Introduction: Vitamin B6 is a water-soluble vitamin that is naturally present in many foods and is accessible in many dietary supplements. The three natural forms are pyridoxine, pyridoxal, and pyridoxamine. Both vitamin B6 deficiency and high B6 intake have been described as risk factors for developing peripheral neuropathy (PN). The aim of this systematic review is to characterize and comprehensively describe B6-related PN. Method: A systematic, computer-based search was conducted using the PubMed database. Twenty articles were included in this review. Results: Higher vitamin B6 levels, which usually occur following the taking of nutritional supplements, may lead to the development of a predominantly, if not exclusively, sensory neuropathy of the axonal type. After pyridoxine discontinuation, such patients subjectively report improved symptoms. However, although low vitamin B6 levels can be seen in patients suffering from peripheral neuropathy of various etiologies, there is no firm evidence that low B6 levels have a direct causal relationship with PN. Many studies suggest subjective improvement of neuropathy symptoms in patients suffering from PN of various etiologies after receiving B6 supplementation; however, no data about B6 administration as a monotherapy exist, only as part of a combination treatment, usually with other vitamins. Therefore, the potential therapeutic role of B6 cannot be confirmed to date. Supplementation with vitamin B6, even as part of a nutritional multivitamin supplement, has not been proven harmful at permitted daily doses in patients who already suffer from PN. Conclusion: Current scientific evidence supports a neurotoxic role of B6 at high levels. Although some studies suggest that low B6 is also a potential risk factor, further studies in this area are needed.

This systematic review aims to reassess the expanding role of the cerebellum in pain perception, challenging its traditional and simplistic association with the motor domain. Pain perception is a complex experience shaped by sensory, emotional, and cognitive factors, with recent findings underlining the cerebellum’s influence over these systems. This paper evaluates findings from 24 relevant studies to elucidate key findings with regard to pain and their potential clinical applications. The cerebellum's role in pain processing is assessed through its interaction with nociceptive pathways, pain anticipation, and the intonation of pain-related emotional responses. Key cerebellar regions such as Crus I, lobules VI and VIII, and the vermis, are persistently activated during pain perception and anticipation. These regions are linked to sensory-discriminative and affective-motivational elements of pain. Studies on patients with migraines, chronic low back pain, and irritable bowel syndrome (IBS) demonstrated increased cerebellar activation, suggesting its role in chronic pain conditions. Non-invasive neurostimulation techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), administered onto these cerebellar regions, show potential in modulation of pain and clinical application. Future research should aim to standardise methodologies, explore the cerebellum's role in acute pain, and investigate long-term effects of cerebellar-targeted treatments. Understanding the cerebellum's multifaceted role in pain perception can advance diagnostic and therapeutic strategies, offering a more comprehensive approach to pain management. This review underscores the need for further investigation into cerebellar mechanisms and their clinical applications, potentially transforming pain treatment paradigms.

Aim of this study is to investigate the safety, efficacy and impact on Health-Related Quality of Life (HRQoL) of Vertebroplasty (VP) and Kyphoplasty (KP) in the management of Osteoporotic Vertebral Compression Fractures (OVCFs) in elderly individuals. VP and KP represent Minimally Invasive Vertebral Augmentation (MIVA) procedures that are increasingly implemented for surgical treatment of OVCFs in recent years. These interventions have been associated with minimal traumatization and intraoperative hemorrhage, considerable analgesic effect and rapid postoperative recovery. Seventy-seven (77) consecutive individuals with OVCFs were subjected to VP/KP and recruited in this prospectively designed non-randomized study. Clinical evaluation was performed preoperatively and postoperatively at particular chronic intervals at 1, 6 weeks and at 3, 6, 12 months and 2 years. Assessment was conducted via the standardized Visual Analogue Scale (VAS) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire for pain and HRQoL, respectively. No perioperative complications were observed. All studied indices were demonstrated to present a statistically significant amelioration following overall analysis. Pain intensity measured by the VAS score was depicted to be significantly reduced during the first 3 months, but continuous improvement of all indices of SF-36 and VAS was demonstrated to reach a plateau at 6 months, featuring no further clinical improvement.VP and KP represent safe and efficient options for interventional treatment of OVCFs in elderly and oldest-old patients, improving self-reported symptoms of pain as well as overall HRQoL.

Chronic pain in post-critical care patients is a multifaceted issue with profound implications for patient well-being and quality of life. This review aims to address the rehabilitation of patients who suffer from chronic pain following discharge from the intensive care unit (ICU). Despite growing awareness of the prevalence and impact of this condition, significant gaps in knowledge persist regarding the optimal rehabilitation strategies for these patients. To conduct this study, an extensive literature search was undertaken, encompassing peer-reviewed articles, clinical trials, and observational studies in Medline, Scopus, and Cinahl databases, using specific keywords. Studies were identified based on their titles, abstracts, and those that met the inclusion criteria. Sixteen studies were eligible for inclusion in this review, varying in methodology, assessment tool, assessment time, or follow-up. The findings of this review illuminate the existing gaps in knowledge by synthesizing evidence on the various rehabilitation approaches employed, their effectiveness, and the factors influencing patient outcomes. So far, healthcare professionals have targeted either pain treatment, finding an analgesic medication or the proper position/exercise, or pain management, helping the patient manage life despite the unrelieved pain. Conventional pain treatment or control has been replaced by pain rehabilitation, in which a biopsychosocial approach enables healthcare professionals to provide patients with the knowledge and skills to manage their pain and disability through personal multidimensional choices. Early rehabilitation programs, quick mobilization, and greater family participation should be encouraged. The strengths of this study lie in its thorough analysis of the available literature and the provision of valuable insights into the heterogeneous nature of chronic pain in post-critical care patients. However, limitations include the limited availability of high-quality randomized controlled trials in this domain. Overall, this review contributes to an improved understanding of rehabilitation strategies for chronic pain in post-critical care patients and underscores the need for further research to enhance patient care and outcomes.

Background/Objectives: Black hairy tongue syndrome (BHT) is characterized by structural epithelial changes and a dark discoloration on the surface of the tongue, causing a variety of symptoms such as xerostomia, altered taste, and nausea. Methods: Herein, we report a 70-year-old female patient with a history of Sjogren’s syndrome, rheumatoid arthritis, and occasional use of intranasal and inhaled corticosteroids, who presented with BHT exacerbated by consumption of colored beverages and carbohydrates. We also provide a review of the literature on published articles reporting cases of BHT syndrome. Results: Our patient’s condition improved after implementing dietary restrictions in combination with local care. A literature review revealed that the most common reported exposures and underlying conditions in patients with BHT were the recent administration of antibiotics, solid organ or hematologic malignancy, immunosuppressants, smoking, corticosteroids, autoimmune conditions, receipt of antidepressants, local radiation therapy, proton pump inhibitors, and alcohol. The majority of cases were successfully managed with the elimination of implicated factors when possible and local hygiene. Conclusions: Different factors may contribute to the development of BHT. Discontinuation of implicated medications together with measures for topical care constitute the most effective ways to achieve resolution.