Editorial – Musculoskeletal pain: Which role for tapentadol?

Chronic pain is defined as pain persisting after healing of an underlying pathology or as persisting pain in the absence of tissue damage. In the last decade, the understanding of mechanisms involved in chronic pain led to an improved approach to patient management, with the aim to reduce discomfort, improve quality of life (QoL) and enhance functional recovery. Chronic musculoskeletal pain, which is frequently encountered in clinical practice, can affect patients of all ages and is particularly common in older patients. Indeed, low back pain is the most frequent chronic pain condition worldwide, with a lifetime prevalence of >70% in western countries1,2. Neck pain is also a common disabling disease, with a prevalence of 23%, and is associated with high costs for medical visits and physiotherapy. Both low back pain and neck pain involve nociceptive and neuropathic pain mechanism

Hypericum scruglii bacch., brullo & salmeri, a potential natural remedy for fibromyalgia: A narrative review

Abstract: Fibromyalgia (FM) is a disorder of central pain processing marked by widespread chronic pain together with fatigue, sleep disturbances, cognitive dysfunction, and depressive episodes. Tested treatments have expressed limited efficacy. Oxidative stress plays a role in the pathology of FM, while multiple neurotransmitters are involved in this syndrome. Antidepressants are used as conventional treatment, especially those with double action on serotonin and norepinephrine that leads to an increased risk of a manic switch. It should be noted that fibromyalgia is high-frequency comorbidity in bipolar disorder. This narrative review, given the limited literature, consisted of animal and in vitro studies, which aims to highlight the positive aspects of Hypericum scruglii as a potential remedy against FM. Many in vitro and clinical studies confirm the Hypericum genus as a natural antidepressant resource. The use of Hypericum derivatives in various acute and chronic diseases has been known for a long time. It is reported that the phloroglucinol derivatives from Hypericum longistylum improve and accelerate the differentiation of neural progenitor cells. The advantage of Hypericum scruglii is that it owns greater antioxidant potential than other species of the Hypericum genus. Suggestions for improving the oral bioavailability of very poor water-soluble molecules of hypericum extracts are also described in this paperFibromyalgia (FM) is a disorder of central pain processing marked by widespread chronic pain together with fatigue, sleep disturbances, cognitive dysfunction, and depressive episodes. Tested treatments have expressed limited efficacy. Oxidative stress plays a role in the pathology of FM, while multiple neurotransmitters are involved in this syndrome. Antidepressants are used as conventional treatment, especially those with double action on serotonin and norepinephrine that leads to an increased risk of a manic switch. It should be noted that fibromyalgia is high-frequency comorbidity in bipolar disorder. This narrative review, given the limited literature, consisted of animal and in vitro studies, which aims to highlight the positive aspects of Hypericum scruglii as a potential remedy against FM. Many in vitro and clinical studies confirm the Hypericum genus as a natural antidepressant resource. The use of Hypericum derivatives in various acute and chronic diseases has been known for a long time. It is reported that the phloroglucinol derivatives from Hypericum longistylum improve and accelerate the differentiation of neural progenitor cells. The advantage of Hypericum scruglii is that it owns greater antioxidant potential than other species of the Hypericum genus. Suggestions for improving the oral bioavailability of very poor water-soluble molecules of hypericum extracts are also described in this paper

Dealing With COVID-19 Patients: A Moderated Mediation Model of Exposure to Patients' Death and Mental Health of Italian Health Care Workers

Introduction: The COVID-19 pandemic is asking health care workers (HCWs) to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements (ERs) arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms. Purpose: The aim of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19. Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs (physicians and nurses) participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model. Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant. Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher

Characterisation of flow dynamics within and around an isolated forest, through measurements and numerical simulations

The case study of 'Bosco Fontana', a densely-vegetated forest located in the north of Italy, is analysed both experimentally and numerically to characterise the internal ventilation of a finite forest with a vertically non-homogeneous canopy. Measurements allow for the evaluation of the turbulent exchange across the forest canopy. The case study is then reproduced numerically via a two-dimensional RANS simulation, successfully validated against experimental data. The analysis of the internal ventilation leads to the identification of seven regions of motion along the predominate-wind direction, for whose definition a new in-canopy stability parameter was introduced. In the vertical direction, the non-homogeneity of the canopy leads to the separation of the canopy layer into an upper foliage layer and a lower bush layer, characterised respectively by an increasing streamwise velocity and turbulence intensity, and a weak backflow. The conclusions report an improved description of the dynamic layer and regions of motion presented in the literature

Characterisation of flow dynamics within and around an isolated forest, through measurements and numerical simulations

