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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
Thu Apr 11 2024
Journal Name
Hemodialysis International
Using cryotherapy, <scp>EMLA</scp> (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial
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Abstract<sec><title>Introduction

In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre‐puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture.

Methods

This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel‐group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (contr

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Publication Date
Wed Aug 07 2019
Journal Name
Iraqi National Journal Of Nursing Specialties
Effect of Non-Pharmacological Pain Management Methods on Reduction the Duration of Labor Stages in Primigravida Women at AL-Elwyia Maternity Teaching Hospital
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Objectives: To evaluate the effect of non-pharmacological pain relief methods on duration of labor stage.
Methodology: A quasi-experimental study design was conducted during the period of (4th July 2018 through 24th October 2018) on non-probability of (60) women (30) of them were a control group and (30) were the study group whom admitted to Al-Elwyia Maternity Teaching Hospital suffering from labor pain. A questionnaire was used as a tool of data collection Descriptive& Inferential statistical analyses were used to analyze the data.
Result: The highest percentages of study and control groups were in age group (< 20) years old, primary schools graduates, housewife, from "urban area", within low category of socioeconomic scal

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Publication Date
Sun Jun 30 2019
Journal Name
Iraqi National Journal Of Nursing Specialties
Effect of Non-Pharmacological Pain Management Methods on Reduction the Duration of Labor Stages in Primigravida Women at AL-Elwyia Maternity Teaching Hospital
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Objectives: To evaluate the effect of non-pharmacological pain relief methods on duration of labor stage.Methodology: A quasi-experimental study design was conducted during the period of (4th July 2018 through 24th October 2018) on non-probability of (60) women (30) of them were a control group and (30) were the study group whom admitted to Al-Elwyia Maternity Teaching Hospital suffering from labor pain. A questionnaire was used as a tool of data collection Descriptive& Inferential statistical analyses were used to analyze the data.Result: The highest percentages of study and control groups were in age group (< 20) years old, primary schools graduates, housewife, from "urban area", within low category of socioeconomic scale,

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Publication Date
Fri May 16 2014
Journal Name
Journal Of The College Of Basic Education
interaction of L-Threonine in aqueous THFA and in mixed aqueous solutions at 298.15 K
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Publication Date
Fri Mar 01 2024
Journal Name
Bahrain Medical Bulletin
Challenges Facing Nurses Toward Providing Care to Patients with Cerebrovascular Accidents: A Mixed Methods Study
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Background: Understanding the challenges facing nurses toward providing care to patients with cerebrovascular accidents is the initial step in developing strategies to address these challenges, thereby ensuring high-quality care. Aim: The study aimed to assess the challenges experienced by nurses in delivering care to patients with CVAs in neurological wards. Results: Of the 80 questionnaire participants in the qualitative part, (MS = 0.66) reported a "moderate" rating as an overall assessment. These challenges are divided into workload (MS = 0.53) at a moderate rate, the psychological burden (MS = 0.85) at a high rate, the supporting materials (MS = 0.85) at a high rate, the sense of responsibility (MS = 0.77) at a high rate, and the role

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Scopus
Publication Date
Tue Aug 02 2011
Journal Name
J. College Of Education / Al-mustansiriya University
Synthesis and characterization of mixed ligand complexes of some metals with ( L- phenylalanine and nicotinamide)
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This paper presents the synthesis and study of some new mixed-ligand complexes containing nicotinamide(C6H7N2O) symbolized (NA) and phenylalanine (C9H11NO2)symbolized (pheH)] with some metal ions. The resulting products were found to be solid crystalline complexes which have been characterized by :Melting points, Solubility, Molar conductivity. determination the percentage of the metal in the complexes by flame(AAS), magnetic susceptipibility, Spectroscopic Method [FT-IR and UV-Vis]. The proposed structure of the complexes using program , chem office 3D(2006) . The general formula have been given for the prepared complexes : [M(NA)2(phe)]cl M(II): Mn(II) ,Co(II) , Ni(II) , Cu(II) , Zn(II) , Cd(II) & Hg(II)). NA = Nicotinamide= C6

