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.
Abstract
Prescribing drugs to patients to treat ailments or reducing their morbidity may not be enough, even if the drugs were all indicated and in the right dose. Clinical pharmacists play a pivotal role in conducting information and instruction to patients and conveying feedback to treating physician when appropriate, and the final goal is in the interest of the patient. Identification and classification of drug related problems and discussing them with the health care providers. Prospective, interventional, clinical study for 180 hemodialysis patients, and was designed as two phases, an observational phase to identify drug related problems and classifying them according to the latest Pharmaceutical
... Show MoreA superb demonstration of one of the wonders of technology providing the people with great aid is the employment of Artificial Intelligence in the medical field, and mainly the introduction of Clinical Decision Support Systems (CDSS). Nevertheless, non-’black-box’ AI systems have a significant problem, that is, although they are visible and understandable, there is still a considerable issue of trust by healthcare professionals. Explainable AI (XAI) technology is a means to overcome all the obstacles by unveiling more and offering the explanations of the procedures that AI performs in decision making. This study was conducted by examining various widely used approaches to XAI, which illustrate how XAI verifies the trustworthiness of CDS
... Show MoreBackground: Behçet’s disease (BD) is a disorder of systemic inflammatory condition. Its important features are represented by recurrent oral, genital ulcerations and eye lesions. Aims. The purpose of the current study was to evaluate and compare cytological changes using morphometric analysis of the exfoliated buccal mucosal cells in Behçet’s disease patients and healthy controls, and to evaluate the clinical characteristics of Behçet’s disease. Methods. Twenty five Behçet’s disease patients have been compared to 25 healthy volunteers as a control group. Papanicolaou stain was used for staining the smears taken from buccal epithelial cells to be analyzed cytomorphometrically. The image analysis software has been used to
... Show MoreOne hundred forty three of Klebsiellapneumoniae isolates had been collected from some hospitals in Baghdad city. The isolates were taken from different clinical specimens.Antimicrobial susceptibility test was carried out towards fifteen antimicrobial agents by using Vitek2 system with Antimicrobial susceptibility test cards. The results of antibiogram showed that the local isolates were possess highly resistance towards most antimicrobial agents under study. The high resistance wastoAmpicillin while the low resistance was to Imipenem.Two methods were used for detection of Extended Spectrum Beta Lactamases (ESBLs) production; first methods by using of Vitek2 system,thesecondmethods by using of polymerase chain reaction (PCR) technique to dis
... Show MoreOut of a total of fifty samples, thirty-five isolates were identified as Serratia marcescens. Thesediverse clinical samples were collected over a three-month period, from October 2023 to December 2023, fromseveral hospitals in Baghdad, including Fatima Al-Zahraa Hospital, Al-Sader Hospital, Ibn Al-Balady Hospital,and Al-Imam Ali Hospital. The clinical samples primarily included urine from patients with urinary tractinfections (UTIs). All isolates were cultured on nutrient agar, MacConkey agar, and blood agar, and theiridentities were confirmed through biochemical testing and the Vitek 2 compact system. Based on phenotypicvirulence factors, the S. marcescens isolates showed varying positive patterns: 32 out of 35 (91.42%) forprotease
... Show MoreObjective To highlight the main demographic characteristics and clinical profiles of female patients registered with breast cancer in Iraq; focusing on the impact of age.Methods This retrospective study enrolled 1172 female patients who were diagnosed with breast cancer at the Main Center for Early Detection of Breast Cancer/Medical City Teaching Hospital in Baghdad. Data were extracted from an established information system, developed by the principal author under supervision of WHO, that was based on valid clinical records of Iraqi patients affected by breast cancer. The recorded information regarding clinical examination comprised positive palpable lumps, bloody nipple discharge, skin changes, bilateral breast involvement, tumor
... Show MoreAbstract in English The aim of this study is to identify the effectiveness of rehabilitation exercises in conjunction with aquatic therapy for those suffering from sacroiliitis in football players. The researcher used the experimental approach, using the experimental design (pre-measurement, post-measurement). Similar to the objectives and procedures of the research, the researcher assumed the following: the existence of significant differences. Statistics between pre- and post-measurements in variables in favor of post-measurement for the following variables (degree of pain and level of balance). The experimental approach was used with a pre- and post-measurement design on one group of football players with sacroiliitis, nu
... Show MoreThe aim of the study was to evaluate the efficacy of diode laser (λ=940 nm) in the management of gingival hyperpigmentation compared to the conventional bur method. Materials and methods: Eighteen patients with gingival hyperpigmentation were selected for the study with an age between 12-37 years old. The site of treatment was the upper gingiva using diode laser for the right half and the conventional method for the left half. All patients were re-evaluated after the following intervals: 3 days, 7 days, 1 month and 6 months post-operation. Pain and functions were re-evaluated in each visit for a period of 1 day, 3 days and 1 week post-operation. Laser parameters included 1.5 W in continuous mode with an initiated tip (400 μm) placed in
... Show MoreThis paper considers approximate solution of the hyperbolic one-dimensional wave equation with nonlocal mixed boundary conditions by improved methods based on the assumption that the solution is a double power series based on orthogonal polynomials, such as Bernstein, Legendre, and Chebyshev. The solution is ultimately compared with the original method that is based on standard polynomials by calculating the absolute error to verify the validity and accuracy of the performance.
Transient mixed convection heat transfer in a confined porous medium heated at periodic sinusoidal heat flux is investigated numerically in the present paper. The Poisson-type pressure equation, resulted from the substituting of the momentum Darcy equation in the continuity equation, was discretized by using finite volume technique. The energy equation was solved by a fully implicit control volume-based finite difference formulation for the diffusion terms with the use of the quadratic upstream interpolation for convective kinetics scheme to discretize the convective terms and the temperature values at the control volume faces. The numerical study covers a range of the hydrostatic pressure head , , , , and ), sinusoidal amplitude range of
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