Neuropathic Pain: Mechanism, Representation, Management and Treatment

   Despite the development of screening tests and diagnostic tools, neuropathic pain is still identified as an underdiagnosed condition lacking proper epidemiological studies. It is difficult to estimate its incidence and prevalence the population. The objective of this narrative review is to summarize current knowledge concerning complications. The underlying mechanisms have also been reviewed in the development of diagnostic or treatment strategies in patients with neuropathic pain to investigate its unique symptoms. The main focus is concentrated on expansion of possible therapeutic options for neuropathic pain treatment. Many therapies are not effective and this often leads to a significant deterioration in the patients’ quality of life. So, the crucial and strategic role of therapeutics in guiding patients in the right direction should not be overlooked. The existing knowledge is so limited and has safety risks. It is truly important to provide alternative treatment strategies in selected patients with refractory neuropathic pain. Interventional therapies include different types of effective treatments for reducing neuropathic pain. Giving insight into recent findings on mechanisms of neuropathic pain may help understand and further develop strategies for correct diagnosis and successful treatment.&nbsp

Metabolic risk factors attributed burden in Iran at national and subnational levels, 1990 to 2019

Introduction: Metabolic risk factors (MRFs) predispose populations to a variety of chronic diseases with a huge burden globally. With the increasing burden of these risk factors in Iran, in this study, we aimed to report the estimated burden attributed to MRFs at national and subnational scales in Iran, from 1990 to 2019. Methods: Based on the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, data of deaths and disability-adjusted life years (DALYs) attributable to four top MRFs in Iran including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body mass index (BMI), and high low-density lipoprotein (LDL) for the 1990–2019 period, were extracted. The socio-demographic index (SDI) was used to report the data based on the corresponding socio-economic stratifications. The results were reported in national and subnational 31 provinces of Iran to discover disparities regarding the attributable burden to MRFs. Furthermore, we reported the causes of diseases to which the attributable burden to MRFs was related. Results: Overall, the age-standardized high LDL, high SBP, high BMI, and high FPG-attributed death rate changed by -45.1, -35.6, +2.8, and +19.9% from 1990 to 2019, respectively. High SBP was the leading risk factor regarding attributed age-standardized death rates reaching 157.8 (95% uncertainty interval: 135.3–179.1) and DALY rates reaching 2973.4 (2652.2–3280.2) per 100,000 person-years, in 2019. All rates increased with aging, and men had higher rates except for the +70 years age group. At the subnational level, provinces in the middle SDI quintile had the highest death and DALY rates regarding all four MRFs. Total deaths, DALYs, YLLs and YLDs number by the causes of diseases linked to MRFs increased over the study period. Cardiovascular diseases, diabetes mellitus, and kidney diseases were the main causes of burden of disease attributable to MRFs. Conclusion: Herein, we found divergent patterns regarding the burden of MRFs as well as disparities in different regions, sex, and age groups for each risk factor and related causes. This could provide policymakers with a clearer vision toward more appropriate decision-making and resource allocation to prevent the burden of MRFs in Iran