared compounds was performed by elemental analysis, molar conductivity, magnetic measurements, 1H-NMR, 13C-NMR, FT-IR, and Ultraviolet-visible (UV-Vis) spectral studies. The recorded infrared data is reinforced with density functional theory (DFT) calcul

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