Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 5 Articles
Musculoskeletal (MSK) pain is a prevalent clinical condition that significantly impairs quality of life, and current treatment options are not effective on all patients or have severe, long-term side effects. Sustained Acoustic Medicine (SAM) delivers therapeutic ultrasound, providing diathermic and mechanical stimulation to local tissue and facilitating healing. Additionally, therapeutic ultrasound has been shown to enhance transdermal drug delivery via sonophoresis. Cannabidiol (CBD) is a small molecule that has been shown to have anti-inflammatory effects drug delivery. However, CBD has never been studied in conjunction with therapeutic ultrasound, and its potential effects on ultrasound efficacy are unknown. Therefore, this study compares standard high viscosity ultrasound (US) gel and commercially available CBD gel both in terms of acoustic properties and in an ex vivo bovine muscle model with SAM treatment. The acoustic properties of CBD & US gels were measured using a hydrophone, an oscilloscope and a function generator. The function generator propagated a pulsed wave through each gel, and the time between the original and reflected waves was used to determine the acoustic coefficients. Then, a SAM transducer was positioned and placed into the coupling bandage and gel depot on the bovine muscle with 3 mL of US gel or CBD gel. Tissue was stimulated by SAM for 240 min with a 60-min cooldown, and internal muscle temperatures at 1 cm, 2 cm, and 5 cm were continuously monitored. US gel and CBD had no significant differences in their acoustic properties. There were no significant differences in the change in temperature for SAM treatment with CBD gel compared to SAM treatment with US gel at 1 cm (Δ12.06 ± 1.04 ◦C vs. Δ12.52 ± 1.84 ◦C, p > 0.05), 2 cm (Δ8.13 ± 1.01 ◦C vs. Δ8.97 ± 1.04 ◦C, p > 0.05), and 5 cm (Δ4.83 ± 0.91 ◦C vs. Δ3.83 ± 0.66 ◦C, p > 0.05). CBD gel does not compromise SAM’s ultrasonic delivery and diathermic efficacy, making this combination a novel option formusculoskeletal rehabilitation. Future studies could explore changes in transdermal CBD delivery with SAM treatment for deep tissue delivery....
Background and Objectives: Janus kinase (JAK) inhibitors have expanded the therapeutic options for moderate-to-severe atopic dermatitis (AD). The possibility of dose modulation with abrocitinib (100 and 200 mg) and upadacitinib (15 and 30 mg), both selective JAK1 inhibitors, represents a potential clinical advantage, allowing dose escalation in cases of insufficient response and dose de-escalation in the seing of poor tolerability or during maintenance treatment. However, real-world data remain limited, and the rationale for dose adjustment is not always standardized. This study aimed to describe, using a realworld database, the frequency, timing, and reasons for dose modifications of these agents. Materials and Methods: We retrospectively analyzed the clinical data of 212 patients with moderate-to-severe AD treated with abrocitinib (n = 47) or upadacitinib (n = 165). Dose adjustments, including dose escalation and dose de-escalation, were recorded together with their timing and clinical reasons. Results: In the abrocitinib group, 34/47 patients (72.3%) initiated treatment at 100 mg, whereas 13/47 patients (27.7%) started at 200 mg. Six patients (12.8%) underwent a dose adjustment. One patient (2.1%) switched from 200 to 100 mg because of complete AD remission and concomitant menstrual cycle alterations, whereas five patients (10.6%) underwent dose escalation from 100 to 200 mg because of incomplete disease control. Among the six abrocitinib-treated patients who underwent dose adjustment, achievement of IGA 0/1 after dose modification was documented in all cases. In the upadacitinib group, 93/165 patients (56.4%) started at 15 mg, whereas 72/165 patients (43.6%) started at 30 mg. Overall, 44/165 patients (26.7%) underwent at least one dose adjustment, accounting for a total of 50 dose modifications: 27 escalations from 15 to 30 mg and 23 de-escalations from 30 to 15 mg. Among patients initiating treatment at 15 mg, 23/93 patients (24.7%) increased the dose to 30 mg after a median of 33.1 weeks because of suboptimal disease control. Among those starting at 30 mg, 21/72 patients (29.2%) reduced the dose to 15 mg after a median of 44.3 weeks. Of these, 12/21 patients (57.1%) reduced the dose because of adverse events, including herpetic infections and acne, whereas the remaining patients de-escalated because of optimal disease control. Some patients underwent multiple dose modifications: four followed a 30→15→30 mg sequence, with re-escalation after 13.2 weeks because of suboptimal disease control, and two followed a 15→30→15 mg sequence, with dose reduction after approximately 26.7 weeks because of herpes zoster. Overall, 29/44 patients achieved IGA 0/1 within 16 weeks and 38/44 within 32 weeks after dose modification. Conclusions: In this real-world cohort, dose adjustments of selective JAK1 inhibitors were frequently performed in patients with moderate- to-severe AD, particularly among those treated with upadacitinib. Dose escalation was mainly used to address suboptimal disease control, whereas dose de-escalation was performed in the seing of adverse events or optimal disease control. The availability of two dosing regimens may allow treatment intensity to be adapted to individual disease severity, response, and tolerability, supporting a personalized approach to AD management....
