WorldWideScience

Sample records for chronic knee pain

  1. [Chronic knee pain and specific heat phobia. A case report].

    Science.gov (United States)

    Pepke, W; Neubauer, E; Schiltenwolf, M

    2013-02-01

    This case report presents the medical history of a patient suffering from chronic knee pain with specific heat phobia who had a long history of sick certificates. Using multimodal pain therapy and biofeedback therapy the acquired anxiety disorder could be solved. Long-term working ability could be achieved. PMID:23321701

  2. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    Full Text Available Lindsay C Burns,1–3 Sarah E Ritvo,1 Meaghan K Ferguson,1 Hance Clarke,3–5 Ze’ev Seltzer,3,5 Joel Katz1,3–5 1Department of Psychology, York University, Toronto, ON, Canada; 2Arthritis Research Centre of Canada, Vancouver, BC, Canada; 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; 4Department of Anesthesia, University of Toronto, Toronto, ON, Canada; 5Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada Background: Total knee arthroplasty (TKA is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant

  3. Knee pain

    Science.gov (United States)

    ... time, overuse, or injury. Dislocation of the kneecap Fracture of the kneecap or other bones Iliotibial band syndrome . Injury to the thick band that runs from your hip to the outside of your knee. Pain in the front of your knee around ...

  4. Help-seeking behaviour among people living with chronic hip or knee pain in the community

    OpenAIRE

    Adamson Joy; Gooberman-Hill Rachael; Thorstensson Carina A; Williams Susan; Dieppe Paul

    2009-01-01

    Abstract Background A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample. Methods Health care utilization, def...

  5. Knee pain

    Science.gov (United States)

    ... the bones of the knee Infection in the knee joint Injuries and overuse Bursitis . Inflammation from repeated pressure ... felt on the inside or outside of the knee joint. Strain or sprain . Minor injuries to the ligaments ...

  6. The Results of Intraosseous Drilling and Decompression in the Treatment of Chronic Anterior Knee Pain

    Directory of Open Access Journals (Sweden)

    Saberi S

    2012-01-01

    Full Text Available Background: Anterior knee pain is one of the most common complaints of patients in orthopedic clinics. The first step in the treatment of this problem is conservative treatment which includes administration of anti-inflammatory drugs, exercise and changes in life style. Many patients respond well to these measures in about six months, but a small number of patients may not respond to the conservative treatment; therefore, surgical procedures such as Maquet osteotomy or lateral retinacular release may be needed in these cases. The aim of this study was to determine the efficacy of intraosseous drilling and decompression of patella in the treatment of chronic anterior knee pain.Methods : This study was performed as a case series on ten patients with chronic anterior knee pain attending the Orthopedic Clinic of Imam Khomeini Hospital, in Tehran, Iran in 2009-2010. Eight of the patients were male and the rest were female. The patients met the inclusion criteria and were followed up for at least 12 months after the surgery. Results : The mean age of the patients was 27.8±4.66 yr and their mean BMI was 22.5±1.71 kg/m2. The mean pain severity before the interventions was 8.2±0.78 based on VAS but it decreased to 2.5±1.26 post-surgically. An average reduction of 5.7 scores were noticed in pain severity depicting a significant reduction of pain (P<0.0001.Conclusion: It may be concluded that intraosseous drilling and decompression of patella is a safe and effective method in the treatment of chronic anterior knee pain not responding to conservative treatment.

  7. Help-seeking behaviour among people living with chronic hip or knee pain in the community

    Directory of Open Access Journals (Sweden)

    Adamson Joy

    2009-12-01

    Full Text Available Abstract Background A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample. Methods Health care utilization, defined as having seen a family doctor (GP during the past 12 months; or an allied health professional (AHP or alternative therapist during the past 3 months, was assessed in a community based sample aged 35 or over and reporting pain in hip or knee. Adjusted odds ratios were determined for social deprivation, rurality, pain severity, mobility, anxiety/depression, co-morbidities, and body mass index. Results Of 1119 persons reporting hip or knee pain, 52% had pain in both sites. Twenty-five percent of them had seen a doctor only, 3% an AHP only, and 4% an alternative therapist only. Thirteen percent had seen more than one category of health care professionals, and 55% had not seen any health care professional. In the multivariate model, factors associated with consulting a GP were mobility problems (OR 2.62 (1.64-4.17, urban living (OR 2.40 (1.14-5.04 and pain severity (1.28 (1.13-1.44. There was also some evidence that obesity was associated with increased consultation (OR 1.72 (1.00-2.93. Factors were similar for consultation with a combination of several health care professionals. In contrast, seeing an alternative therapist was negatively associated with pain severity, anxiety and mobility problems (adjusting for age and sex. Conclusion Disability appears to be a more important determinant of help-seeking than pain severity or anxiety and depression, for adults with chronic pain in hip or knee. The determinants of seeking help from alternative practitioners

  8. Knee pain (image)

    Science.gov (United States)

    ... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

  9. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... or playing soccer). You have flat feet. Anterior knee pain is more ... skiers, bicyclists, and soccer players who exercise often ...

  10. Bone scintigraphy in chronic knee pain: comparison with magnetic resonance imaging

    Science.gov (United States)

    Boegard, T.; Rudling, O.; Dahlstrom, J.; Dirksen, H.; Petersson, I.; Jonsson, K.

    1999-01-01

    OBJECTIVE—To compare increased bone uptake of 99Tcm-MDP and magnetic resonance (MR) detected subchondral lesions, osteophytes, and cartilage defects in the knee in middle aged people with longstanding knee pain.
METHODS—Fifty eight people (aged 41-58 years, mean 50) with chronic knee pain, with or without radiographic knee osteoarthritis, were examined with bone scintigraphy. The pattern and the grade of increased bone uptake was assessed. On the same day, a MR examination on a 1.0 T imager was performed. The presence and the grade of subchondral lesions, osteophytes, and cartilage defects were registered.
RESULTS—The κ values describing the correlation between increased bone uptake and MR detected subchondral lesions varied between 0.79 and 0.49, and between increased bone uptake and MR detected osteophytes or cartilage defects the values were <0.54. The κ values describing the correlation between the grade of bone uptake and the grade of the different MR findings was <0.57.
CONCLUSIONS—Good agreement was found between increased bone uptake and MR detected subchondral lesion. The agreement between increased bone uptake and osteophytes or cartilage defects was in general poor as well as the agreement between the grade of bone uptake and the grade of the MR findings.

