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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
Wed Jan 01 2014
Journal Name
Advances In Physics Theories And Applications
Preparation, Characterization, and Antibacterial Properties of mixed ligand Complexes of L leucine and Sulfamethoxazole with Mn ( II),Co (II),Ni(II),Cu( II),Zn (II),Cd(II)and Hg(II) ions
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The research includes the synthesis and identification of the mixed ligands complexes of M 2 Ions in general composition ,[M(Leu) 2 (SMX)] Where L leucine (C 6 H 13 NO 2 )symbolized (LeuH) as a primary ligand and Sulfamethoxazole C 10 H 11 N 3 O 3 S) symbolized (SMX)) as a secondary ligand . The ligands and the metal chlorides were brought in to reaction at room temperature in(v/v) ethanol /water as solvent containing NaOH. The reaction required the following [(metal: 2(Na Leu --): (SMX )] molar ratios with M(II) ions, Were M (  Mn ( II),Co (II),Ni(II),Cu( II),Zn (II),Cd(II)and Hg( The UV Vis and magnetic moment data revealed an octahedral geometry around M(II), The conductivity data show a non electrolytic nature of the complexes . The

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Publication Date
Fri Oct 24 2014
Journal Name
Journal Of Chemical And Pharmaceutical Research
Synthesis, characterization and antimicrobial activities of [Fe(II), Co(II), Ni(II),Cu(II) and Zn(II)] mixed ligand complexes schiff base derived from amoxicillin drug and 4-(dimethylamino)benzaldehyde with nicotinamide
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New Schiff base ligand (E)-6-(2-(4-(dimethylamino)benzylideneamino)-2-(4-hydroxyphenyl)acetamido)-3,3- dimethyl-7-oxo-4-thia-1- azabicyclo[3.2.0]heptane-2-carboxylic acid = (HL) was synthesized via condensation of Amoxicillin and 4(dimethylamino)benzaldehyde in methanol. Figure -1 Polydentate mixed ligand complexes were obtained from 1:1:2 molar ratio reactions with metal ions and HL, 2NA on reaction with MCl2 .nH2O salt yields complexes corresponding to the formulas [M(L)(NA)2Cl],where M=Fe(II),Co(II),Ni(II),Cu(II),and Zn(II), A=nicotinamide .

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Publication Date
Thu Jan 01 2015
Journal Name
Chemical And Process Engineering Research
SYNTHESIS, Spectroscopic Characterization and Evaluation (Antibacterial & (GOT, G pT) Enzyme )Activity of Mixed Ligand Complexes of M(II) with Amino Acid (L-Asparagine) and Schiff Bases Derived from (Sulfamethoxazo Drug with 2,4Dimethoxybenzaldehyde)
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The research includes the synthesis and identification of the mixed ligands complexes of M 2 Ions in general composition ,[M(Leu) 2 (SMX)] Where L leucine (C 6 H 13 NO 2 )symbolized (LeuH) as a primary ligand and Sulfamethoxazole C 10 H 11 N 3 O 3 S) symbolized (SMX)) as a secondary ligand . The ligands and the metal chlorides were brought in to reaction at room temperature in(v/v) ethanol /water as solvent containing NaOH. The reaction required the following [(metal: 2(Na Leu --): (SMX )] molar ratios with M(II) ions, Were M (  Mn ( II),Co (II),Ni(II),Cu( II),Zn (II),Cd(II)and Hg( The UV Vis and magnetic moment data revealed an octahedral geometry around M(II), The conductivity data show a non electrolytic nature of the complexes . The

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Publication Date
Thu Sep 18 2014
Journal Name
Journal Of Chemical And Pharmaceutical Research
Preparation, characterization, and antibacterial properties of mixed ligand complexes of L-aspargine and sulfamethoxazole(antibiotic) with Mn(II), Co(II), Ni(II), Cu(II), Zn(II), Cd(II) and Hg(II) ions
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The research includes the synthesis and identification of the mixed ligands complexes of M+2ions in general composition[M(Asn)2(SMX)] Where L- Aspargine (C4H8N2O3)symbolized (AsnH) as a primary ligand and Sulfamethoxazole(C10H11N3O3S) symbolized (SMX) as a secondary ligand. The ligands and the metal chlorides were brought in to reaction at room temperature in(v/v) ethanol /water as solvent containing NaOH. The reaction required the following [(metal: 2(Na+Asn-): (SMX)] molar ratios with M(II) ions, Where: M(II)=Mn(II), Co(II), Ni(II), Cu(II), Zn(II), Cd(II) and Hg(II). The UV–Vis and magnetic moment data revealed an octahedral geometry around M(II), The conductivity data show a non-electrolytic nature of the complexes. The antimicrobial a

