http://bura.brunel.ac.uk/handle/2438/13040 2026-04-13T20:09:12Z 2026-04-13T20:09:12Z Hakak, Y http://bura.brunel.ac.uk/handle/2438/32804 2026-02-16T09:55:22Z 2026-01-15T00:00:00Z

Title: Safeguarding from power: trauma, violence and the case of Israel Authors: Hakak, Y Abstract: Since October 2023, numerous international human rights organisations, special observers, journalists and scholars have documented the genocidal violence inflicted on Palestinians by the Israeli army and the settlers – violence that is often live-streamed. Their calls to safeguard the Palestinian people in Gaza and the West Bank from Israeli violence have largely fallen on deaf ears. I will therefore try to provide additional evidence and justification for international intervention by shifting the focus to the Israeli side, which is holding and abusing unrestrained powers... Description: Editorial Commentary.

2026-01-15T00:00:00Z Gilanyi, Y Ferraro, MC Goebel, A O'Connell, NE Jones, MD Sharma, S Bean, D Gustin, SM McAuley, JH http://bura.brunel.ac.uk/handle/2438/32087 2025-10-13T17:59:04Z 2025-10-03T00:00:00Z

Title: Amputation for complex regional pain syndrome: a systematic review Authors: Gilanyi, Y; Ferraro, MC; Goebel, A; O'Connell, NE; Jones, MD; Sharma, S; Bean, D; Gustin, SM; McAuley, JH Abstract: Complex regional pain syndrome (CRPS) is a disabling pain condition, usually confined to a single limb. Amputation of the affected limb is sometimes performed to improve pain and function for treatment-resistant CRPS. This systematic review evaluated the benefits and harms of amputation for CRPS. Primary studies of adults with CRPS that investigated the effects of amputation of a CRPS affected limb were included. Primary outcomes were pain intensity and adverse events. The following databases were searched from inception to 23 September 2024: PubMed, EMBASE, Scopus, CENTRAL, CINAHL, and PsycINFO for published literature, and BASE, Web of Science, OpenMD and MedNar for grey literature. Study methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Data were synthesised using systematic review without meta-analysis guidance. The review included 66 studies, comprising one comparative study, 23 case series and 42 case studies. Studies included 249 patients who received 263 amputations. Amputation indications included pain relief, functional improvement, infection, fracture, and prosthetic complications. The heterogeneous designs of included studies precluded quantitative estimation of treatment effects. The only included comparative study reported that CRPS patients had lower mean pain intensity scores post-amputation than non-amputated, non-matched control patients. The four studies that assessed pain intensity scores before amputation and at least 6 months post-operatively, reported reductions in average pain post-amputation. Adverse events in assessed patients included phantom pain (67%), residual limb pain (66%), and recurrence of CRPS (47%). The critically low quality of included evidence and incomplete reporting greatly reduced confidence in the results. This review found no clear evidence that amputation of a CRPS-affected limb offers greater pain relief than no amputation. High-quality, controlled prospective studies with embedded qualitative research are needed to determine the benefits and harms of amputation for CRPS, as well as the factors that drive patients to seek this permanent intervention that does not guarantee improvement. Description: Perspective: This article presents a systematic review of the benefits and harms of amputation for complex regional pain syndrome. The unclear benefits and likely harms can help inform individuals and clinicians considering amputation of the potential outcomes of this intervention.

2025-10-03T00:00:00Z Ferraro, MC Cashin, AG Visser, EG Abdel Shaheed, C Wewege, MA Wand, BM Gustin, SM O'Connell, NE McAuley, JH http://bura.brunel.ac.uk/handle/2438/31748 2025-09-04T12:14:31Z 2025-08-18T00:00:00Z

