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The practice of pain medicine has radically changed over the last twenty years, morphing from an almost exclusively anesthesia-based, recovery room, and procedure-oriented part-time practice into a multidisciplinary, multimodality, multispecialty field. These changes have been the consequence and the stimuli for the expansion of new medications and techniques, which have improved the diagnosis and treatment of painful conditions. This issue attempts to highlight some of the advances in anesthesiology and pain, including epidural analgesia, spinal cord stimulation, and trigger point diagnosis and treatment. There is also a case report of a technique utilizing transforaminal blood patches to treat intracranial hypotension, analogous to postdural puncture headaches. Particularly intriguing, given the current controversy regarding the role of opioids in the management of chronic pain, is the report of the lasting developmental delays seen in infant rats exposed to fentanyl. This observation could have a significant impact on the decision to initiate opioids in human infants and children and adds data to the current dilemma.

Pain medicine is a rapidly growing field, and the innovations described in this issue move the field further into the future. Hopefully, the reader will be encouraged to utilize and expand on these topics in their own practice

OBJECTIVES: To compare pain intensity among individuals with idiopathic inflammatory myopathies (IIMs), other systemic autoimmune rheumatic diseases (AIRDs), and without rheumatic disease (wAIDs).

METHODS: Data were collected from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an international cross-sectional online survey, from December 2020 to August 2021. Pain experienced in the preceding week was assessed using numeral rating scale (NRS). We performed a negative binomial regression analysis to assess pain in IIMs subtypes and whether demographics, disease activity, general health status, and physical function had an impact on pain scores.

RESULTS: Of 6988 participants included, 15.1% had IIMs, 27.9% had other AIRDs, and 57.0% were wAIDs. The median pain NRS in patients with IIMs, other AIRDs, and wAIDs were 2.0 (interquartile range [IQR] = 1.0-5.0), 3.0 (IQR = 1.0-6.0), and 1.0 (IQR = 0-2.0), respectively (P < 0.001). Regression analysis adjusted for gender, age, and ethnicity revealed that overlap myositis and antisynthetase syndrome had the highest pain (NRS = 4.0, 95% CI = 3.5-4.5, and NRS = 3.6, 95% CI = 3.1-4.1, respectively). An additional association between pain and poor functional status was observed in all groups. Female gender was associated with higher pain scores in almost all scenarios. Increasing age was associated with higher pain NRS scores in some scenarios of disease activity, and Asian and Hispanic ethnicities had reduced pain scores in some functional status scenarios.

CONCLUSION: Patients with IIMs reported higher pain levels than wAIDs, but less than patients with other AIRDs. Pain is a disabling manifestation of IIMs and is associated with a poor functional status.

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Hepatitis C virus (HCV) infection is a major cause of chronic liver disease in the world. It is a challenging medico-social problem in the paediatric population. High HCV infection rates are reported in low and middle incomes countries. From the health economic point of view treatment of hepatitis C virus (HCV) with subsequent virus eradication is very effective as it eliminates the long-term sequelae of untreated or maltreated HCV. In this review we summarize the updates and highlight the historical approach of treatment of chronic HCV infection in children in the new era of directly acting antiviral (DAA) agents.