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Publication Date
Thu Oct 01 2009
Journal Name
National Journal Of Chemistry
Synthesis and study of the mixed ligand (phenylalanine and alanine acid)with some transition Ions
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Thispaperpresentsthesynthesisandstudyofsomenewmixed-liagnd complexescontainingtowaminoacids[Alanine(Ala)andphenylalanine(phe)]withsome metals .Theresultsproductswerefoundtobesolidcrystallinecomplexeswhichhave been characterized by using (FT-IR,UV-Vis) spectra , melting point, elemental analysis (C.H.N) , molar conductivity and solubiltyThe proposed structure of the complexes using program , chem office 3D(2000) .The general formula have been given for the prepared complexes :[M(A-H)(phe-H)]M(II): Hg , Mn ,Co , Ni , Cu ) , Zn , Cd(II) .Ala = Alanine acid = C3H7NO2Phe = phenylalanine = C9H11NO2

Publication Date
Sat Dec 15 2018
Journal Name
Research Journal Of Pharmaceutical, Biological And Chemical Sciences
Synthesis, Spectroscopic and Antimicrobial Studies of Mixed Ligand Metal (II) Complexes with three amino acids
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The research includes synthesis and identification of novel three amino acids ligands complexes of some heavy metal (II) ions by using the amino acids like glycine, L-alanine and L-valine. New metal mixed ligand complexes with amino acids are prepared the reaction by reacting the three amino acids with the metals(II) chloride by using 50% ethanolic solution and 50% distall water in the molar ratio [1:1:1:1] ( M:Gly:Ala:Val) except for Co(II) and Ni(II) complexes were found after diagnosis the coordination with both Lalanine and L-valine. The prepared complexes identified by using physical properties, flame atomic absorption and conductivity measurements, in addition, mass, FT.IR and UV.vis spectrum as well magnetic moment data. The general

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Publication Date
Fri Jan 16 2009
Journal Name
National Journal Of Chemistry
Synthesis and study of the mixed ligand (phenylalanine and alanine acid) with some transition Ions
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This paper presents the synthesis and study of some new mixed-liagnd complexes containing tow amino acids[Alanine(Ala) and phenylalanine (phe)] with some metals . The results products were found to be solid crystalline complexes which have been characterized by using (FT-IR,UV-Vis) spectra , melting point, elemental analysis (C.H.N) , molar conductivity and solubilty The proposed structure of the complexes using program , chem office 3D(2000) . The general formula have been given for the prepared complexes : [M(A-H)(phe-H)] M(II): Hg , Mn ,Co , Ni , Cu ) , Zn , Cd(II) . Ala = Alanine acid = C3H7NO2 Phe = phenylalanine = C9H11NO2

Publication Date
Sun Jan 01 2012
Journal Name
Al-mustansiriya J. College Of Education
Synthesis and characterization of mixed ligand complexes of some metals with ( L- phenylalanine and nicotinamide)
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This paper presents the synthesis and study of some new mixed-liagnd complexes containing nicotinamide(C6H7N2O) symbolized (NA) and phenylalanine (C9H11NO2)symbolized (pheH)] with some metal ions. The resulting products were found to be solid crystalline complexes which have been characterized by :Melting points, Solubility, Molar conductivity. determination the percentage of the metal in the complexes by flame(AAS), magnetic susceptipibility, Spectroscopic Method [FT-IR and UV-Vis]. The proposed structure of the complexes using program , chem office 3D(2006) . The general formula have been given for the prepared complexes :[M(NA)2(phe)]cl M(II): Mn(II) ,Co(II) , Ni(II) , Cu(II) , Zn(II) , Cd(II) & Hg(II) . NA = Nicotinamide= C6H7N2O Phe -

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