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.
Ureteric obstruction is rarely noted in cases of gastric cancer. Its involvement by distant metastasis from gastric adenocarcinoma without direct invasion is an exceptionally unusual occurrence. This is the story of a 58-year-old man who arrived at the emergency department with acute flank pain and fever. He was initially diagnosed with obstructive pyelonephritis after the discovery of a new onset, complete ureteric obstruction on the left side. Subsequent investigations and follow-up revealed the presence of gastric adenocarcinoma with possible ureteric metastasis bilaterally, flank pain and hydronephrosis were the first and only presentations of gastric cancer. The rarity of the condition and the unusual presentation encouraged us to r
... Show Morethose affected by technological development risks within the scope of medical works. The unprecedented technological development the world witnesses nowadays has been providing brilliant medical service to the human being including examination, diagnosis and the treatment or follow up. However, such works hide behind potential risks threatening people's lives and such risks my be discovered within the limits of now – how and technical knowledge prevailing the time of rendering the medical service. Also this the question is raised on how to keep up between the safety of the patients and such risks are being unknown by the provider and questioning them contradicts the justices. subsequently, can the patients (affected) acquire the compensat
... Show MoreThe research aims to measure the accounting conservatism practice of listed companies in the Iraq stock exchange using Basu model to measure the degree of accounting conservatism in a sample of companies of (21) companies for the period from 2007 to 2011, the researcher found that most of the listed companies in the market exercised accounting conservatism when measurement and disclosure of the result of the activity and financial position and there is a variation in the degree of accounting conservatism between economic sectors , which included banking , investment , insurance , industry , agriculture , tourism and hotels.
Because the practice of accounting conservatism properly
... Show MoreThis paper is concerned with introducing and studying the first new approximation operators using mixed degree system and second new approximation operators using mixed degree system which are the core concept in this paper. In addition, the approximations of graphs using the operators first lower and first upper are accurate then the approximations obtained by using the operators second lower and second upper sincefirst accuracy less then second accuracy. For this reason, we study in detail the properties of second lower and second upper in this paper. Furthermore, we summarize the results for the properties of approximation operators second lower and second upper when the graph G is arbitrary, serial 1, serial 2, reflexive, symmetric, tra
... Show MoreThe method of measurement dosimetry in neutron – gamma field by using CaSo4 : Dy (PTFE) disc which has a diameter of 1.3mm and thickness of 0.2mm and using hydrogenated material as a converters of neutron to recoil protons (n-p) reaction, the discs were irradiated by neutron source (241Am-Be) with flux of 4.5?105 n/cm2s for different time to obtain different dose. The TL signals, which we have been obtained by using the converters, are increases to 71%. So we can resolve the neutron and gamma in mixed field.
Methods of speech recognition have been the subject of several studies over the past decade. Speech recognition has been one of the most exciting areas of the signal processing. Mixed transform is a useful tool for speech signal processing; it is developed for its abilities of improvement in feature extraction. Speech recognition includes three important stages, preprocessing, feature extraction, and classification. Recognition accuracy is so affected by the features extraction stage; therefore different models of mixed transform for feature extraction were proposed. The properties of the recorded isolated word will be 1-D, which achieve the conversion of each 1-D word into a 2-D form. The second step of the word recognizer requires, the
... Show MoreIn this research, we highlight the most important research related to the mixed ligand complexes of the drug trimethoprim (TMP), and for the past 7 years where this drug has been used as a chelating ligand and gives stability to the complexes with ions of metal elements where these complexes, prepared and diagnosed, and for some research the bacterial activity was studied against different types of bacteria.
In this research, we highlight the most important research related to the mixed ligand complexes of the drug trimethoprim (TMP), and for the past 7 years where this drug has been used as a chelating ligand and gives stability to the complexes with ions of metal elements where these complexes, prepared and diagnosed, and for some research the bacterial activity was studied against different types of bacteria