 Keywords: knee; osteoarthritis; magnetic resonance imaging; bone scintigraphy PMID:10343536

  11. Diagnostic criterial to differentiate medial meniscal injury from degenerative changes on {sup 99m}Tc-MDP knee SPECT in patients with chronic knee pain

    Energy Technology Data Exchange (ETDEWEB)

    Paeng, Jin Chul; Chung, June Key; Kang, Won Jun; So, Young; Lee, Dong Soo; Lee, Myung Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of); Yoo, Jae Ho; Lee, Myung Chul [Seoul National University Nuclear Medicine, Seoul (Korea, Republic of); Jeong, Hwan Jeong [Wonkwang University College of Medicine, Iksan (Korea, Republic of)

    2003-04-01

    In patients with chronic knee pain, the diagnostic performance of {sup 99m}Tc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake in increased in medial compartment. A total of 49 knee SPECT of the patients with chronic(more than 3 months) knee pain, which showed increased {sup 99m}Tc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion, I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improve diagnostic performance, especially, specificity. In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

  12. Diagnostic criterial to differentiate medial meniscal injury from degenerative changes on 99mTc-MDP knee SPECT in patients with chronic knee pain

    International Nuclear Information System (INIS)

    In patients with chronic knee pain, the diagnostic performance of 99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake in increased in medial compartment. A total of 49 knee SPECT of the patients with chronic(more than 3 months) knee pain, which showed increased 99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion, I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improve diagnostic performance, especially, specificity. In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain

  13. 人工髋膝置换术后慢性疼痛原因分析%Etiology of the chronic pain after artiifcial hip and knee replacement

    Institute of Scientific and Technical Information of China (English)

    徐远坤; 柯岩; 林剑浩

    2014-01-01

    Chronic pain after hip and knee replacement is common but easily overlooked. The etiology and mechanism of chronic pain are more complex than that of other complications after hip and knee replacement. In this article, the deifnition, epidemiology, reason analysis, conclusion and prospect of chronic pain after hip and knee replacement are reviewed and investigated. Based on the summary and analysis of the present data, a comprehensive and clear understanding of chronic pain after hip and knee replacement is expected, and the development of treatment plans is assisted.

  14. Posterior knee pain

    OpenAIRE

    English, S.; Perret, D.

    2010-01-01

    Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical ...

  15. The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review

    Directory of Open Access Journals (Sweden)

    Foster Nadine E

    2010-01-01

    Full Text Available Abstract Background Joint pain, specifically chronic knee pain (CKP, is a frequent cause of chronic pain and limitation of function and mobility among older adults. Multiple evidence-based guidelines recommend exercise as a first-line treatment for all patients with CKP or knee osteoarthritis (KOA, yet healthcare practitioners' attitudes and beliefs may limit their implementation. This systematic review aims to identify the attitudes, beliefs and behaviours of General Practitioners (GPs regarding the use of exercise for CKP/KOA. Methods We searched four electronic databases between inception and January 2008, using subject headings to identify studies examining the attitudes, beliefs or behaviours of GPs regarding the use of exercise for the treatment of CKP/KOA in adults aged over 45 years in primary care. Studies referring to patellofemoral pain syndrome or CKP secondary to other causes or that occurring in a prosthetic joint were excluded. Once inclusion and exclusion criteria were applied, study data were extracted and summarised. Study quality was independently reviewed using two assessment tools. Results From 2135 potentially relevant articles, 20 were suitable for inclusion. A variety of study methodologies and approaches to measuring attitudes beliefs and behaviours were used among the studies. Quality assessment revealed good reporting of study objective, type, outcome factors and, generally, the sampling frame. However, criticisms included use of small sample sizes, low response rates and under-reporting of non-responder factors. Although 99% of GPs agreed that exercise should be used for CKP/KOA and reported ever providing advice or referring to a physiotherapist, up to 29% believed that rest was the optimum management approach. The frequency of actual provision of exercise advice or physiotherapy referral was lower. Estimates of provision of exercise advice and physiotherapy referral were generally higher for vignette-based studies

  16. Anterior knee pain

    Science.gov (United States)

    ... or playing soccer). You have flat feet. Anterior knee pain is more common in: People who are overweight People who have had a dislocation, fracture, or other injury to the kneecap Runners, jumpers, ...

  17. Prevalent knee pain and sport

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders

    1998-01-01

    weekly hours of participation in competitive gymnastics but negatively with weekly hours of tennis. Constant or recurrent knee pain was positively associated with years of swimming. Absence from sport due to knee pain was positively associated with weekly hours of soccer participation. CONCLUSIONS: Knee...

  18. Co-creating an online exercise-based rehabilitation programme for people with chronic knee and hip pain based on user preferences and behavioural change techniques.

    OpenAIRE

    Michael Hurley

    2015-01-01

    Background: Chronic knee and hip pain in elderly people is very prevalent (1,2) and causes reduced mobility, disability and co-morbidity. Evidence-based many men guidelines recommend exercise and self-management as effective interventions (3). “Enabling Self-management and Coping of Arthritic Pain through Exercise, ESCAPE-pain” (www.escape-pain.org), is a rehabilitation programme that integrates patient self-management information and advice with an exercise regimen (4). Increased knowledge o...

  19. Anterior knee pain

    International Nuclear Information System (INIS)

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries

  20. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of ...

  1. Chronic Pain

    Science.gov (United States)

    ... who have chronic pain may also have low self-esteem, depression, and anger. Causes & Risk Factors What causes ... as stretching and strengthening activities) and low-impact exercise (such as walking, swimming, or biking) can help ...

  2. Retrowalking as an adjunct to conventional treatment versus conventional treatment alone on pain and disability in patients with acute exacerbation of chronic knee osteoarthritis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Gauri Arun Gondhalekar

    2013-01-01

    Full Text Available Background: Increased external knee adduction moment during walking alters the joint biomechanics; which causes symptoms in chronic knee osteoarthritis patients. Aims: To assess additional effects of Retro-walking over conventional treatment on pain and disability in patients with acute exacerbation of chronic knee osteoarthritis. Materials and Methods: Thirty chronic knee osteoarthritis patients were randomly assigned into 2 groups. Group ′A′ (7 men, 8 women received conventional treatment. Group ′B′ (8 men, 7 women received conventional treatment and Retro-walking. Pain, assessed through visual analogue scale (VAS, and Western Ontario and McMaster Universities Arthritis Index (WOMAC were the primary outcomes and knee range of motion (ROM, hip abductor and extensor strength were secondary outcomes; measured pre-intervention, after 1 week and after 3 weeks of intervention. Results: Two factors analysis of variance for repeated measures was used for all outcomes. At the end of 3 weeks; WOMAC score showed highly significant difference within ( P < 0.0001 and significant difference between groups ( P = 0.040 also by Time × group interaction ( P = 0.024, VAS showed highly significant difference within groups ( P < 0.0001. Knee ROM showed significant difference within groups. Hip abductor and extensor strength showed significant difference by Time × group interaction ( P < 0.05. Conclusion: Retrowalking is an effective adjunct to conventional treatment in decreasing disability in patients with knee osteoarthritis.

