Celiac plexus block (CPB) is an established interventional technique for the management of severe upper abdominal pain, particularly in patients with chronic pancreatitis (CP) and pancreatic cancer (PC). Pain in these conditions is complex, involving visceral and neuropathic mechanisms and, in CP, additional contributions from neuropathic remodeling, central sensitization, and altered descending modulation play a role.

The effectiveness of GV20-based Wearable Low-level Laser Acupoint Therapy for pain on right temporal head was investigated. The study was designed as a triple-blinded, randomized controlled clinical trial. The deep pressure pain targeted by 300g monofilament and Visual Analog Scale (VAS, 0-10) scores on right temporal head were assessed were randomly assigned to wearable LLLAT (650 nm, 5 mW, 30 min, about 9 joule each acupoint) on Baihui (GV20) with four Sishencong (EX-HN1) or sham group (n=24 vs 24). The mean VAS pain scores in wearable LLLAT group after GV20 with EX-HN1 acupoint treatment were significantly decreased comparing with sham group. This trial suggested that wearable Low-level Laser Acupoint Therapy 650 nm 5 mW for 30 min each acupoint simultaneously could effectively reduce deep pressure pain on temporal head.

Mild traumatic brain injury (mTBI) often leads to migraine-like post-traumatic headache (PTH), yet effective treatments are limited. Clinical and preclinical studies have shown that mTBI disrupts glymphatic transport of cerebrospinal fluid in the brain. We hypothesized that altered glymphatic transport might underlie facial allodynia commonly associated with migraine and PTH. A closed-head impact model was used to induce mTBI in mice. Facial allodynia, a symptom of PTH and migraine, was evaluated using periorbital von Frey testing. Glymphatic influx was assessed using slice-based imaging of a fluorescent tracer injected into the cisterna magna. Here we show that prazosin (PZN), an α1-noradrenergic receptor antagonist, restores glymphatic function and treats facial allodynia induced by calcitonin gene-related peptide (CGRP) and a nitric oxide donor in mice. In contrast, propranolol, a β-noradrenergic receptor antagonist, was ineffective. Even in the absence of mTBI, CGRP reduced glymphatic function and PZN was able to restore glymphatic function in the dorsal cortex. Importantly, the role of glymphatic function was confirmed by the lack of PZN efficacy in aquaporin-4 knockout mice. These findings indicate that targeting α1-noradrenergic receptors to enhance glymphatic transport may offer a therapeutic strategy for treating migraine and PTH.

Central nervous system (CNS) involvement in multiple myeloma (MM) is rare - occurring in approximately 1% of cases - and typically presents as dural-based lesions, leptomeningeal infiltration or solitary parenchymal tumors. Multifocal extra-axial intracranial lesions without systemic relapse are extremely uncommon. We describe a 51-year-old male with plasma cell leukemia who initially presented with headache, hydrocephalus, and suspected meningitis. Magnetic Resonance Imaging (MRI) revealed multiple extra-axial contrast-enhancing lesions in the pineal region, sellar area, tectal plate, and cribriform plate. Cerebrospinal fluid (CSF) flow cytometry and neuro-navigation guided biopsy confirmed central nervous system (CNS) dissemination of plasma cell dyscrasia, bone marrow, serum, and urine studies were negative, confirming that this was an isolated CNS event. He underwent ventriculoperitoneal shunting and resection of the dominant pineal lesion. Despite treatment, follow-up imaging showed persistent intracranial disease along with new, abnormally enhancing nodular lesions within the cauda equine at the L2-L3 level. This case represents a rare case of multifocal extra-axial intracranial involvement of MM without systemic recurrence. It underscores the need for high clinical suspicion in atypical neuro-oncologic presentations and supports early surgical intervention for both diagnosis and symptomatic relief.

