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Dr Abdelrahman Taha, السويس, Suez (2026)

24/10/2025

🚨 Shifting the Paradigm for Acute Sciatica Care in the ED! 🚨

A recent pilot study explored a new, non-invasive approach to managing acute lumbar radiculopathy (sciatica) from disc herniation—right in the emergency hospital setting. The results suggest a powerful combination for quicker relief and reduced need for strong painkillers.

The Study Protocol:
Patients with acute sciatica arriving at the ED were randomized into two groups (10 patients each):
- Control Group: Standard care including medication, forward bending, and walking.
- Experimental Group: Standard care PLUS a specific Static Nerve Root Foramen Opening Protocol. This involved using side-lying flexion and contralateral lateral flexion maneuvers to physically decompress the nerve root.

Key Findings & Conclusion:
The group that received the Nerve Root Foramen Opening Protocol alongside standard care showed:
✅ Greater improvements in both back and leg pain (measured by VAS).
✅ Greater improvements in disability (measured by ODI).
✅ A significant reduction in opioid consumption.
✅ No adverse responses were reported.

This initial evidence suggests that adding a simple, static physical maneuver to the early conservative treatment for acute sciatica in the ED may dramatically improve patient outcomes and help tackle the reliance on strong pain medication.

22/10/2025

quote for today:

The clinical history is at least 50% of the assessment so never underestimate its importance. Take it seriously, and take the time. You should present as clean, competent, interested and caring. This is where you establish a good patient/clinician relation, and start the process of building the all-important therapeutic alliance.

21/10/2025

Dive Deeper into the Mystery of Neuropathic Pain! 🧠💡

Clinical pain, especially the persistent agony following nerve injury (neuropathic pain), is a complex puzzle. Ever wondered how pain can exist without a stimulus, or why a light touch suddenly feels like a painful jab?

This paper explores the fascinating and intricate mechanisms behind this debilitating condition. It goes far beyond simple 'neuronal pathways' to reveal a surprising cast of characters involved:

* Peripheral Support Cells: Discover the crucial roles of Schwann cells and satellite cells in the dorsal root ganglia.

* The Immune Connection: Understand how components of the peripheral immune system contribute to the chronic pain state.

* Glial Game-Changers: Learn about the active participation of spinal microglia and astrocytes—the brain's and spinal cord's own immune and support cells—in driving pain sensitization.

👉 Why you should read this paper:

1* Gain a holistic view: Move beyond the traditional focus on neurons and appreciate the full cellular complexity of chronic pain.

2* Understand hypersensitivity: See the cellular basis for reduced nociceptive thresholds (allodynia/hyperalgesia), where normally innocuous stimuli become painful.

3* Inform therapeutic targets: The diverse involvement of these cell types highlights new avenues for developing more effective, non-opioid pain treatments.

Highly recommended reading for: Neuroscientists, pain researchers, pharmacologists, neurologists, and anyone interested in the complex interplay between the nervous system, immunity, and chronic disease. Don't miss out on this cutting-edge perspective! 🔬📚

17/10/2025

It's time to rethink pain! Emerging research is shattering the traditional view of pain as purely a neuronal phenomenon, highlighting the neuroimmune axis as a critical player.

Immune Drivers of Pain:
Pain is not just in nerves—it’s a neuroimmune condition! Immune cells are central to both protective (physiological) and persistent (pathological) pain.

- Key Insight: Immune cells in the skin, nerves, DRGs, and spinal cord interact with sensory neurons to trigger and modulate all types of pain, including acute, inflammatory, and neuropathic pain.

- Inflammatory Control: Macrophages show functional plasticity, initially promoting pain but later producing anti-inflammatory molecules like IL-10 to aid in resolution.

- Adaptive Immunity's Role: T and B cells can drive pain: autoantibodies from rheumatoid arthritis patients, for example, can induce pain without clinical inflammation.

- CNS and Chronic Pain: Microglia in the spinal cord and brain, and neutrophils in the DRGs, are linked to persistent and dysfunctional pain syndromes like fibromyalgia.

- The Future of Analgesia: The neuroimmune axis is an attractive drug target, but novel therapies must consider challenges like s*x differences in pain presentation and the risks of immune modulation.

