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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
Fri Dec 31 2021
Journal Name
Dental And Medical Problems
Effect of the local application of bupivacaine in early pain control following impacted mandibular third molar surgery: A randomized controlled study
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Background: Postoperative pain is one of the main complications following impacted mandibular third molar (IMTM) surgery. Objectives: The aim of this study was to assess the effect of the local application of bupivacaine on reducing early postoperative pain following IMTM surgery. Material and methods: A prospective, single-blinded, randomized controlled study was conducted on 40 patients who had undergone the surgical removal of an IMTM under local anesthesia. In the study group (n = 20), absorbable gelatin sponge (AGS) soaked in 3 mL of 0.5% plain bupivacaine hydrochloride was locally applied in the post-extraction socket. In the control group (n = 20), AGS soaked in 3 mL of normal saline was used. Pain intensity was assessed using a pa

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Publication Date
Tue Apr 01 2025
Journal Name
Nigerian Postgraduate Medical Journal
Pain and Satisfaction among Type 2 Diabetic Patients: Effects of Coughing, ShotBlocker and Vibration during Insulin Injection: A Randomised Controlled Trial
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Background:

Diabetes mellitus is a chronic illness that commonly leads to progressive and incapacitating of patients’ condition over the past 20 years.

Aim:

The aim of the study was to evaluate the effects of the coughing technique, ShotBlockerTo evaluate the effects of the coughing technique, ShotBlocker and vibration device on pain intensity and patient satisfaction during subcutaneous (SC) insulin injections in hospitalised adults with Type 2 diabetes mellitus (T2DM).

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Publication Date
Fri Sep 27 2019
Journal Name
Iop Conf. Series: Journal Of Physics: Conf. Series
Preparation and Spectroscopic Characterization of Chromium(III) and Iron(III) Mixed Ligand Complexes
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.Curcumin (Cur) and L phenylalanine (Phy) compounds were used to prepare two mixed ligand complexes with Cr (III) and Fe (III) ions. The synthesized complexes are characterized by using conductivity measurement and different spectral methods like FT-IR and UV- Vis .Molar conductance and analytical studies confirmed that the complexes exhibit octahedral geometry., suggest that the complexes are formed in 1: 1 :2 [ L : Metal : 2phe ] ratio and they proposed to have the general formulae [M(Cur)(phe)2] Cl (M= Cr (III) and Fe (III) The compound dyeing method was studied and applied to acrylic fabric.The antibacterial activity of curcumin, phenylalanine and their mixed ligand complexes were examined on pathogenic bacterial strains and showed good

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Publication Date
Wed Jan 14 2026
Journal Name
Bulletin Of The Chemical Society Of Ethiopa
SYNTHESIS, CHARACTERIZATION AND BIOLOGICAL ACTIVITY STUDY OF MIXED COMPLEXES WITH VARIOUS METAL IONS .
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Four mixed ligand complexes were prepared from 1,10-phenanthroline (Phen), 5-chlorosalicylic acid (CSA), and anthranilic acid (Anthra) dissolved in aqueous ethanol at a ratio of (1:1:1:1) M: Phen:CSA: Anthra, M(II)= Cu, Zn, Cd, and Hg. The prepared compounds were analyzed by flame atomic absorption, FT—IR, UV-Vis, and spectroscopic methods, as well as conductivity measurements and magnetic properties. After analyzing the prepared compounds using the acquired data, the complexes formed by mixing ligands were concluded to adopt an octahedral geometry. That study has been conducted to test the inhibitory effectiveness of the complexes (1,10-Phenanthroline (Phen), 5-Chlorosalicylic acid (CSA), Na[Cu(Phen)(CSA)(Anthra), Na[Zn(Phen)(CSA)(Anthr

