The tripeptide glutathione is found in all eukaryotic cells, and due to the compartmentalization of biochemical processes, its synthesis takes place exclusively in the cytosol. At the same time, its functions depend on its transport to/from organelles and interorgan transport, in which the liver plays a central role. Glutathione is determined as a marker of the redox state in many diseases, aging processes, and cell death resulting from its properties and reactivity. It also uses other enzymes and proteins, which enables it to engage and regulate various cell functions. This paper approximates the role of these systems in redox and detoxification reactions such as conjugation reactions of glutathione-S-transferases, glyoxylases, reduction of peroxides through thiol peroxidases (glutathione peroxidases, peroxiredoxins) and thiol–disulfide exchange reactions catalyzed by glutaredoxins.

Acute pain is a physiologic, protective life-important warning neurological signal indicating multi-level tissue modulations caused by a broad spectrum of health adverse events such as stress overload, mechanical trauma, ischemia–reperfusion, sterile and infection-triggered inflammation, single- and multi-organ damage, acute and chronic wounds, tissue remodeling and degeneration, amongst others. On the other hand, pain chronification results in a pathologic transformation from the protective pain signaling into persistent debilitative medical condition with severe consequences including but not restricted to phenotype-specific behavioral patterns, reduced quality of life, and cognitive and mood disorders. Who is predisposed to an increased vs. decreased pain sensitivity and to the pain chronification? The motivation of personalized medicine that “same size does not fit all” is getting obvious also for an advanced approach in algesiology. Consequently, an in-depth patient stratification is essential for the paradigm change in overall pain management from currently applied reactive medical services to the cost-effective predictive, preventive, and personalized medicine (PPPM/3PM) in primary (reversible damage to health and targeted protection against health-to-disease transition) and secondary (personalized protection against disease progression) care. To this end, specifically innovative concepts of phenotyping elaborated in this study play a crucial role in patient stratification for predicting pain-associated outcomes, evidence-based targeted prevention of the pain chronification, and creation of treatment algorithms tailored to individualized patient profiles.

Pancoast tumors, also known as superior sulcus tumors, encompass a diverse spectrum of neoplasms that infiltrate the apex of the chest wall, yielding distinctive clinical presentations. One of the earliest signs of tumor growth is pain radiating to the upper limb, stemming from peripheral nerve involvement, which can mimic joint pain or spinal radicular irritation. In this case report, we present the clinical history of a 64-year-old female smoker who had previously been recommended for orthopedic elbow surgery due to epicondylitis. Subsequent to the development of additional symptoms and rigorous investigation, a Pancoast tumor was diagnosed. Furthermore, we discuss the characteristic treatment modalities available for Pancoast tumors, including pharmacological pain management and interventional strategies such as spinal cordotomy and spinal alcoholysis. This case underscores the significance of recognizing atypical presentations and emphasizes the importance of comprehensive evaluation in the diagnosis and management of Pancoast tumors.

Radiofrequency denervation of the zygapophysial (facet) joints is a frequently performed procedure for chronic low back pain. However, cryoablation represents a novel therapeutic approach for this condition. We observed and analyzed 3 cases with confirmed positive lumbar facet joint syndrome. Our results show a significant improvement in the clinical state of the patients in the first and third months after the procedure. The 6-month follow-up examination demonstrates a recurrence of pain and a gradual deterioration in the quality of life with a lasting partial pain-relief effect. Thermal radiofrequency denervation and cryoablation of the lumbar zygapophysial joints represent an effective, albeit temporary treatment option for lumbar facet joint syndrome patients, resulting from the pathophysiology of sensory nerve regeneration after destructive procedures. This type of treatment can be used repeatedly in the case of a positive response.

Rationale: Acute aortic syndromes, including dissection and aneurysm, are life-threatening vascular emergencies that often present with vague, nonspecific pain. Such pain may mimic common musculoskeletal or visceral disorders such as vertebrogenic, renal, or gastrointestinal pain, leading to diagnostic delays and adverse outcomes. This case series underscores how atypical vertebrogenic-like pain can conceal underlying aortic pathology and highlights the importance of early imaging in suspicious cases. Patient concerns: A 56-year-old man with descending thoracoabdominal aortic aneurysm, and 35-year-old man with Stanford Type A ascending aortic dissection. Diagnoses: CT angiography of the aorta due to persistent vertebrogenic back pain despite treatment of lumbar spine pathology revealing a large descending thoracoabdominal aortic aneurysm. In second case a CT scan of the cervical and thoracic spine performed after persistent pain despite cervical vertebrogenic syndrome analgesics treatment led to aortic dissection confirmation. Interventions: Elective surgical repair of aneurysm via thoraco-phreno-laparotomy. The aneurysm was resected and replaced with a 22-mm aorto-aortic Dacron graft. In second case, an emergency surgery with veno-arterial extracorporeal membrane oxygenation support with an open chest due to ongoing uncontrollable hemorrhage was provided. Outcomes: Patient was discharged on postoperative day 7 in stable condition. A second patient passed away of early complications as systemic inflammatory response syndrome, acute renal failure, and circulatory shock. Lessons: These cases emphasize the diagnostic challenges of aortic pathologies in the context of misleading clinical features. Physicians must maintain a high index of suspicion for acute aortic syndromes, particularly when encountering atypical or refractory pain in patients with cardiovascular risk factors. Early diagnosis and adherence to guideline-based management are critical to improving survival in these high-risk emergencies.