Objective: Neuropathic pain (NP) is a chronic debilitating pain and is caused by disease or lesion of somatosensory system. NP respond worse to the pharmacological drugs leading to this pain still a big problem in medical treatment and furthermore make many patients seek alternative treatment. Wet cupping therapy (WCT) has been widely used to relief both of acute and chronic pain, but the mechanism for reducing pain has not yet been clear. Recent studies have shown that NP is associated with alteration of GLT-1/EAAT2, and WCT has beneficial role to reduce the pain in various pain models. This is the pilot study, no other study has applied WCT in chronic constriction injury (CCI) models, the most commonly employed animal model of NP. Therefore, we investigate the association between WCT and the reducing pain by looking at the increase of GLT-1 and time withdrawal latency (TWL) in rats with CCI. Methodology: The study design was randomized, post-test only, controlled trial with a total of 21 male rats (Rattus Norvegicus) with CCI, aged 4 months, weighing 220 to 250 g, randomly divided into three groups, P1 (sham CCI group), P2 (CCI group), and P3 (CCI group plus WCT). WCT had been applied 2 times/week for 3 weeks to all of the groups in paralumbar region, both left and right side. TWL was recorded to assess pain threshold of the rats by hot plate and the expression of GLT-1 on glial cells in spinal cord were counted. Results: This study revealed that mean ± SD values for P1, P2, and P3 were 7.20 ± 1.30, 2.57 ± 1.27, and 18.20 ± 3.50 respectively. There were significant differences in the TWL between groups P1-P2, P1-P3, and P2-P3 (p = 0.003, p = 0.0001, and p = 0.0001 respectively) and GLT-1 increase was significant between groups P2-P3 (p =  0.009). Conclusion: It can be concluded that wet cupping therapy decreases the pain by increasing the time withdrawal latency and GLT-1 in chronic constriction injury models. We suggest that wet cupping therapy as a promising method to reduce pain in peripheral neuropathic pain models. However, further investigation is still needed to confirm its mechanism of action. Key words: GLT-1/EAAT2; Neuropathic pain; Wet cupping therapy; Chronic constriction injury; CCI, TWL Citation: Hidayati HB, Machfoed MH, Kuntoro, Subadi I, Khaerunnisa S, Widjiati. Increase in the glutamate transporter 1 and time withdrawal latency following wet cupping therapy in chronic constriction injury in rats. Anaesth. pain & intensive care 2021;25(1):48-54. DOI: 10.35975/apic.v25i1.1441 Received: 24 January 2019, Reviewed: 4 January 2019, 14 January 2019, Revised: 24 January 2019, Accepted: 20 May 2019

Background & Objectives: Treatment of chronic pain using NSAIDs, steroids, opioids, and herbs has been associated with many complications with the long-term use. Wet cupping therapy (WCT) has been used to reduce pain, by triggering mu opioid receptor expression. We conducted this study to compare the effectiveness between WCT with oral opioids for pain management. Methodology: It was an experimental study with randomized control group post-test only design. Thirty two male white rats of strain Wistar were divided into four groups: (1) Group-NC; mice in this group were given nothing as a negative control group, (2) Group-CFA; group that was given Complete Freund’s Adjuvant (CFA) only as a positive control group, (3) Group-WCT; mice were given CFA and WCT, and (4) Group-O was given CFA and oral opioids. The measured variables were pain threshold value and mu opioid receptors. Statistical analysis was done us(ing SPSS software (version 22.0, Chicago, IL). Results: The results showed no significant differences in the expression of mu opioid receptors between Group-NC and Group-CFA (p = 0.061). There were significant differences in the expression of opioid receptors between Group-CFA and Group-WCT (p < 0.001), and also between WCT group and Group-O (p = 0.002). The differences of pain threshold value were only significant between Group-NC (p = 0,006) and Group-CFA (p = 0,013) with Group-O. Conclusion: Wet cupping therapy triggers the expression of mu opioid receptors. Wet cupping therapy as effective in relieving pain as opioids. Citation: Subadi I, Kusumawardani MK, Qorib MF, Susilo I, Hidayati HB. Wet cupping therapy improves mu opioid receptor expression and pain threshold in animal models of inflammation. Anaesth pain & intensive care 2019;23(4):__   Received: 6 February 2019; Reviewed: 16 February 2019, 2 August 2019; Revised: 9 September 2019; Accepted: 15 September 2019

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Putri, et al. Comparison of Acute Ischemic Stroke Functional Outcome 65 ARTIKEL PENELITIAN PERBANDINGAN LUARAN FUNGSIONAL PASIEN STROKE ISKEMIK AKUT PADA PEROKOK DAN BUKAN PEROKOK YANG DIUKUR DENGAN CANADIAN NEUROLOGIC SCALE (CNS) DAN NIHSS COMPARISON OF ACUTE ISCHEMIC STROKE FUNCTIONAL OUTCOME IN SMOKERS AND NON-SMOKERS MEASURED BY CANADIAN NEUROLOGICAL SCALE (CNS) AND NIHSS

Carpal tunnel syndrome (CTS) is a condition when median nerve, located in the carpal tunnel, is being suppressed by the surrounding structure. In 1854, the first clinical narration of median nerve compression in a carpal tunnel was found. CTS causes pain, tingling, and weakness in the half ring finger, middle finger, index finger, and thumb. These complaints lead the patients to seek medical help by a visiting doctor. CTS has become the major cause of upper extremity chronic neuropathic pain. CTS affects women 3.6 times more than men. This would cause high costs in medical treatment, rehabilitation, work hours lost compensation, initial pension costs, and new worker training. This makes CTS as a major problem in the field of employment. Carpal tunnel syndrome occurs as a result of chronic repetitive forceful work and other risk factors such as sex, age, heredity, hormonal, and weight. Knowledge of the diagnosis and comprehensive management of CTS are important to the doctor. Recent management based on the newest guidelines are important for clinician knowledge update. Correct diagnosis will lead to appropriate management based on recent CTS guidelines, which in turn will improve the quality of life for patients with CTS. This article will comprehensively discuss the diagnosis and recent management. Abbreviations:  CTS - Carpal tunnel syndrome; NHIS - National Health Interview Study; EDX - Electrodiagnostic studies; SCT - Scratch Collapse Test; CSA - Cross-sectional area; PRP - Platelet-rich plasma; LLLT - Low-Level Laser Therapy; US – Ultrasound; DN - Dry needling; ECTR - Endoscopic carpal tunnel release; PDI - perineural dextrose injection; BCTQ - Boston Carpal Tunnel Questionnaire Key word: Carpal tunnel syndrome (CTS); neuropathy; pain; numbness; safe working environment; human; disease Citation: Hidayati HB, Subadi I, Fidiana, Puspamaniar VA. Current diagnosis and management of carpal tunnel syndrome: A review. Anaesth. pain intensive care 2022;26(3):394-404. DOI: 10.35975/apic.v26i3.1902 Received: August 16, 2021; Reviewed: April 24, 2022; Accepted: April 28, 2022