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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
Mon Apr 10 2017
Journal Name
Al-mustansiriyah Journal Of Science
Synthesis, characterization and antibacterial Evaluation for mixed-ligand Complexes of Nickle (II), Manganese(II), Copper( II),Cobalt(II) and Mercury(II) with Tetradentate Schiff base and 1,10-phenanthroline
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An abstract is a brief summary of a research article, thesis, Schiff base ligand (L) was prepared by the reaction of 4-aminantipyrine with o-phenylenediamine, the prepared ligand characterized by Micro elemental Analysis, FT. IR, UV-Vis, and 1H,13C-NMR spectroscopy.complexes of Mn(II), Co(II), Ni(II), Cu(II) and Hg(II) with Schiff base and 1,10-phenanthroline (Phen) have been investigated in aqueous ethanol with (1:1:1) (M:L:Phen). The prepared complexes were characterized using flame atomic absorption, (C. H. N) Analysis, FT. IR and UV-Vis spectroscopic methods as well as magnetic susceptibility and conductivity measurements. From the obtained data the octahedral structure was suggested for all complexes. The biological screening effects o

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Publication Date
Thu Jan 01 2015
Journal Name
Chemistry And Materials Research
Synthesis , Characterization and Antibacterial Activities of Co (II),Ni(II),Cu(II),Zn(II),Cd(II)and Hg(II) Mixed-Ligand Complexes of L-Proline and Trimethoprim antibiotic
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The Co(II), Ni(II) ,Cu(II), Zn(II) ,Cd(II) and Hg(II) complexes of mixed of amino acid (L-Proline ) and Trimethoprim antibiotic were synthesized. The complexes were characterized using solubility, melting point, conductivity measurement ,. and determination the percentage of the metal in the complexes by flame(AAS).Magnetic susceptibility, Spectroscopic Method [FT-IR and UV-Vis]. Draw the proposed structure of the complexes using program , Chem. office 3D(2006). The ligands and there metal complexes were screened for their antimicrobial activity against four bacteria (gram + ve) and (gram -ve){Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Bacillus}.The proposed structure of the complexes using program , Chem office 3D(

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Publication Date
Sun Dec 07 2014
Journal Name
Baghdad Science Journal
Synthesis and Spectral Analysis of Mn (II), Cu (II) ,Ni (II) and Cd (II) Complexes with Mixed Ligands containing 1,10-phenanthroline and Schiff base derived of 4-aminoantipyrine
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The complexes of Schiff base of 4-aminoantipyrine and 1,10-phenanthroline with metal ions Mn (II), Cu (II), Ni (II) and Cd (II) were prepared in ethanolic solution, these complexes were characterized by Infrared , electronic spectra, molar conductance, Atomic Absorption ,microanalysis elemental and magnetic moment measurements. From these studies the tetrahedral geometry structure for the prepared complexes were suggested.The prepared ligand of 4-aminoantipyrine was characterized by using Gc-mass spectrometer .

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Publication Date
Thu Jan 01 2015
Journal Name
Chemistry And Materials Research
Synthesis, Physico-Chemical and Antimicrobial Activities Co(II),Ni (II) ,Cu(II), Zn(II),Cd(II) and Hg(II) Mixed- Ligand Complexes of L- Alanine and Trimethoprim Antibiotic
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The Co (II), Ni (II) ,Cu(II), Zn(II) ,Cd(II) and Hg(II) complexes of mixed of amino acid (L-Alanine ) and Trimethoprim antibiotic were synthesized. The complexes were characterized using melting point, conductivity measurement and determination the percentage of the metal in the complexes by flame (AAS). Magnetic susceptibility, Spectroscopic Method [FTIR and UV-Vis]. The general formula have been given for the prepared mixed ligand complexes [M(Ala)2(TMP)(H2O)] where L- alanine (abbreviated as (Ala ) = (C5H9NO2) deprotonated primary ligand, L- Alanine ion .= (C5H8NO2 -) Trimethoprim (abbreviated as (TMP ) = C10H11N3O3S M(II) = Co (II),Ni(II) ,Cu(II), Zn(II) ,Cd(II) and Hg(II). The results showed that the deprotonated L- Alanine by KOH (Ala

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Publication Date
Mon Aug 17 2020
Journal Name
Systematic Reviews In Pharmacy
New mixed ligand complexes of New Schiff base 4,4'- ((naphthalen-1-ylimino) methylene) dibenzene-1,3-diol and 8-hydroxy quinoline: Synthesis, Spectral Characterization, Thermal studies and Biological Activities
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New mixed ligand complexes of New Schiff base 4,4'- ((naphthalen-1-ylimino) methylene) dibenzene-1,3-diol and 8-hydroxy quinoline: Synthesis, Spectral Characterization, Thermal studies and Biological Activities