Title: Ketamine and other NMDA receptor antagonists for chronic pain Authors: Ferraro, MC; Cashin, AG; Visser, EG; Abdel Shaheed, C; Wewege, MA; Wand, BM; Gustin, SM; O'Connell, NE; McAuley, JH Abstract: Rationale: N‐methyl‐D‐aspartate (NMDA) receptor antagonists are a group of medicines classed according to their mechanism of action. Ketamine and other NMDA receptor antagonists are used to treat chronic pain, despite uncertain benefits and harms. Objectives: To evaluate the benefits and harms of ketamine and other NDMA receptor antagonists compared to placebo, usual care, or other medicines for adults with chronic non‐cancer, non‐headache pain. Search methods: We searched CENTRAL, MEDLINE, Embase, and three trial registries (with reference checking, citation searching, and contact with study authors/experts) to identify included studies. The last search was 3 June 2025. Eligibility criteria: We included randomised controlled trials (RCTs) in adults with chronic pain (≥ 3 months' duration), evaluating ketamine, memantine, dextromethorphan, amantadine, or magnesium versus placebo, usual care, or another medicine. We excluded studies of cancer or headache pain. Outcomes: Critical outcomes were pain intensity and adverse events. Important outcomes were disability, depressive symptoms, health‐related quality of life, tolerability, and opioid consumption. For adverse events and tolerability, follow‐up was until the end of treatment. For all other outcomes, we were interested in treatment effects in the immediate term (48 hours–1 week), short term (> 1 week–3 months), medium term (> 3 months–6 months), and long term (> 6 months). Risk of bias: We assessed risk of bias using the Cochrane Risk of Bias tool for RCTs (RoB 2). Synthesis methods: We converted all continuous pain intensity scores to a 0‐to‐100 scale (0 = no pain; 100 = worst pain). We synthesised results using random‐effects meta‐analysis where possible, reporting mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, each with its 95% confidence interval (CI). We assessed the certainty of evidence with GRADE. Included studies: We found 67 RCTs (2309 participants): 30 parallel‐group RCTs (1568 participants) and 37 cross‐over RCTs (741 participants). Most studies (96%) were from high‐income countries. Female participation ranged from 11% to 100%. The interventions were ketamine (39 studies), memantine (10 studies), dextromethorphan (9 studies), amantadine (3 studies), and magnesium (8 studies). Sixty‐two studies used placebo comparators. Our quantitative synthesis included 28 studies. Synthesis of results: Results are presented for pain intensity (continuous measures, at reported time points) and total adverse events. Ketamine: Intravenous ketamine versus placebo There is no clear evidence that intravenous ketamine reduces pain intensity in the immediate term (MD −15.79, 95% CI −32.09 to 0.51; 3 studies, 173 participants; very low certainty), short term (MD −5.32, 95% CI −15.51 to 4.87; 4 studies, 114 participants; low certainty), or medium term (MD −8.70, 95% CI −31.05 to 13.65; 1 study, 19 participants; very low certainty). Intravenous ketamine may increase the risk of adverse events (RR 3.26, 95% CI 1.05 to 10.09; 4 studies, 140 participants; low certainty). Oral ketamine versus placebo There is no clear evidence that oral ketamine reduces pain intensity in the immediate term (MD −2.64, 95% CI −13.42 to 8.14; 2 studies, 46 participants; low certainty) or short term (MD −9.80, 95% CI −23.55 to 3.95; 2 studies, 40 participants; low certainty). No studies reported total adverse events. Topical ketamine versus placebo There is no clear evidence that topical ketamine reduces pain intensity in the immediate term (MD 1.90, 95% CI −18.73 to 22.53; 1 study, 47 participants; very low certainty) or short term (MD 2.82, 95% CI −14.49 to 20.12; 2 studies, 64 participants; low certainty). There is no clear evidence that topical ketamine increases the risk of adverse events (RR 1.14, 95% CI 0.47 to 2.73; 1 study, 47 participants; low certainty). Memantine Oral memantine versus placebo There is no clear evidence that oral memantine reduces pain intensity in the immediate term (MD 4.00, 95% CI −9.93 to 17.93; 1 study, 36 participants; very low certainty), short term (MD −8.69, 95% CI −19.40 to 2.02; 6 studies, 217 participants; very low certainty), or medium term (MD −1.74, 95% CI −43.18 to 39.70; 2 studies, 101 participants; very low certainty). There is no clear evidence that oral memantine increases the risk of adverse events (RR 1.09, 95% CI 0.76 to 1.56; 3 studies, 100 participants; low certainty). Dextromethorphan Oral dextromethorphan versus placebo The evidence is very uncertain about the effect of oral dextromethorphan on pain intensity in the short term (MD −9.00, 95% CI −22.86 to 4.86; 1 study, 40 participants; very low certainty). The evidence is very uncertain about the risk of adverse events with oral dextromethorphan (RR 1.80, 95% CI 0.73 to 4.43; 1 study, 40 participants; very low certainty). Amantadine Oral amantadine versus placebo The evidence is very uncertain about the effect of oral amantadine on pain intensity in the immediate term (MD 6.00, 95% CI −12.45 to 24.45; 1 study, 26 participants; very low certainty). The evidence is very uncertain about the risk of adverse events with oral amantadine (RR 0.86, 95% CI 0.14 to 5.20; 1 study, 26 participants; very low certainty). Magnesium Intravenous magnesium versus placebo There is no clear evidence that intravenous magnesium reduces pain intensity in the immediate term (MD −2.00, 95% CI −14.43 to 10.43; 1 study, 55 participants; low certainty) and short term (MD −3.47, 95% CI −15.25 to 8.31; 2 studies, 82 participants; low certainty). The evidence is very uncertain about the risk of adverse events with intravenous magnesium (0/35 events in intravenous magnesium group versus 0/35 in placebo group; 1 study, 70 participants; very low certainty). Oral magnesium versus placebo There is no clear evidence that oral magnesium reduces pain intensity in the short term (MD −0.55, 95% CI −8.32 to 7.21; 2 studies, 118 participants; low certainty). No studies reported total adverse events. Authors' conclusions: Limited low‐ to very low‐certainty evidence limits conclusions about the effects of ketamine, memantine, dextromethorphan, amantadine, and magnesium on pain intensity. Intravenous ketamine may increase the risk of adverse events, but the harms of ketamine and other NMDA receptor antagonists are generally unclear. Adequately powered RCTs are needed to determine the benefits and harms of ketamine and other NMDA receptor antagonists for chronic pain. Funding: No dedicated funding. Registration: Protocol available: doi.org/10.1002/14651858.CD015373 Description: Version CD015373.pub2

2025-08-18T00:00:00Z Ager, AL Roy, JS Dubé, MO Cools, AM Borms, D http://bura.brunel.ac.uk/handle/2438/29687 2024-09-09T02:01:09Z 2024-02-12T00:00:00Z

Title: Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain Authors: Ager, AL; Roy, JS; Dubé, MO; Cools, AM; Borms, D Abstract: Background: Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood. Purpose: This study aimed to investigate the relationship between shoulder pain and proprioception. Study design: This was a cross-sectional comparative study. Methods: Twenty-two participants with RCRSP (mean age 27.6 ± 4.8 years) and 22 matched pain-free participants (23.4 ± 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations. Results: Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = −0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = −0.31 [−0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 ± 1.2 cm vs 5.5 ± 1.5 cm; superior 3.8 ± 2.1 cm vs 5.7 ± 2.9 cm; superior-lateral nondominant targets 4.3 ± 2.2 cm vs 6.1 ± 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]). Conclusions: Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain. Description: Availability of data materials: All authors consent to all data being openly public and accessible.; Supplementary material is available online at: https://www.sciencedirect.com/science/article/pii/S0894113023001680#sec0145 .

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