  3. Chronic Pelvic Pain

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  4. Employees with Chronic Pain

    Science.gov (United States)

    ... Home | Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information ... at http://AskJAN.org/soar. Information about Chronic Pain How prevalent is chronic pain? Chronic pain has ...

  5. Acetaminophen for Chronic Pain

    DEFF Research Database (Denmark)

    Ennis, Zandra Nymand; Dideriksen, Dorthe; Vaegter, Henrik Bjarke;

    2016-01-01

    conducted according to PRISMA guidelines. All studies were conducted in patients with hip- or knee osteoarthritis and six out of seven studies had observation periods of less than three months. All included studies showed no or little efficacy with dubious clinical relevance. In conclusion, there is little......Acetaminophen (paracetamol) is the most commonly used analgesic worldwide and recommended as first-line treatment in all pain conditions by WHO. We performed a systematic literature review to evaluate the efficacy of acetaminophen when used for chronic pain conditions. Applying three broad search...... evidence to support the efficacy of acetaminophen treatment in patients with chronic pain conditions. Assessment of continuous efficacy in the many patients using acetaminophen worldwide is recommended. This article is protected by copyright. All rights reserved....

  6. Experimental knee pain reduces muscle strength

    DEFF Research Database (Denmark)

    Henriksen, Marius; Mortensen, Sara Rosager; Aaboe, Jens;

    2011-01-01

    experimental knee pain in healthy volunteers, and if these changes were associated with the pain intensities. In a crossover study, 18 healthy subjects were tested on 2 different days. Using an isokinetic dynamometer, maximal muscle strength in knee extension and flexion was measured at angular velocities 0....... Knee pain reduced the muscle strength by 5 to 15% compared to the control conditions (P <.001) in both knee extension and flexion at all angular velocities. The reduction in muscle strength was positively correlated to the pain intensity. Experimental knee pain significantly reduced knee extension and...

  7. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Programs Resource Guide to Chronic Pain Treatments Pain Awareness Toolkits Partners for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is ...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... bones grinding against each other, leading to pain, stiffness and inflammation. At times in younger patients this ... full knee replacement, what are the risks of stiffness with a partial knee replacement? Yeah, also known ...

  9. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  10. Untying chronic pain

    OpenAIRE

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-01-01

    Background: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods: A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic ...

  11. What Is Chronic Pain?

    Medline Plus

    Full Text Available Already a member? Log In or Sign Up Home About Us Support the ACPA Contact Us Shop ... for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is Chronic Pain? ...

  12. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... ACPA Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  13. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  14. Chronic Pain

    Science.gov (United States)

    ... NINDS). NINDS Trigeminal Neuralgia Information Page Trigeminal Neuralgia (tic doloreaux) information compiled by NINDS, the National Institute ... Complex Regional Pain Syndromes (CRPS): State-of-the-Science A workshop on Reflex Sympathetic Dystrophy/ Complex Regional ...

  15. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... talking a little bit about the kind of knee injuries that weekend warriors tend to have, and the ... symptom for those having either knee arthritis or knee injuries is obviously pain, and that’s obviously what drives ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... have done in knee surgery, which is the pain management. In spite of this patient having a spinal ... Can you talk a little bit about the pain management. Absolutely. Behind the curtain here we have Dr. ...

  17. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... acute pain and both naturally expect that some cause will be found, and when it’s found, it ... pain even in the absence of an apparent cause. But chronic pain has a physiological or neurological ...

  18. Magnification bone scan of knees for knee pain evaluation

    International Nuclear Information System (INIS)

    Knee pain is one of the common complaints of patients seen in our orthopedic clinic. Routine anterior and posterior views of whole body bone scan (WBBS) is often not sufficient in the evaluation of these patients. An ideal bone scan using pinhole collimator or single photon emission tomography (SPECT), however, is impractical and time consuming in busy nuclear medicine department with limited resources. Therefore, the aim of the study is to assess limited bone scan of knees with magnification (LNSKM) for knee pain evaluation. Technical aspect of LBSKM and diagnostic efficacy are discussed on this poster. Adult patients with knee pain were reffered for LBSKM from an orthopedic surgen specializing knees. Four hundred fifteen LBSKMs were performed since 1999. patients were given 740 MBq (20mCi) Tc-99m MDP intravenously and 3 hours later LBSKM was performed using a low energy high resolution parallel hole collimator and Siemens Orbitor camera. (Simens medical systems. Inc., Hoffman Estates, III., USA). Anterior view of the knees was taken for 5 min, without magnification and both lateral views of symptomatic knees were obtained with electronic magnification (1.25, upto 2.0) for 8 min each. Disease processes such as DJD, traumatic arthritis, P-F tendonitis, SONK, meniscus tear are detected and illustrated along with normal knee scan finding. We believe LBSKM may not be as good as SPECT or pinhole imaging of the knees in the evaluation of knee pain but superior to routine WBBS in the nuclear medicine department with limited resources of instrumentation and manpower

  19. Managing your chronic pain

    Science.gov (United States)

    ... your chronic back pain To use the sharing features on this page, please enable JavaScript. Managing chronic pain means finding ways to make your back pain tolerable so you can live your life. You may not be able to ...

  20. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

    Directory of Open Access Journals (Sweden)

    Vicente Sanchis-Alfonso

    2015-01-01

    Full Text Available Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS, knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS. Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS. Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment.

  1. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... chronic pain there may be no apparent physical injury or illness to explain it. The physician and ... expected period of healing for an illness or injury. You can experience pain even if you are ...

  2. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available Arthritic Pain Relief through Partial Knee Replacement NewYork-Presbyterian New York City, New York May 4, 2010 I've always felt ... cortisone injections, which really only provided short-lived relief. Ultimately, she underwent a knee arthroscopy procedure, where ...

  3. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available Knee Pain and the Weekend Warriors Mercy Hospital Miami, FL March 17, 2009 Welcome to this “OR-Live” webcast presentation, live from Mercy Hospital in Miami, Florida. During the program, it’s ...