Publication Date
Fri Jan 01 2016
Journal Name
Tofiq Journal Of Medical Sciences
SYNTHETIC, SPECTROSCOPIC AND ANTIBACTERIAL STUDIES OF Co(II),Ni(II),Cu(II),Zn(II),Cd(II)AND Hg (II),MIXED LIGAND COMPLEXES OF TRIMETHOPRIME ANTIBIOTIC AND ANTHRANILIC ACID
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Mixed ligand complexes of bivalent metal ions, viz ; M= Co(II),Ni(II),Cu(II), Zn(II), Cd (II), and Hg(II) of the composition [M(Anth)2(TMP)] in 1:2:1 molar ratio, (where . AnthrH= Anthranilic acid (C7H7NO2) and Trimethoprime (TMP) = (C14H18N4O3) have been synthesized and characterized by repeated melting point determination, Solubility, Molar conductivity (Λm ),determination the percentage of the metal (M%) in the complexes by (AAS), FT-IR, magnetic susceptibility measurements [μeff (BM)] and electronic spectral data. The two ligands and their metal complexes have been screened for their bacterial activity against selected microbial strains (Gram +ve) & (Gram -ve).

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Publication Date
Wed Jun 01 2016
Journal Name
Tofiq Journal Of Medical Sciences
SYNTHETIC, SPECTROSCOPIC AND ANTIBACTERIAL STUDIES OF CO(II),NI(II),CU(II),ZN(II),CD(II)AND HG (II),MIXED LIGAND COMPLEXES OF TRIMETHOPRIME ANTIBIOTIC AND ANTHRANILIC ACID
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Mixed ligand complexes of bivalent metal ions, viz ; M= Co(II),Ni(II),Cu(II), Zn(II), Cd (II), and Hg(II) of the composition [M(Anth)2(TMP)] in 1:2:1 molar ratio, (where . AnthrH= Anthranilic acid (C7H7NO2) and Trimethoprime (TMP) = (C14H18N4O3) have been synthesized and characterized by repeated melting point determination, Solubility, Molar conductivity (Λm ),determination the percentage of the metal (M%) in the complexes by (AAS), FT-IR, magnetic susceptibility measurements [µeff (BM)] and electronic spectral data. The two ligands and their metal complexes have been screened for their bacterial activity against selected microbial strains (Gram +ve) & (Gram -ve).

Publication Date
Wed Mar 30 2022
Journal Name
Journal Of Economics And Administrative Sciences
The Extent of the Practice of Iraqi Banks to Manage Profits Using the (LLp it) Model and Its Reflection on the Tax Base, A Case Study of A Sample of Iraqi Private Banks Listed in The Iraqi Stock Exchange
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The research aims to identify the extent to which Iraqi private banks practice profit management motivated by reducing the taxable base by increasing the provision for loan losses by relying on the LLP it model, which consists of a main independent variable (net profit before tax) and independent sub-variables (bank size, total debts to total equity, loans granted to total obligations) under the name of the variables governing the banking business. (Colmgrove-Smirnov) was used to test the normal distribution of data for all banks during the period 2017-2020, and then find the correlation between the main independent variable sub and the dependent variable by means of the correlation coefficient person, and then using the multiple

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Publication Date
Wed Dec 01 2021
Journal Name
International Medical Journal
Effect of Accelerated Canine Retraction by Vitamin D3 Local Administration on Apical Root Resorption, Alveolar Bone Integrity, and Chair-side Time: A Prospective Clinical Study.
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Objectives: To evaluate the effect of vitamin D3 local injections on apical root resorption, alveolar bone integrity, and chair-side time following three and six months of canine retraction. Subjects and Methods: Seventeen adult patients (18-35 years old) of class I and II malocclusions were recruited, who required bilateral maxillary 1st premolars extraction before starting maxillary canines retraction. The experimental side received 25 pg dose of vitamin D3 injected locally into the distal periodontal sulcus of the canine (before force application) every three weeks, while the control side received retraction force only. Periapical radiographic evaluation was conducted after 3 and 6 months of the start of canines' retraction. Results: At

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Publication Date
Fri Sep 05 2014
Journal Name
International Journal Of Pharmacy And Pharmaceutical Sciences0975-1491
THE CORRELATION BETWEEN FRAMINGHAM RISK SCORE AND THE CLINICAL AND BIOCHEMICAL PARAMETERS THAT MEASURE FUNCTIONAL DISABILITY AND DISEASE ACTIVITY IN IRAQI PATIENTS WITH RHEUMATOID ARTHRITIS
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Objective: Rheumatoid arthritis (RA) patients have increased morbidity and mortality from premature cardiovascular (CV) disease (CVD). Framingham risk score (FRS) is a simplified coronary prediction tool developed to enable clinicians to assess the risk of a cardiovascular event and to identify candidate patients for risk factors modifications worldwide. The predictive ability of the FRS varies between populations, ethnic groups, and socio-economic status. The aim of this study is to find if there is any correlation between the Framingham risk score and the inflammatory and biochemical parameters used to measure disease activity and functional ability in Iraqi patients with active RA.

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