The case study of ‘Bosco Fontana’, a densely-vegetated forest located in the north of Italy, is analysed both experimentally and numerically to characterise the internal ventilation of a finite forest with a vertically non-homogeneous canopy. Measurements allow for the evaluation of the turbulent exchange across the forest canopy. The case study is then reproduced numerically via a two-dimensional RANS simulation, successfully validated against experimental data. The analysis of the internal ventilation leads to the identification of seven regions of motion along the predominate-wind direction, for whose definition a new in-canopy stability parameter was introduced. In the vertical direction, the non-homogeneity of the canopy leads to the separation of the canopy layer into an upper foliage layer and a lower bush layer, characterised respectively by an increasing streamwise velocity and turbulence intensity, and a weak backflow. The conclusions report an improved description of the dynamic layer and regions of motion presented in the literature

Equianalgesia, opioid switch and opioid association in different clinical settings: a narrative review

Emergency or postoperative pain often represents an authentic challenge in patients who were already on opioid treatment for chronic pain. Thus. their management requires not only the physician's ability to treat acute pain. but also competence in switching the opioid that lost efficacy. Different aspects should be considered, such as opioids titration, switching, association and equianalgesia.The objective of this paper is to provide a narrative review. which has been elaborated and discussed among clinicians through an iterative process involving development and review of the draft during two web-based meetings and via email. This expert opinion aims to facilitate the correct opioid use through appropriate practices with a focus on pain treatment in emergency and postoperative pain.Equianalgesia tables were reviewed and integrated by clinicians and researchers with expertise in anesthesia, postoperative medicine, intensive care, emergency medicine pharmacology and addiction medicine. Special populations (liver/kidney failure. elder, pediatric, pregnancy/lactation) are discussed in detail along with other critical scenarios, such as: (i) rapid pain worsening in chronic pain (aggravating pain due to disease progression or tolerance development to analgesic therapy): (ii) acute pain on maintenance treatment: and (iii) pain management of complicated patients in emergency care.Extended and updated equianalgesia tables and conversion rates for 17 different opioid formulations (of 9 different molecules) are presented as follows.Opioids remain the class that best suits clinical needs of emergency and post-operative medicine. However, it should be stressed that equianalgesia can be affected by drug-to-drug interactions and pharmacological imprecision. in a complex field where clinical experience may be the main guiding principle

Concerns, Perceived Impact, Preparedness in Coronavirus Disease (COVID-19) Pandemic and Health Outcomes among Italian Physicians: A Cross-Sectional Study

Background: Health care workers (HCWs) are among the professionals at serious risk for the impact of the COVID-19 pandemic on their mental health. In this sense, the next public health challenge globally will be to preserving healthy HCWs during this pandemic. Aim: The present study has the aim of investigating the relationship among concerns, perceived impact, preparedness for the COVID-19 pandemic and the mental health of Italian physicians. Methods: From March 29th to April 15th 2020, we conducted an online survey using snowball sampling techniques through Limesurvey platform. Data were analyzed using descriptive statistics and multiple binary logistic regressions. Results: Multivariate analysis showed that the risk factors for perceived job stress were concerns about catching COVID-19 (OR = 3.18 [95% CI = 2.00-5.05] P <.001), perceived impact on job demands (OR = 1.63 [95% CI = 1.05-2.52] P <.05), perceived impact on job role (OR = 2.50 [95% CI = 1.60-3.90] P <.001), and non-working concerns (OR = 1.86 [95% CI = 1.15-3.03] P <.05). With respect to the risk factors for rumination about the pandemic emerged concerns about catching COVID-19 (OR 1.74, [95% CI = 1.12-2.71] P <.05), perceived impact on job role (OR = 1.68 [95% CI = 1.12-2.52] P <.05), and impact on personal life (OR = 2.04 [95% CI = 1.08-3.86] P <.05). Finally, the risk factors for crying at work were perceived impact on job role (OR = 2.47, [95% CI = 1.20-5.09] P <.05), rumination about the pandemic (OR = 3.027 [95% CI = 1.27-7.19] P <.01), watching colleagues crying at work (OR = 3.82 [95% CI = 1.88-7.77] P <.01), and perceived job stress (OR = 3.53 [95% CI = 1.24-10.07] P <.05). Conclusion: In general, our results highlighted that being concerned about being infected/infecting other people, carrying out new and unusual tasks, and witnessing colleagues crying at work were important risk factors for physicians’ well-being. Additional data are necessary to advance understanding of these risk factors in a long-term perspective

Spectral Analysis of a Two Body Problem with Zero Range Perturbation

We consider a class of singular, zero-range perturbations of the Hamiltonian of a quantum system composed by a test particle and a harmonic oscillators in dimension one, two and three and we study its spectrum. In facts we give a detailed characterization of point spectrum and its asymptotic behavior with respect to the parameters entering the Hamiltonian. We also partially describe the positive spectrum and scattering properties of the Hamiltonian.Comment: Version submitted for publication, AMStex, 22 page