  4. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... 000 of these operations a year, and they project that we’ll be doing approximately 3 to ... done in knee surgery, which is the pain management. In spite of this patient having a spinal ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... fair to say that arthritis would tend to lean one more towards the knee replacement if it ... so must faster these days with the pain management protocol and the smaller incisions that it’s almost ...

  6. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... having in relationship to the intervention? Oh, she should have significant improvements of pain relief with this ... an expert knee surgeon using good implants, it should last you a good 30 years. You can ...

  7. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... knee. The damaged joint was caused by bones grinding against each other, leading to pain, stiffness and ... smaller hospitals with lower volume. It's fairly demanding technology surgery that you were just doing there. Don' ...

  8. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... a few weeks ago. He had a twisting injury to his knee and felt immediate pain, was ... going on, to see if there’s any cartilage injuries that we may be missing. Okay. We go ...

  9. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... pivot injury to the knee. Is that something related to exercise, lack of exercise? Is there anything ... here. What is the improvement, the expected improvement related to the pain that the patient was having ...

  10. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

    DEFF Research Database (Denmark)

    Henriksen, Marius; Nielsen, Thomas Graven; Aaboe, Jens;

    2010-01-01

    Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease...... progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients....

  11. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain

    OpenAIRE

    Doménech, J.; Sanchis-Alfonso, Vicente; Espejo Tort, Begoña

    2014-01-01

    Purpose. The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain. Methods. A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting. Pain was measured with the visual analogue scale and disability with the Lysholm scale. The psychological variables, such as anxiety, depression, pain coping strategies, c...

  12. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... major advances that we have done in knee surgery, which is the pain management. In spite of this patient having a spinal ... Dr. Rudy, who is our expert in pain management, and he has, before we started this operation, given the patient what’s called a “femoral block,” ...

  13. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacement - a total knee replacement - is a rehab process. And so, to go through a rehab process and still have pain is not necessarily worth ... ll do a femoral nerve block, which helps control pain for about 24 hours or so. These ...

  14. Knee Pain in Children: Part I: Evaluation.

    Science.gov (United States)

    Wolf, Michael

    2016-01-01

    • On the basis of primarily consensus, due to lack of relevant clinical studies, the information obtained from the history and physical examination is the key to establishing a diagnosis and directing initial management of knee pain. • By applying history and physical examination findings to a diagnosis and management algorithm, clinicians can efficiently and effectively determine the potential cause of the knee pain. • On the basis of primarily consensus, due to lack of relevant clinical studies, the most important step of the evaluation of knee pain is to identify emergent conditions, including limb- and life-threatening conditions (eg, septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. PMID:26729778

  15. Comparison of lbuprofen with Acupuncture in Reducing Knee Osteoarthritis Pain

    Directory of Open Access Journals (Sweden)

    MR Emad

    2008-01-01

    Full Text Available ABSTRACT: Introduction & Objective: Osteoarthritis is the most common joint disease of humans. Acupuncture is one of the treatments for osteoarthritis. This study aimed to compare lbuprofen with acupuncture in the pain reduction in knee osteoarthritis. Materials & Methods: This is a clinical trial which was performed in Shiraz Medical School Clinics in 2007. Forty six patients with chronic pain due to the knee osteoarthritis were recruited using strict inclusion and exclusion criteria. All the patients were randomly divided into two groups (A and B who received lbuprofen (1200 mg/day or acupuncture (2 sessions per week for 2 weeks, respectively. Evaluating measuring tools were pain intensity (based on VAS, ROM (based on degree and morning stiffness of the knee joint. Collected data were analyzed by Chi-Square test, using SPSS software. Results: Pain intensity at baseline, after the course of treatment and 3 weeks after the treatment in group A was 7.29 ± 0.61, 4.20±0.93 and 5.20± 1.32 cm, respectively while these figures for group B were 7.35±0.82, 3.43±0.96 and 4.93±1.32 cm, respectively (p<0.005. Also knee ROM degree in group A was 21.54±7.46, 13.08±5.60 and 15.38±3.2 and for group B was 20.36±7.19, 12.40±5.78 and 10.36±5.30, respectively (p=0.003. Knee morning stiffness improved more in group B. Conclusion: Result of this study showed that both modalities significantly reduced the pain in patients with knee osteoarthritis and improved ROM while morning stiffness improved more in group B.

  16. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... after a period of time the spinal cord has changed, after a period of time there are ... absence of an apparent cause. But chronic pain has a physiological or neurological basis even when we ...

  17. Chronic Pain: Symptoms, Diagnosis, & Treatment

    Science.gov (United States)

    ... in the treatment. Treatment With chronic pain, the goal of treatment is to reduce pain and improve ... some treatments used for chronic pain. Less invasive psychotherapy, relaxation therapies, biofeedback, and behavior modification may also ...

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... And if you have a problem in your lower back, it can cause problems in your hips. It can cause problems in your knees and your ankles down the road. So absolutely true. Dr. Hommen, in addition to pain, some of the patients, particularly those that reach ...

  19. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... pain. All right. Now let’s look at the rest of the knee. Let’s have the table up ... feeds the meniscus to about right here. The rest of this meniscus really does not have any ...

  20. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... left knee pain. She had arthritis on her x-rays, as you can see in this outline here, ... history, physical exam, and other modalities such as x-rays, MRI's or CAT scans. And again, operative treatment ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Pain Relief through Partial Knee Replacement NewYork-Presbyterian New York City, New York May 4, 2010 I've always felt ... carry it out every single day. Located in New York City, New York Presbyterian is ranked among ...

  2. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... with chronic pain is that when we start looking for an explanation it’s not so much that we’re looking in the wrong place, but we may be looking in the wrong time. And what I mean ...

  3. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... manageable, but chronic pain is different. And because it is different, we need to think about it in very different ways. Ed Covington, M.D.: ... no apparent physical injury or illness to explain it. The physician and the patient are accustomed to ...

  4. Care-seeking behaviour of adolescents with knee pain

    DEFF Research Database (Denmark)

    Rathleff, Michael S; Skuldbøl, Sune K; Rasch, Mads N B;

    2013-01-01

    Knee pain is common during adolescence. Adolescents and their parents may think that knee pain is benign and self-limiting and therefore avoid seeking medical care. However, long-term prognosis of knee pain is not favourable and treatment seems to offer greater reductions in pain compared to a...... "wait-and-see" approach. The purpose of this study was to describe the determinants of care-seeking behaviour among adolescents with current knee pain and investigate what types of treatment are initiated....