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Publication Date
Thu Dec 01 2022
Journal Name
Chemical Methodologies
Formation, Characterization and Antioxidant Study of Mixed Ligand ‎Complexes Derived from Succinyl Chloride
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In the present study, mixed ligand compounds of Mn(II), Ni(II), Co(II), Cu(II), Cd(II) and ‎Hg(II) were synthesized using new Ligand N1,N4-bis (pyrimidin-2-ylcarbamothioyl) ‎succinimide (NPS) derived from [Butanedioyl diisothiocyanate with 2- aminipyridine] as ‎first ligand, proline (pro) as second ligand and evaluation of their antioxidant activities for ‎ligand, nickel and cobalt complex towards 1.1-Di-phenyl-2picrylhydrazyl (DPPH) will be ‎compared to the standard anti-oxidants (i.e. the ascorbic acid). Those materials that have ‎been prepared provided results are a result of exhibiting different activities of the radical ‎scavenging for all of the compounds. Compounds were observed then confirmed through ‎the Fourier-tra

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Publication Date
Sat Jul 01 2023
Journal Name
Journal Of Physics: Conference Series
Mixed Ligand Complexes of Schiff Base and Nicotinamide: Synthesis, Characterization and Antimicrobial Activities
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A new Schiff base of HL has been synthesized from amoxicillin drug and 4- Chlorobenzophenone. Cr (III), Fe (III), Co (II), Ni (II), Cu (II), Cd (II) and Hg (II) mixed ligands complexes of Schiff base and Nicotinamide. Diagnosis of synthesis ligand and its complexes are done by 1HNMR, 13CNMR and thermal analysis for HL ligand, FTIR, UV-visible, molar conductance, CHN analysis, magnetic susceptility and atomic absorption. Octahedral geometries have been suggested for all complexes. All compounds under study were tested antimicrobial activity against four type of bacteria such as Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus Bacillis subtilis in nutrient agar.

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Publication Date
Sat Apr 01 2023
Journal Name
Fluid Phase Equilibria
Prediction of solubility of vitamins in the mixed solvents using equation of state
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Publication Date
Mon Aug 03 2020
Journal Name
Digest Journal Of Nanomaterials And Biostructures
PREPARATION OF MIXED In2O3 – CdO THIN FILMS BY CSP TECHNIQUE FOR LIGHT SENSING
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In this work, chemical spray pyrolysis deposition (CSP) technique was used to prepare a mixed In2O3-CdO thin films with different CdO content (10, 30 and 50)%volume ratio on glass substrates at 150 ᵒC substrate temperature. The surface morphology and structural properties were measured to find the optimum conditions to improve thin films properties for using as photo detector. Current –Time, the sensitivity and response speed vary for each mixture. Samples with 10% vol. CdO content has square pulse response with average rise time nearly 1s and fall time 1s.

Publication Date
Fri Oct 01 2010
Journal Name
Iraqi Journal Of Physics
Analysis of Initiation and Growth of Plasma Channels Within Non-Mixed Dielectric Liquids
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Pre-breakdown phenomenon was investigated within the two, non-mixed dielectric liquids; transformation oil and cresol. Finite element technique was used to follow the initiation and growth of plasma channels (streamer discharge) within pin-plane configuration. That was done for different spacing between the pin-electrode and the liquid-liquid interface. Streamer growth model assumed that, the streamer initiation occurs at the region of the highest value of electric field. Our study shows that the streamer initiates at the tip of the pin and growths toward the other electrode. The study shows, too, that the streamer path controlled by the difference of permittivity of the two liquids and spacing distance of the liquid-liquid interface fro

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Publication Date
Thu Feb 05 2026
Journal Name
Bulletin Of The Chemical Society Of Ethiopia
Synthesis, characterization and biological activity study of mixed complexes with various metal ions
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Four mixed ligand complexes were prepared from 1,10-phenanthroline (Phen), 5-chlorosalicylic acid (CSA), and anthranilic acid (Anthra) dissolved in aqueous ethanol at a ratio of (1:1:1:1) M: Phen:CSA: Anthra, M(II)= Cu, Zn, Cd, and Hg. The prepared compounds were analyzed by flame atomic absorption, FT-IR, UV-Vis, and spectroscopic methods, as well as conductivity measurements and magnetic properties. After analyzing the prepared compounds using the acquired data, the complexes formed by mixing ligands were concluded to adopt an octahedral geometry. That study has been conducted to test the inhibitory effectiveness of the complexes (1,10-Phenanthroline (Phen),  5-Chlorosalicylic acid (CSA), Na[Cu(Phen)(CSA)(Anthra), Na[Zn(Phen)(CSA

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