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Pain is a major public health problem, causing heavy social and economic burdens to patients and society while consuming tremendous medical resources at the same time. Thus, there is a critical need to find low-cost, efficacious, and therapeutic approaches to help manage pain. While acupuncture is increasingly recognized as a promising pain-relieving method, less is known about a specific form of auricular acupuncture known as Battlefield Acupuncture (BFA). The BFA technique involves the sequential placement of semi-permanent, single-use, French ASP${}^{Ⓡ}$ golden needles to five specific acupoints in one or both ears, where they are left in place for 3–4 days or longer [Niemtzow, R.C., Battlefield acupuncture. Med. Acupunct. 19: 225–228, 2007]. The BFA needles (more accurately described as tiny conical darts) pierce the ear in designated locations in a particular order [Levy, C.E., N. Casler and D.B. FitzGerald. Battlefield acupuncture: an emerging method for easing pain. Am. J. Phys. Med. Rehabil. 97: e18–e19, 2018.]. (Figs. 4 and 5) It was developed by Dr. Richard C. Niemtzow in 2001, as a subgroup form of an auricular acupuncture technique based on the somatotopic arrangement of an inverted fetus pattern on the external ear [Romoli, M. Ear acupuncture: historical abstract–differences of ear cartography between the east and the west. Dtsch. Z. Akupunkt. 53: 24–33, 2010.]. Currently, BFA is widely used in the US military, but to our knowledge, there is no review which comprehensively synthesizes the current publications surrounding pain management. This review aims to investigate the effects and safety of BFA in adults with pain. Electronic databases were searched for randomized controlled trials (RCTs) published in English evaluating efficacy and safety of BFA in adults with pain, from database inception to September 6, 2019. The primary outcome was pain intensity change, and the secondary outcome was safety. Nine RCTs were included in this review, and five trials involving 344 participants were analyzed quantitatively. Compared with no intervention, usual care, sham BFA, and delayed BFA interventions, BFA had no significant improvement in the pain intensity felt by adults suffering from pain. Few adverse effects (AEs) were reported with BFA therapy, but they were mild and transitory. BFA is a safe, rapid, and easily learned acupuncture technique, mainly used in acute pain management, but no significant efficacy was found in adult individuals with pain, compared with the control groups. Given the poor methodological quality of the included studies, high-quality RCTs with rigorous evaluation methods are needed in the future.

This study aimed to analyze and predict various types of knee pain in knee osteoarthritis (KOA) patients based on Semi-Quantitative MRI Osteoarthritis Knee Score (SQ-MOAKS) features. The goal was to identify structural abnormalities in the knee joint associated with different types of pain, thereby aiding in the development of personalized treatment plans. Subjects were selected from the Osteoarthritis Initiative (OAI) database, including 297 patients who underwent both SQ-MOAKS assessment on knee MRI images and WOMAC knee pain assessment. Univariate and multivariate logistic regression analyses were used for feature selection, followed by the construction of multi-risk factor models and corresponding nomograms for each pain type. The predictive values of the models were evaluated using ROC curves and related metrics (AUC, accuracy, sensitivity, specificity), and the DeLong test was used to assess the significance of differences between various ROCs and AUCs. Significant associations were found between specific SQ-MOAKS features and different types of knee pain. Bone marrow lesions (BML) and cartilage morphology (CM) features were crucial in predicting the walking pain and rest pain, while osteophytes (OS) were more associated with nocturnal pain and pain during stair climbing. The models demonstrated high predictive accuracy, particularly for walking pain and rest pain. This study demonstrated that SQ-MOAKS features could effectively predict different types of knee pain, revealing the structural basis of knee pain in KOA patients. These results prompted the use of SQ-MOAKS in developing personalized treatment strategies, enhancing clinical decision-making, and improving patient quality of life.

The number of smartphone users is growing dramatically. Using the smartphone frequently forces the users to adopt an awkward posture leading to an increased risk of musculoskeletal disorders and pain. The objective of this study is to conduct a systematic review of studies that assess the effect of smartphone use on musculoskeletal disorders and pain. A systematic literature search of AMED, CINAHL, PubMed, Proquest, ScienceDirect using specific keywords relating to smartphone, musculoskeletal disorders and pain was conducted. Reference lists of related papers were searched for additional studies. Methodological quality was assessed by two independent reviewers using the modified Downs and Black checklist. From 639 reports identified from electronic databases, 11 were eligible to include in the review. One paper was found from the list of references and added to the review. The quality scores were rated as moderate. The results show that muscle activity of upper trapezius, erector spinae and the neck extensor muscles are increased as well as head flexion angle, head tilt angle and forward head shifting which increased during the smartphone use. Also, smartphone use in a sitting position seems to cause more shift in head–neck angle than in a standing position. Smartphone usage may contribute to musculoskeletal disorders. The findings of the included papers should be interpreted carefully in light of the issues highlighted by the moderate-quality assessment scores.

Background: Endometriosis is a chronic disease that affects approximately 10% of reproductive-age women, and one of the primary symptoms is pain, which can significantly impact quality of life and productivity. This has resulted in substantial income loss for women across the world.

Aims: This study aimed to systematically review the evidence of nutrition interventions for improving pain in endometriosis patients based on randomized controlled trials (RCTs) and to perform a meta-analysis of the risk difference in mean visual analogue scale (VAS) between the treatment group and control.

Methods: A comprehensive search strategy was used in PubMed, Embase, Cochrane Library, and Scopus using the keywords endometriosis, diet, nutrition, and pain. Screening, full-text review, and risk assessment were performed by two independent reviewers, and risk assessment bias was conducted using Risk of Bias 2 (RoB2).

Results: The search resulted in 1,084 records, and eight studies were included in the review. Most studies were concluded to have low risk of bias based on RoB2 assessment, with two studies with some concern and one study with high risk of bias according to missing outcome data in reports. A total of 225 cases and 245 controls, laparoscopically confirmed with endometriosis, were included in this review. Nutrition interventions included in this review were vitamin C, D, E, fish oils, and complementary diet therapy for 8-24 weeks. Meta-analysis using a random-effect model showed an 18% risk reduction in mean VAS in the treatment group compared to the control. Although this analysis found substantial heterogeneity within the study (I2=82.51%), this finding can be explained by subgroup analysis, in which fish oils showed a positive mean risk difference with a large confidence interval.

Conclusions: This study found that nutrition interventions show promising effects in alleviating pain in endometriosis. However, further research, especially RCTs for comparing nutrition intervention and medical treatments in managing endometriosis pain, is still much needed. These findings highlight the importance of exploring alternative, non-pharmacological approaches in endometriosis management, which could potentially improve the quality of life for patients.