  5. TOIB Study. Are topical or oral ibuprofen equally effective for the treatment of chronic knee pain presenting in primary care: a randomised controlled trial with patient preference study. [ISRCTN79353052

    Directory of Open Access Journals (Sweden)

    Parsons Suzanne

    2005-11-01

    Full Text Available Abstract Background Many older people have chronic knee pain. Both topical and oral non- steroidal anti-inflammatory drugs (NSAIDs are commonly used to treat this. Oral NSAIDS are effective, at least in the short term, but can have severe adverse effects. Topical NSAIDs also appear to be effective, at least in the short term. One might expect topical NSAIDs both to be less effective and to have fewer adverse effects than oral NSAIDs. If topical NSAIDs have fewer adverse effects this may outweigh both the reduction in effectiveness and the higher cost of topical compared to oral treatment. Patient preferences may influence the comparative effectiveness of drugs delivered via different routes. Methods TOIB is a randomised trial comparing topical and oral ibuprofen, with a parallel patient preference study. We are recruiting people aged 50 or over with chronic knee pain, from 27 MRC General Practice Research Framework practices across the UK. We are seeking to recruit 283 participants to the RCT and 379 to the PPS. Participants will be followed up for up to two years (with the majority reaching one year. Outcomes will be assessed by postal questionnaire, nurse examination, laboratory tests and medical record searches at one and two years or the end of the study. Discussion This study will provide new evidence on the overall costs and benefits of treating chronic knee pain with either oral or topical ibuprofen. The use of a patient preference design is unusual, but will allow us to explore how preference influences response to a medication. In addition, it will provide more information on adverse events. This study will provide evidence to inform primary care practitioners, and possibly influence practice.

  6. Dynamic weight-bearing assessment of pain in knee osteoarthritis

    DEFF Research Database (Denmark)

    Klokker, Louise; Christensen, Robin; Wæhrens, Eva E;

    2016-01-01

    BACKGROUND: The Osteoarthritis Research Society International (OARSI) has suggested to asses pain after specific activities consistently in clinical trials on knee OA. The Dynamic weight-bearing Assessment of Pain (DAP) assesses pain during activity (30 s of performing repeated deep knee-bends from...

  7. Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study

    DEFF Research Database (Denmark)

    W-Dahl, Annette; Toksvig-Larsen, Sören; Roos, Ewa

    2009-01-01

    radiographs including the hip and ankle joints. Knee pain was measured by the subscale pain (0 - 100, worst to best scale) of the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at one year follow-up. To estimate the association between knee alignment and knee pain multivariate......BACKGROUND: The association between knee alignment and knee pain in knee osteoarthritis (OA) is unclear. High tibial osteotomy, a treatment option in knee OA, alters load from the affected to the unaffected compartment of the knee by correcting malalignment. This surgical procedure thus offers the...... possibility to study the cross-sectional and longitudinal association of alignment to pain. The aims were to study 1) the preoperative association of knee alignment to preoperative knee pain and 2) the association of change in knee alignment with surgery to change in knee pain over time in patients operated...

  8. Effectiveness and safety of tapentadol prolonged release with tapentadol immediate release on-demand for the management of severe, chronic osteoarthritis-related knee pain: results of an open-label, phase 3b study

    Directory of Open Access Journals (Sweden)

    Steigerwald I

    2012-06-01

    Full Text Available Ilona Steigerwald,1 Matthias Müller,1 Jolanta Kujawa,2 Jean-Charles Balblanc,3 Jaime Calvo-Alén,41Medical Affairs Europe & Australia, Grünenthal GmbH, Aachen, Germany; 2Medical University of Lodz, Medical Rehabilitation Clinic, Lodz, Poland; 3Department of Rheumatology, General Hospital of Belfort, Belfort, France; 4Hospital Universitario Sierrallana and IFIMAV Research Institute, Universidad de Cantabria, Cantabria, SpainAbstract: This open-label, phase 3b study (ClinicalTrials.gov Identifier: NCT00983073 evaluated the effectiveness, and tolerability of tapentadol for severe, chronic osteoarthritis knee pain that was inadequately managed with World Health Organization (WHO Step I or II analgesics or co-analgesics, or that was not treated with regular analgesics. Prior to starting study treatment, patients discontinued any WHO Step II analgesics, while Step I analgesics and/or co-analgesics were continued at the same dose. Patients received tapentadol prolonged release (50–250 mg bid during a 5-week titration period and a 7-week maintenance period. Doses of tapentadol immediate release 50 mg (≤twice/day; ≥4 hours apart were permitted throughout the study (total daily dose of tapentadol prolonged and immediate release, ≤250 mg bid. The primary endpoint was the change in pain intensity on an 11-point numerical rating scale-3 (NRS-3; recalled average pain intensity [11-point NRS] during the last 3 days from baseline to Week 6, using the last observation carried forward (LOCF to impute missing pain intensity scores. The mean (standard deviation change from baseline to Week 6 (LOCF in pain intensity was -3.4 (2.10; P < 0.0001 for all patients evaluated for effectiveness (n = 195. Significant decreases in pain intensity were also observed at Weeks 6, 8, and 12 (all P < 0.0001 using observed-case analysis. Corresponding significant improvements from baseline to Weeks 6 and 12 were observed in the Western Ontario and McMaster Universities

  9. Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study.

    OpenAIRE

    Roos Ewa M; Toksvig-Larsen Sören; W-Dahl Annette

    2009-01-01

    Abstract Background The association between knee alignment and knee pain in knee osteoarthritis (OA) is unclear. High tibial osteotomy, a treatment option in knee OA, alters load from the affected to the unaffected compartment of the knee by correcting malalignment. This surgical procedure thus offers the possibility to study the cross-sectional and longitudinal association of alignment to pain. The aims were to study 1) the preoperative association of knee alignment to preoperative knee pain...

  10. Co-creating an online exercise-based rehabilitation programme for people with chronic knee and hip pain based on user preferences and behavioural change techniques.

    Directory of Open Access Journals (Sweden)

    Michael Hurley

    2015-10-01

    Conclusions: Using persuasive technology, human centred design and business modelling we established the features people want from an online programme to manage chronic joint pain. Combining these with BCTs known to be effective in face-to-face behavioural change programmes have enabled us to develop an online resources that will make an effective programme available to many more people to improve their pain, function, general health and wellbeing and quality of life.

  11. Peripheral Pain Mechanisms in Chronic Widespread Pain

    OpenAIRE

    Staud, Roland

    2011-01-01

    Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxiou...