17/10/2025

Using NSAIDs to suppress acute inflammatory neutrophil response correlated with the development of chronic low back pain in patients (Parisien et al., 2022)!!!

Reference:
Parisien, M., L.V. Lima, C. Dagostino, N. El-Hachem, G.L. Drury, A.V. Grant, J. Huising, V. Verma, C.B. Meloto, J.R. Silva, et al. 2022. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci. Transl. Med. 14:eabj9954.

17/10/2025

Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive therapeutic technique based on the application of low-voltage electrical currents to the skin surface, through electrodes placed on or near the area of pain or along the nerve pathways.

In this case I used stimulation at a relatively high frequency (80 - 130Hz) and employ a relatively narrow (short duration) pulse but in burst mode stimulation, with intensity adjusted until patient reports strong but comfortable. Total duration 20 minutes.

In this instance, the higher frequency stimulation output (typically at about 100Hz) is interrupted (or burst) at the rate of about 2 - 3 bursts per second. When the machine is ‘on’, it will deliver pulses at the 100Hz rate, thereby activating the Aβ fibres and the pain gate mechanism, but by virtue of the rate of the burst, each burst will produce excitation in the Aδ fibres, therefore stimulating the opioid mechanisms. For some patients this is by far the most effective approach to pain relief, though as a sensation, numerous patients find it less acceptable and usually more by way of muscle twitching.

I used this type over sciatic nerve course with used trigger points in superior-lateral quadrant of gluteal area (as specific sign for radicular pain) before & after application. I found The ‘carry over’ effect may last for several minutes to hours (during session), though the duration of this carry over will vary between patients.

16/10/2025

Case Report: Progressive Functional Restoration Following Nerve surgery in Traumatic Forearm Neuropathy

Introduction
Traumatic peripheral nerve injuries in the upper extremity present a significant clinical challenge, often resulting in severe functional deficits and compromised quality of life. Timely and appropriate intervention, including surgical repair and subsequent intensive physical therapy, is crucial for optimizing outcomes. This case report details the clinical course and initial rehabilitation progress of a patient with severe left forearm traumatic neuropathy treated with nerve surgery followed by a structured physical therapy regimen.

Case Presentation:

A 33-year-old male presented following a traumatic injury resulting in complete left forearm neuropathy.
Initial Presentation and Baseline Assessment (Pre-Surgical/First Physiotherapy Attempt)

👉 Motor Examination:
The patient exhibited a complete loss of hand function, with the only spared motor function being the thenar muscles of the thumb. Manual Muscle Testing (MMT) revealed Grade 0 strength in all other muscles of the left hand and forearm (excluding the spared thenar group).

👉 Sensory Examination (Compared to the right side):
Bedside sensory testing revealed significant deficits:

* Cotton Wool Test (Crude Sensation/Light Touch): Complete loss of crude sensation over the first dorsal web space, the skin of the palmar side of the little finger, and the central palmar area.

* Pinprick Test (Pain Sensation): Exhibited hypersensitivity (hyperesthesia/allodynia) over the left palmar area and the first dorsal web space between the thumb and index finger.

First Physiotherapy Attempt:
A three-month course of physical therapy was initially attempted. However, the patient showed no measurable change in the baseline bedside neurological examination findings during this period.

Post-Operative Course and Second Physiotherapy Attempt:

Following the failure of conservative management, the patient underwent an nerve surgery procedure. Post-operatively, a second structured physical therapy program was initiated at "the Physical Therapy Department of Suez Medical Complex". This phase of rehabilitation spanned three months and included careful follow-up assessments for both motor and sensory function.

👉 Follow-up Assessment (Three Months Post-Surgery and Second Physiotherapy Phase):

🛑 Motor Examination (MMT):
Significant motor recovery was observed:
* Wrist Extension: Grade 3 (Movement against gravity)
* Wrist Flexion: Grade 3 (Movement against gravity)
* Finger Flexion: Grade 2 (Movement with gravity eliminated)
* Finger Extension: Grade 1 (Flicker/trace contraction)

🛑 Sensory Examination (Compared to the right side):
Substantial sensory restoration was documented:

A) Cotton Wool Test (Light Touch):
Light touch sensation was fully restored across all previously affected areas (compared to the contralateral side).