Paediatric optic neuritis is a rare inflammatory demyelinating condition that frequently presents with bilateral involvement and a generally favourable prognosis compared to adult-onset forms. We report the case of a seven-year-old boy with a history of thalassemia trait and mild autism who presented with a one-day history of sudden bilateral painful vision fluctuation, headache, and fever. Initial visual acuity (VA) was 6/12 in the right eye and 6/30 in the left eye, with normal optic nerve function test and fundoscopic examination indicating retrobulbar involvement. While initial computed tomography (CT) imaging was unremarkable, urgent magnetic resonance imaging (MRI) of the brain and orbit revealed features consistent with inflammatory demyelinating disease. Extensive investigations, including cerebrospinal fluid (CSF) analysis and testing for myelin oligodendrocyte glycoprotein (MOG-IgG) and aquaporin-4 (AQP4-IgG) antibodies, were negative, suggesting a seronegative monophasic demyelinating event such as acute disseminated encephalomyelitis (ADEM) spectrum. The patient was treated with high-dose intravenous methylprednisolone (IVMP) followed by a six-week oral steroid taper, resulting in a rapid recovery of VA to 6/6 bilaterally. At the six-month follow-up, the patient remained asymptomatic with stable neuroimaging. This case highlights the critical role of early contrast-enhanced MRI in diagnosing paediatric retrobulbar optic neuritis and the effectiveness of prompt, aggressive corticosteroid therapy in achieving excellent visual outcomes in seronegative paediatric demyelinating disorders.

Sex differences in signs and symptoms of cognitive impairment are well described in research cohorts, but whether they are reflected in routine clinical documentation is unknown.

Chronic pain in children and adolescents affects physical, psychological, social, and academic function. Although physical activity may play a role, its direct effects and its interactions with sleep difficulties and psychological symptoms remain unclear. This cross-sectional study examined whether physical activity is associated with chronic pain, and whether these associations vary by sleep difficulties and psychological symptoms. We analyzed data from 212,105 individuals (49% girls, age: 11-15 years) from the 2018 Health Behavior in School-aged Children study. Chronic pain, psychological symptoms, sleep difficulties, moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were assessed using validated self-report measures. Three multivariate logistic regression models (for chronic back pain, stomachache, and headache) examined main and moderation effects, adjusting for age, gender identity, and socioeconomic status. In adjusted main-effects models, higher MVPA was associated with higher odds of chronic back pain (aOR 1.15, 95% CI 1.06-1.25) and stomachache (aOR 1.02, 95% CI 1.00-1.09) but not headache. Interaction models indicated that MVPA associations differed by sleep difficulties, and the VPA-pain association differed by psychological symptoms. In stratified analyses, several MVPA frequency categories (vs 0 d/wk) were associated with lower odds of back pain and stomachache in both low and high sleep-difficulty groups. Vigorous physical activity was associated with lower odds of back pain and stomachache among adolescents with moderate or high psychological symptoms but not those with low symptom frequency. Overall, physical activity was not uniformly protective; associations were pain-type specific and varied according to adolescents sleep and psychological profiles.

The Canadian National Vaccine Safety Network (CANVAS) conducted active vaccine safety surveillance during the two-dose primary COVID-19 mRNA vaccine rollout in Canadian adults and expanded on the findings of prior active safety surveillance studies by including an unvaccinated control group. In this cohort study, vaccinated and unvaccinated adults from 7 provinces and territories were recruited to complete emailed surveys one week after each vaccine dose (or at registration for unvaccinated controls). The primary outcome was a health event that resulted in missed work or school or required medical consultation. Multivariable regression models examined health events associated with the first and second doses of BNT162b2 (Pfizer) and mRNA-1273 (Moderna) vaccines. Surveys were completed by 567,781 and 301,717 individuals following dose one and dose two, and by 14,984 unvaccinated participants. In the multivariate analysis, health events within a week following vaccination were higher among vaccinated individuals compared to controls, with risk ratios (RR) ranging from 2.3 [95% Confidence Interval (C·I.) 2.1 to 2.6] for the first dose of BNT162b2 to 7 [95% C·I. 6.3 to 7.8] for the second consecutive dose of mRNA-1273. Common symptoms included fatigue/malaise, headache, fever and joint pain, and most were self-limited. Health events requiring an ED visit or hospitalization were significantly increased after the first dose of mRNA-1273 (RR 2.1 [95% C.I. 1.5 to 3.1]) or the second consecutive dose of mRNA-1273 (RR 2 [95% C.I. 1.3 to 2.9]). In summary, self-limited health events were more common in the week following vaccination with a first or second dose of an mRNA COVID-19 vaccine, compared with controls, with the highest frequency occurring after a second dose of mRNA-1273. Health events requiring an ED visit or hospitalization were more common in participants who received the mRNA-1273 vaccine, compared with controls. This difference was not observed for the BNT1262b2 vaccine.