  12. Effect of compression therapy on knee swelling and pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Jensen, Niels J F; Andersen, Ida;

    2013-01-01

    PURPOSE: Knee swelling after total knee arthroplasty may impair postoperative mobilisation and training, and as medical elastic compression stockings are well tolerated and effective to prevent oedema, haematoma and postoperative pain after venous surgery, we wanted to study whether this effect...... could be transferred to total knee arthroplasty surgery reducing postoperative swelling and pain and thereby facilitating mobilisation and improving patient-reported knee function. METHODS: In a randomised controlled study, 88 patients were randomised to use either a medical elastic compression stocking...... or no stocking from the first postoperative day and the following 4 weeks after total knee arthroplasty. Outcome measures were knee, calf and ankle swelling, knee flexion, pain and patient-reported knee function. RESULTS: Seventy per cent of the swelling had occurred before application of the...

  13. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... the inner aspect of her knee, what we call the medial compartment of her knee, she's got ... only one part of the knee, what we call a compartment of the knee, when one compartment ...

  14. Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study

    DEFF Research Database (Denmark)

    Holm, Bente; Husted, Henrik; Kehlet, Henrik;

    2012-01-01

    Objective: To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty.Design: A prospective, single-blinded, randomized, cross-over study.Setting: A fast-track orthopaedic arthroplasty unit at a university hospital.......Participants: Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty.Interventions: The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30...... minutes of elbow icing (control treatment). The order of treatments was randomized.Main outcome measures: Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments by an...

  15. Chronic pain, perceived stress, and cellular aging: an exploratory study

    Directory of Open Access Journals (Sweden)

    Sibille Kimberly T

    2012-02-01

    Full Text Available Abstract Background Chronic pain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL, a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronic pain and chronic pain is experienced as a physical and psychosocial stressor. However, the utility of TL as a biological marker reflecting the burden of chronic pain and psychosocial stress has not yet been explored. Findings The relationship between chronic pain, stress, and TL was analyzed in 36 ethnically diverse, older adults, half of whom reported no chronic pain and the other half had chronic knee osteoarthritis (OA pain. Subjects completed a physical exam, radiographs, health history, and psychosocial questionnaires. Blood samples were collected and TL was measured by quantitative polymerase chain reaction (qPCR. Four groups were identified characterized by pain status and the Perceived Stress Scale scores: 1 no pain/low stress, 2 no pain/high stress, chronic pain/low stress, and 4 chronic pain/high stress. TL differed between the pain/stress groups (p = 0.01, controlling for relevant covariates. Specifically, the chronic pain/high stress group had significantly shorter TL compared to the no pain/low stress group. Age was negatively correlated with TL, particularly in the chronic pain/high stress group (p = 0.03. Conclusions Although preliminary in nature and based on a modest sample size, these findings indicate that cellular aging may be more pronounced in older adults experiencing high levels of perceived stress and chronic pain.

  16. Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis

    OpenAIRE

    Hassan, B.; Mockett, S; Doherty, M

    2002-01-01

    Objectives: To investigate whether a "standard" sized (that is, a size that would be prescribed by a physiotherapist) elastic bandage (S-bandage) around the knee of subjects with knee osteoarthritis (OA) would, in the short term (a) reduce pain, (b) improve knee joint proprioception, and (c) decrease sway in comparison with a looser (L-bandage).

  17. Adductor canal block for postoperative pain treatment after revision knee arthroplasty

    DEFF Research Database (Denmark)

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Schrøder, Henrik M;

    2014-01-01

    arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an adductor canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT......BACKGROUND: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total...... difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. TRIAL REGISTRATION: Clinicaltrials.gov NCT01191593....

  18. MRI detected prevalence of abnormalities in patients of knee pain

    Directory of Open Access Journals (Sweden)

    Ritu Mehta

    2015-10-01

    Results: In this present study 72% patients were males and 28% patients females and their ages ranging from (11-80 years. Knee pain was found common in age group 31-40 years. Menisci lesions (44% were more common as compared to ligament lesions (14% in patients of knee pain. Osteoarthritis was found in 40 % of patients of knee pain. Joint effusion and marrow edema was found with incidence of 74% and 62% respectively. 4% patients were suffering from intraarticular tumors. Conclusions: Knee pain can occur at any stage of life due to various causative factors. MRI can demonstrate the exact nature and extent of bony as well as soft tissue abnormality. This has increase the use of MRI in evaluation of patients of knee pain. [Int J Res Med Sci 2015; 3(10.000: 2572-2575

  19. Management of chronic musculoskeletal pain.

    Science.gov (United States)

    Uhl, Richard L; Roberts, Timothy T; Papaliodis, Dean N; Mulligan, Michael T; Dubin, Andrew H

    2014-02-01

    Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain. PMID:24486756

  20. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... knees to allow these knees to do their job. These knees carry sometimes ten times body weight, ... that block in, and he does a great job with these blocks, we work together, at least ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... to a full knee replacement, what are the risks of stiffness with a partial knee replacement? Yeah, also known as arthrofibrosis for the doctors out there, knee surgery has a very - on average a pretty high ...

  2. Radiosynovectomy of the knee joint in chronic arthritis

    International Nuclear Information System (INIS)

    185 MBq (5 mCi) colloidal 198-aurothioglucose (198Au) or colloidal yttrium-90-silicate (90Y) in 10 ml 0.9% NaCl was injected into knee joint cavity after aspiration of joint fluid. After that the patient stayed in bed for 3 days. Clinical examination, erythrocyte sedimentation rate, 99mTc-pertechnetate uptake measurements and radiographs of the knee joints were performed at baseline and during follow-up. Main results, group 1. evaluation after 6 months and after 3 years showed significantly better results in the group of knee joints with no minimal pre-existing radiological abnormalities compared with the group of knee joints with moderate or severe radiological abnormalities (p90Y, 50% of the treated knees showed clinical improvement of the synovitis. Group 3. a significant reduction of haemarthrotic episodes of all 6 joints treated and a reduction of pain in 4 during a follow-up of 2.5 years.It is concluded that radiosynovectomy is a valuable and simple form of treatment for therapy-resistant chronic synovitis. (author). 20 refs.; 3 tabs

  3. Widespread pain in chronic epicondylitis.

    Science.gov (United States)