B) Pinprick Test (Pain Sensation):

1* Left First Dorsal Web Space (between thumb and index): Slight hypoesthesia (reduced sensitivity) compared to the right side.

2* Sensation over the palmar side of the little finger (hypothenar skin area): Restored.

3* Sensation over the central palmar area: Restored.

Conclusion and Acknowledgements:

This case demonstrates encouraging motor and sensory regeneration following nerve surgery and a dedicated physical therapy program for a severe traumatic forearm neuropathy. The patient’s progress from Grade 0 to Grade 3 in wrist movements and the near-complete restoration of light touch sensation within a three-month post-operative period are significant early indicators of functional recovery.

However, this successful outcome is merely the beginning of the recovery process. We remain committed to continuing the physical therapy journey to achieve further functional milestones, particularly in maximizing hand and finger strength.

We extend our sincere gratitude and appreciation to Dr. abdelmohsen, Head of the Physical Therapy Department, for his continuous support, guidance, and leadership. We also thank Dr. Emam for the excellent surgical outcome achieved through the endoscopic nerve repair, and we are committed to meticulously following his post-operative instructions. Finally, a special acknowledgement is due to our colleague, Dr. Ibrahim, a true partner in this success, with whom we consistently collaborated and discussed the case to ensure the best possible results.

12/10/2025

Chronic neuropathic pain is a major cause of disability globally, and its impact is expected to grow. This places a significant moral obligation on us to find more effective treatments. While we've long focused on the nervous system, new research is highlighting the crucial role of the immune system in pain resolution.

This is a paradigm shift. We’re moving beyond simply blocking pain signals to understanding how the body can actively resolve pain on its own.

this recent review delves into the intricate immune-neuro axis and its role in resolving neuropathic pain. This is a must-read for anyone looking to deepen their understanding of:

1) Innate and Adaptive Immunity: How different immune cells, both resident and migrating, can either promote or suppress pain.

2) Meningeal Immunity: The role of the meninges—the protective layers around the brain and spinal cord—as a key site for immune-mediated pain resolution.

3) The Gut-Brain Axis: The surprising but powerful link between gut microbiota and pain.

4) Specialized Pro-Resolving Mediators (SPMs): How the body's own molecules can resolve inflammation and pain.

This review unpacks the complex, dynamic nature of neuroimmune interactions, emphasizing that the function of immune cells can change based on the type of injury, its phase (acute vs. chronic), and the local environment.

The future of pain management lies in immunotherapy and immunomodulation. By leveraging our understanding of these beneficial immune responses, we can develop targeted therapies that amplify the body's natural ability to heal without causing broad immunosuppression. Advances in genomics and personalized medicine hold the promise of tailoring treatments to each patient's unique molecular profile.

We have an opportunity to move from managing symptoms to truly resolving chronic pain 👌👌

12/10/2025

Navigating Neuropathic Pain: A Deeper Look at Immune-Neural Interactions 🕵️

Neuropathic pain, a persistent challenge in clinical practice, is increasingly understood as a complex interplay between the nervous and immune systems. Beyond symptom management, new research highlights the profound role of immune cells in pain resolution, offering a paradigm shift in our approach to treatment.

💥 Key insights for clinicians:

1) Immune cells as pain regulators:
The spinal cord and its meninges are not just passive sites of pain transmission but active arenas for immune-mediated pain resolution. Resident and infiltrating immune cells, including M2-like macrophages, T regulatory cells (Tregs), and T helper (TH) type 2 cells, are key players.

2) The power of anti-inflammatory mediators:
These cells secrete pro-resolving mediators like IL-10 and IL-4, which actively inhibit microgliosis and astrogliosis—cellular processes that amplify pain signals. This reduces neuronal excitability and fosters a less inflammatory environment.

3) Specialized Pro-resolving Mediators (SPMs):
Molecules such as resolvins, protectins, and maresins act to directly resolve pain. They can inhibit pain-sensing channels like TRPV1 on nociceptive neurons and suppress pro-inflammatory signaling.

