Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis.

Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte's phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.

Genital mutilation as a consequence of criminal offence against a person.

OBJECTIVE: The aim: The paper is aimed at creation of a procedure for determining the loss of any body organ or its functions, genital mutilation, as the signs of grievous bodily harm, penalty for which is stipulated by the Article 121 of the Criminal Code of Ukraine, as well as establishing the possibilities of legal setting of the concept of "genital mutilation". PATIENTS AND METHODS: Materials and methods: Over 100 criminal proceedings, involving forensic medical examination, under the Article 121 of the Criminal Code of Ukraine for the period from 2007 to 19.05.2019 have been studied. Common methods of research have been used, namely, the analysis and synthesis, statistical method, as well as own observations of the process of judicial examination of the above criminal proceedings, as well as individual interviews, survey of the victims and their family members in total of 39 people. RESULTS: Results and conclusions: The findings of the investigation enabled detecting the gaps in the regulation of the procedure to define genital mutilation as a characteristic feature of grievous bodily harm. The ways of further improvement of the procedure of conducting expert studies of genital mutilation as a characteristic feature of bodily harm, which facilitates avoiding of errors in forensic medical and judicial practices have been found. The process of criminalization of the illegal conduct of surgical operations, resulted in mutilation of genitalia, must take place with the mandatory involvement of specialists in the field of practical medicine, as well as medical scientists specializing in sexopathology, gynecology, oncogynecology, forensic medicine in order to avoid errors in the lawmaking.