    Pienimäki, Tuomo; Siira, Pertti; Vanharanta, Heikki

    2011-10-01

    We studied the associations of widespread pain with other pain and functional measures among patients with chronic epicondylitis. A total of 190 patients (66% females) participated in the study; with a mean age 43.7, mean duration of symptoms 48weeks, chronic lateral (n=160) and medial (n=30) epicondylitis. We analysed clinical status, grip strength and cubital pain thresholds and interviewed pain and disability, leisure time physical activity, strenuous hobby activities for arms, duration of symptoms, other systemic and upper extremity disorders, arm operations, and work ability. The location of pain was analysed using a whole-body pain drawing, categorized into three groups; the highest of which was classified as widespread pain. A total of 85 patients (45%) reported widespread pain. It was highly associated with female gender, high pain scores, decreased grip strength and pain thresholds (p<0.001 for all), with increased number of positive manual tests, low level of hobby strain for arms and physical activity, long duration of symptoms, and sick leave (p for all <0.05). It was also related to upper extremity disorders and arm surgery, but not with operated epicondylitis, other systemic diseases, workload or work ability. In addition, 39% of patients without other disease reported widespread pain. Widespread pain is common in chronic epicondylitis with and without other diseases, and is related to high pain scores, decreased function of the arm, long duration of symptoms, sick leave, and with a low level of physical activity. PMID:21565536

  4. How to investigate: Chronic pain.

    Science.gov (United States)

    Hague, Matthew; Shenker, Nicholas

    2014-12-01

    Chronic pain is defined as an unpleasant sensory and emotional experience persisting longer than the normal process of healing, usually longer than 3 months. About a fifth of the world's population is believed to suffer from chronic pain. In Europe, chronic pain accounts for nearly 500 m lost working days, and it costs the European economy >€34 billion (£28 billion) every year. Establishing a reliable diagnosis is the primary challenge in evaluating a patient with chronic pain. Common diagnoses not to miss include seronegative spondyloarthritides, endocrine abnormalities including severe vitamin D deficiency and polymyalgia rheumatica. Once important or treatable diagnoses have been ruled out, the history can be used as a tool to establish a therapeutic plan for shared decision-making using the biopsychosocial model. Onward referral to pain clinics can be helpful for more involved patient management, but often good outcomes are achieved with the support of primary care. PMID:26096090

  5. [Neurosurgical treatment of chronic pain].

    Science.gov (United States)

    Fontaine, D; Blond, S; Mertens, P; Lanteri-Minet, M

    2015-02-01

    Neurosurgical treatment of pain used two kind of techniques: 1) Lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (drezotomy, cordotomy, tractotomy…). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain. 2) Neuromodulation techniques try to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation…) is used to treat chronic neuropathic pain. Intrathecal infusion of analgesics (morphine, ziconotide…), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, selected patients with severe and chronic pain, refractory to all other treatments. The quality of the analgesic outcome depends on the relevance of the indications. PMID:25681114

  6. Neuromuscular activity and knee kinematics in adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Samani, Afshin; Olesen, Jens L.;

    2013-01-01

    This study aimed to investigate the neuromuscular control of the knee during stair descent among female adolescents with patellofemoral pain (PFP) and to report its association with self-reported clinical status assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS)....

  7. The pain-relieving qualities of exercise in knee osteoarthritis

    OpenAIRE

    Susko AM; Fitzgerald GK

    2013-01-01

    Allyn M Susko, G Kelley Fitzgerald Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this review article is to explore the role of therapeutic exercise in managing the pain associated with knee osteoarthritis (OA). Therapeutic exercise is often recommended as a first-line conservative treatment for knee OA, and current evidence supports exercise as an effective pain-relieving intervention. We explore the current state of evidence for exerci...

  8. The pain-relieving qualities of exercise in knee osteoarthritis

    OpenAIRE

    Fitzgerald, Kelley

    2013-01-01

    Allyn M Susko, G Kelley Fitzgerald Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this review article is to explore the role of therapeutic exercise in managing the pain associated with knee osteoarthritis (OA). Therapeutic exercise is often recommended as a first-line conservative treatment for knee OA, and current evidence supports exercise as an effective pain-relieving intervention. We explore the current state of evidence for exerc...

  9. Neurovascular Unit in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Beatrice Mihaela Radu

    2013-01-01

    Full Text Available Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU has been recently proposed. In particular, the blood-brain barrier (BBB and blood-spinal cord barrier (BSCB, two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment.

  10. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    Directory of Open Access Journals (Sweden)

    Vicente Sanchis-Alfonso

    2016-01-01

    Full Text Available We present a case of a patient with chronic anterior knee pain (AKP recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP.

  11. Chronic pain management: nonpharmacological therapies for chronic pain.

    Science.gov (United States)

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Although these can be used as stand-alone therapies, nonpharmacologic treatments often are used to augment and complement pharmacologic treatments (ie, multimodal therapy). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence. Clinicians should become familiar with these interventions so that they can offer patients flexibility in the pain management approach. Effective noninvasive treatment modalities for CP include behavioral therapy for short-term pain relief; cognitive behavioral therapy for reducing long-term pain and disability; hypnosis as adjunctive therapy; guided imagery, diaphragmatic breathing, and muscle relaxation, especially for cancer-related pain; mindfulness-based stress reduction for patients with chronic low back pain; acupuncture for multiple pain conditions; combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain; animal-assisted therapy; and S-adenosyl-L-methionine for joint pain. Guidelines for use of these treatment modalities are based on expert panel recommendations in combination with data from randomized controlled trials. PMID:25970869

  12. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Advil and anti-inflammatories, as well as some physical therapy. Continuing with other non-operative treatment modalities, she ... is the full knee replacement. Some of the benefits of a partial knee replacement include a less ...

  13. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... of that knee not being completely and totally flexible. But the knees bend right away. The next ... the past, but in other cases, they have led such active lives and they’re so full ...

  14. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... of articular cartilage lining the bone within the joint. That compares and contrasts to the arthritic knee ... swelling in and around her knee. The damaged joint was caused by bones grinding against each other, ...

  15. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the knee. So welcome to you inside our patient’s knee. And this is a 26-year-old ... ask a quick question. You mentioned that the patient had been playing golf and sustained the injury. ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... knee joint so that we get extra blood flow into the knee. I want a little clot ... a stroke some years ago, and suffers from high blood pressure. Is an individual in their early ...

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is the full knee replacement. Some of the benefits of a partial knee replacement include a less ... get a lot of information, both on the Internet, from other doctors, from friends, and I think ...

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... doesn't have a lot of the mechanical sensations that a total knee replacement patient has, they ... a full knee replacement probably has a better sense of which one will be more helpful for ...

  19. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... lives in the back of the knee, and holds the bones together. The knee replacement design that ... there. It looks real nice. It’s going to hold up real nice. Probe please. I’m going ...

  20. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is gone through the skin and we're working our way down to the knee joint capsule ... that medial partial knee replacements don't really work. So they come in with the idea that ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is what you see on the left, which has a good full healthy layer of articular cartilage ... bone showing that only part of the knee has been replaced, whereas the rest of the knee ...