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Publication Date
Wed Apr 25 2018
Journal Name
Oriental Journal Of Chemistry
Diagnosis, Structure, and In vitro Antimicrobial and Antifungal Evaluation of some Amino benzoic acids, derived Ligand Schiff base and their Mixed Complexes with Cu(II), Hg(II), Mn(II), Ni(II) and Co(II)
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Publication Date
Wed Apr 25 2018
Journal Name
Oriental Journal Of Chemistry
Diagnosis, Structure, and In vitro Antimicrobial and Antifungal Evaluation of some Amino benzoic acids, derived Ligand Schiff base and their Mixed Complexes with Cu(II), Hg(II), Mn(II), Ni(II) and Co(II)
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Innovative various Schiff bases and their Co(II), Ni(II) and Cu(II) and Hg(II)  compounds made by the condensation of 4-amino antipyrine with derived aminobenzoic acid (2-aminobenzoic acid, 3-aminobenzoic acid, and 4-aminobenzoic acid ) have been prepared by conventional approaches. These complexes were described by magnetic sensibility analysis, FT-IR spectra, and molar-conductance and elemental analysis. Analytical values appeared which the mixed-ligand complexes presented ratio about 2:1 (ligand: metal) with the chelation 4 or 6. The prepared compounds offered a good effect on the organisms; bacteria Staphylococcus-aurous, Escherichia-coli and fungi C. albicans, A. niger. Also, the biological products signalize which the mixed compl

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Publication Date
Wed Jun 01 2011
Journal Name
Al Mustansiriyah Journal Of Pharmaceutical Sciences
Comparing the clinical efficacy and safety of high doses of beclomethasone inhaler with medium doses of beclomethasone inhaler combined with oral aminophylline or montelukast tablets in persistent asthmatic Iraqi patients.
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Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The treatment guidelines recommend theuse of a second controller drug in addition to medium doses of inhaled corticosteroids (ICSs) rather than the use of high doses ICS alone in the treatment of moderate-severe persistent asthma. This study was conducted to compare the clinical efficacy and safety of three treatment regimens in Iraqi patients with moderate-severe persistent asthma.The study included three groups; each group included 15 patients. Patients were administered beclomethasone inhaler alone 1500-2000 μg/day, beclomethasone inhaler 750-1000 μg/day plus oral controlled release aminophylline tablets 450 mg/day or

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Publication Date
Thu May 05 2022
Journal Name
Al-kindy College Medical Journal
Safety profile of immediate post-partum intrauterine device insertion during caesarean delivery – a clinical trial with three years of follow up: Utility of Immediate Post Placental Insertion of Intrauterine Device During Cesarean Delivery
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Background: Many countries recommend the use of long-acting reversible contraceptive intrauterine device immediately after cesarean delivery. The cesarean delivery rate in Iraqi public hospitals is 32.2% and may reach 85.8% in private hospitals. Immediate post-partum intrauterine device insertion at cesarean is rarely done in Iraq.

Objectives: To assess the safety and practicality of immediate post-partum intrauterine device insertion during cesarean delivery for family planning and pregnancy spacing in Iraqi women.

Subjects and Methods: A single arm clinical trial included 150 eligible women who attended Al-‎Elwiyah Maternity Teaching Hospital or Al Hayat Rahibat Hospita

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Publication Date
Thu Jan 01 2015
Journal Name
Journal Of Chemical And Pharmaceutical Research
Studies on the interaction and effect of Mn(II), Fe(II), Co(II), Ni(II),Cu(II), Zn(II) and Cd(II) mixed- ligand complexes of cephalexin mono hydrate and furan-2-carboxylic acid to different DNA sources
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To evaluate the Interaction of Mn(II), Fe(II), Co(II), Ni(II),Cu(II), Zn(II) And Cd(II) Mixed- Ligand Complexes of cephalexin mono hydrate (antibiotics) And Furan-2-Carboxylic Acid To The Different DNA Sources. All the metal complexes were observed to cleave the DNA. A difference in the bands of complexes .The cleavage efficiency of the complexes compared with that of the control is due to their efficient DNA-binding ability and the other factors like solubility and bond length between the metal and ligand may also increase the DNA-binding ability. The ligands (Cephalexin mono hydrate (antibiotics) and Furan-2- Carboxylic acid and there newly synthesized metal complexes shows good antimicrobial activities and Binding DNA , thus, can be used

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Publication Date
Mon Jan 01 2024
Journal Name
Heliyon
Synthesis and Characterization of Some Metal Ions Complexes with Mixed Ligand of Azo Dye and Metformin and Evaluation of its Effectiveness on the Growth of Some Pathogenic Bacteria Clinically Isolated and Study of its Toxicity on Normal and Cancerous Hepatocytes
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