4) Microglia's dual role:
While often associated with pro-inflammatory activity in chronic pain, certain M2-like microglia subpopulations are a force for pain resolution. They can suppress neuronal excitability via IL-10Rα signaling and even secrete opioids, offering an endogenous mechanism for pain relief.

5) A broader perspective:
Emerging evidence suggests that CD8+ T cells and Natural Killer (NK) cells in the cerebrospinal fluid may also play a protective role, with higher levels correlating with better pain outcomes.

This evolving understanding of immune-neural crosstalk opens new therapeutic avenues. Instead of solely blocking pain signals, future strategies may focus on modulating the immune system to actively promote pain resolution, offering more targeted and effective relief for our patients.

12/10/2025

The Immune System: A Hidden Ally in Pain Resolution 🥸

Understanding the complex interplay between the immune system and the nervous system is key to managing chronic pain. This is particularly relevant in neuropathic pain, where immune cells play a crucial role not just in inflammation, but also in pain resolution.

💥 The Immune System's Role in Pain Resolution

Pain resolution is a dynamic process involving a cast of specialized immune cells that actively work to calm the nervous system and promote tissue repair.

👉 Macrophages switch from a pro-inflammatory M1 state to a pain-resolving M2 state. They clean up cellular debris, release anti-inflammatory signals like TGFβ, and even produce opioid peptides to directly inhibit pain signals at the nerve fibers.

👉 T cells and neutrophils also contribute by releasing their own pain-inhibiting molecules, such as opioid peptides from neutrophils and cytokines like IL-10 and IL-4 from specialized T cells. These signals help to balance the inflammatory response.

👉 Natural killer (NK) cells help with nerve regeneration by clearing damaged axons, which is a vital step in restoring normal nerve function.

👉 In the dorsal root ganglia (DRG), a critical hub for pain signaling, immune cells and resident cells like fibroblasts work to tamp down hyperactivity. For example, specific T cells secrete IL-13, which stimulates pain-resolving macrophages to release IL-10, further calming neuronal firing.

By understanding these sophisticated mechanisms, we can appreciate that the immune system is a powerful ally in the fight against chronic pain. Future therapeutic strategies may target these cellular interactions to provide more effective and lasting pain relief.

12/10/2025

Dietary Tip for Neuropathic Pain Patients

Consider incorporating omega-3 fatty acid supplementation as a complementary strategy for your patients with neuropathic pain. The therapeutic benefit lies in the body's ability to convert these essential fats into Specialized Pro-resolving Mediators (SPMs), which are endogenous molecules that actively resolve inflammation rather than simply blocking it.

The Mechanism

1. SPM Biosynthesis: SPMs, including resolvins, protectins, and maresins, are biosynthesized from omega-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This process is initiated during the resolution phase of acute inflammation.

2. Receptor-Mediated Action: SPMs act on specific G protein-coupled receptors (GPCRs) like FPR2 and GPR32, and can also modulate transient receptor potential (TRP) channels (TRPV1 and TRPA1). This signaling cascade not only promotes the clearance of inflammatory debris but also directly inhibits pain pathways, providing both immunoregulatory and neuroprotective effects.

3. Clinical Evidence: Clinical studies have demonstrated that daily, high-dose omega-3 supplementation can lead to significant reductions in pain and suppression of pro-inflammatory markers in various neuropathic pain conditions, including those associated with diabetic neuropathy, cervical radiculopathy, and fibromyalgia.

👉 Recommendation

Advise patients to consider a daily high-dose omega-3 supplement, particularly those rich in EPA and DHA. While further rigorous clinical studies are warranted, the existing evidence and the safety profile of omega-3s make this a low-risk, high-potential intervention to support endogenous pain resolution programs.

👇👇👇👇

👉 SPM Biosynthesis: SPMs are biosynthesized from PUFAs by enzymes like COX and LOX. Resolvins, protectins, and maresins are from omega-3s (EPA & DHA), while lipoxins are from omega-6s (arachidonic acid).

👉 Receptor Signaling: Key receptors for SPMs include FPR2, GPR18, GPR32, ChemR23, and LGR6.

👉 Clinical Efficacy: Studies have shown reduced neuropathic pain symptoms with daily omega-3 supplementation over several months.

Dr Abdelrahman Taha

24/10/2025

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