Background: Chronic pain is the leading cause of years lived with disability worldwide, with low back pain representing the most prevalent and disabling condition. Spinal cord stimulation (SCS) and intrathecal drug delivery (IDD) systems are established neuromodulation techniques for refractory chronic pain. However, a subset of patients experiences partial or declining benefit with either modality alone. In such cases, combined therapy may represent a rescue strategy. Methods: retrospective case series at a single center, including patients previously implanted with SCS who subsequently required IDD due to loss of efficacy or inadequate pain coverage. Pain intensity, opioid consumption, healthrelated quality of life, and patient satisfaction were assessed using validated instruments. Results: Twelve patients were included. Persistent low back pain with mixed nociceptive– neuropathic features was the most common indication. Combined therapy was observed in association with a mean reduction of 3.5 points on the Numeric Rating Scale, corresponding to an approximate 40% decrease in pain intensity. More than half of the patients discontinued systemic opioids. Complications occurred in seven patients (58.3%), mostly hardware-related and manageable with surgical revision; only one patient developed a device-related infection. Conclusions: In this case series, combined SCS and IDD therapy was observed in association with clinically meaningful pain reduction, decreased opioid use, and high patient-reported satisfaction. Although quality-of-life scores remained below population norms, patients consistently reported subjective improvement. Combined neuromodulation may represent a valid rescue option in selected patients with insufficient response to SCS alone....
Background/Objectives: Chronic pain represents a core global health burden and remains a leading cause of disability and reduced quality of life. Tramadol is a widely prescribed analgesic with a dual-opioid and non-opioid mechanism of action; however, safety concerns persist. This scoping review summarizes current evidence on tramadol pharmacology, dosing, and safety. Methods: A systematic literature search was conducted across main scientific databases to identify preclinical and clinical studies evaluating tramadol pharmacokinetics, safety, and dosing. Results: The same tramadol presentations have been used for several years, with a high overdose risk due to incorrect dosing measurements. Dosing pump devices represent a viable solution to improve dosing accuracy and minimize this risk. Conclusions: Tramadol drops seem like an easier administration pathway but require careful handling when taking the prescribed dose. A dosing pump in the medication bole will improve dosing accuracy....
Background and Objectives: Bladder neck stenosis (BNS) and vesicourethral anastomotic stenosis (VUAS) are challenging complications following prostate surgery and radiation therapy, with recurrence rates reaching 30–60% after conventional endoscopic management. The Optilume® paclitaxel drug-coated balloon (DCB) has emerged as a novel minimally invasive treatment combining mechanical dilation with local anti-brotic drug delivery. This narrative review synthesizes current evidence on Optilume DCB specically for BNS and VUAS. Materials and Methods: A comprehensive literature search identied eight relevant publications (2024–2026), including randomized controlled trials, prospective and retrospective cohort studies, and case series addressing Optilume DCB for posterior urethral stenoses. Results: Across the reviewed studies, freedom from reintervention for BNS ranged from 77.5% to 100% at 12 months, while VUAS outcomes were more variable (40–81%). A comparative study of 141 patients demonstrated signicantly improved recurrence-free survival with DCB versus standard endoscopic treatment (HR 0.40, p = 0.021). Radiation-induced posterior urethral stenosis showed 81.1% freedom from repeat intervention. Complications were predominantly minor (Clavien-Dindo grade I), with no de novo incontinence aributable to the device. Conclusions: Optilume DCB represents a promising minimally invasive option for BNS and VUAS, particularly in patients with recurrent disease or those unsuitable for reconstructive surgery. BNS appears to respond more favorably than VUAS, likely reecting distinct pathophysiological mechanisms. Prior radiation therapy remains a negative prognostic factor. Prospective randomized trials with longer follow-up are needed to dene the role of DCB in posterior urethral stenosis management....
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