  2. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... itself. And again, this is when only one part of the knee, what we call a compartment ... prosthesis secured to the bone showing that only part of the knee has been replaced, whereas the ...

  3. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... this have a small tear propagate into a large tear, and that kind of tear can really ... knee replacement. So we’re seeing a very large epidemic, if you would, of knee arthritis in ...

  4. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... of pivot injury to the knee. Is that something related to exercise, lack of exercise? Is there ... the knee. And luckily for him, this is something that can be repaired with a little insertion ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... and takes care of the kinematic or the mechanics of the knee without the anterior cruciate ligament. ... the audience will be seeing some of the mechanics of the total knee replacement, and obviously some ...

  6. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... room you’re going to see the end-stage or what happens to the knees that end ... what you’re observing here is the last stage of preparation in the knee replacement in which ...

  7. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... aspect of the partial knee replacement at this stage is you'll see another cut in the ... all practice components. Now how important is this stage, Dr. McCauley, during the knee replacement? Well, it's ...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... in this outline here, where on the inner aspect of her knee, what we call the medial ... injection to try and re-lubricate the inner aspect of the knee. However, this failed to provide ...

  9. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the rest of the knee. Let’s have the table up a little bit. Dr. Hommen, is that ... shame, because you play end up on the table next door getting a knee replacement in 25 ...

  10. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... to introduce our patient. We're going to go into the definition of arthritis. We're going ... a full knee replacement. We are going to go through a surgical video of a partial knee ...

  11. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... the arthritic knee that we see on the right where the cartilage is starting to break down ... different patient who underwent that procedure where the right opaque portion of the knee shows the partial ...

  12. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... of that knee not being completely and totally flexible. But the knees bend right away. The next ... is very dilated and the heart doesn’t work that well, I’m more afraid of that ...

  13. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... that. That’s normal structures in the knee. That helps bathe the knee in normal joint fluid. Okay. ... re saying is that the early intervention can help prevent further problems. Exactly. In certain cases, yes. ...

  14. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... in order to fit this patient with an artificial knee. Dr. Lavernia, the moat common, I think, ... That’s not the case. When you have an artificial knee or hip in you, you have to ...

  15. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... glossy layer of cartilage that's intact without any evidence of arthritis in other aspects of the knee. ... have in their knee from rupturing this ligament, evidence has shown that most of these patients do ...

  16. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to ... pain is real. Site Map Terms & Conditions Privacy Policy Advertising Policy Language Disclaimer Endorsement Policy Development of ...

  17. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs ... pain is different. And because it is different, we need to think about it in very different ...

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... is a camera-insertion-type procedure in the knee joint. Can everybody see the knee joint down here? So what I have outlined here ... And that’s a camera being put into the knee joint through a small skin incision just big enough ...

  19. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... knee is. This is where the medial meniscus structures will be. This is where the lateral structures would be. This is the kneecap tendon right ... we’ll go back to that. That’s normal structures in the knee. That helps bathe the knee ...

  20. Managing chronic pain in family practice.

    OpenAIRE

    Librach, S. L.

    1993-01-01

    Pain is common in family practice. In dealing with chronic pain, both the family physician and the patient often have problems in defining and in understanding the origin of chronic pain and in providing effective pain relief. This article explores a practical, holistic approach to understanding and managing chronic pain.

  1. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial

    OpenAIRE

    Thomas, KS; Muir, KR; DOHERTY, M.; Jones, AC; O'Reilly, SC; Bassey, EJ

    2002-01-01

    Objectives To determine whether a home based exercise programme can improve outcomes in patients with knee pain. Design Pragmatic, factorial randomised controlled trial of two years' duration. Setting Two general practices in Nottingham. Participants 786 men and women aged >45 years with self reported knee pain. Interventions Participants were randomised to four groups to receive exercise therapy, monthly telephone contact, exercise therapy plus telephone contact...

  2. Pregabalin for Pain Treatment in Chronic Pancreatitis

    DEFF Research Database (Denmark)

    Olesen, Søren Schou; Bowense, S; Wilder-Smith, Oliver; van Goor, H; Drewes, Asbjørn Mohr

    2011-01-01

    Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution...

  3. Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study

    Directory of Open Access Journals (Sweden)

    Roos Ewa M

    2009-12-01

    Full Text Available Abstract Background The association between knee alignment and knee pain in knee osteoarthritis (OA is unclear. High tibial osteotomy, a treatment option in knee OA, alters load from the affected to the unaffected compartment of the knee by correcting malalignment. This surgical procedure thus offers the possibility to study the cross-sectional and longitudinal association of alignment to pain. The aims were to study 1 the preoperative association of knee alignment to preoperative knee pain and 2 the association of change in knee alignment with surgery to change in knee pain over time in patients operated on for knee OA by high tibial osteotomy. Methods 182 patients (68% men mean age 53 years (34 - 69 with varus alignment having tibial osteotomy by the hemicallotasis technique for medial knee OA were consecutively included. Knee alignment was assessed by the Hip-Knee-Ankle (HKA angle from radiographs including the hip and ankle joints. Knee pain was measured by the subscale pain (0 - 100, worst to best scale of the Knee injury and Osteoarthritis Outcome Score (KOOS preoperatively and at one year follow-up. To estimate the association between knee alignment and knee pain multivariate regression analyses were used. Results Mean preoperative varus alignment was 170 degrees (153 - 178 and mean preoperative KOOS pain was 42 points (3 - 86. There was no association between preoperative varus alignment and preoperative KOOS pain, crude analysis 0.02 points (95% CI -0.6 - 0.7 change in pain with every degree of HKA angle, adjusted analysis 0.3 points (95% CI -1.3 - 0.6. The mean postoperative knee alignment was 184 degrees (171 - 185. The mean change in knee alignment was 13 degrees (0 - 30. The mean change in KOOS pain was 32 (-16 - 83. There was neither any association between change in knee alignment and change in KOOS pain over time, crude analysis 0.3 point (95% CI -0.6 - 1.2, adjusted analysis 0.4 points (95% CI 0.6 - 1.4. Conclusion We found no

  4. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Jens Ulrik; Mathiesen, Ole; Lind, T;

    2014-01-01

    category compared with placebo. METHODS: Fifty patients with severe pain, defined as having a visual analogue scale (VAS) pain score of >60 during active flexion of the knee on the first or the second postoperative day after TKA, were included in this randomized, double-blind, placebo-controlled trial. All......BACKGROUND: Total knee arthroplasty (TKA) is associated with varying degrees of pain. A considerable proportion (25-40%) of patients experience severe pain, despite a comprehensive multimodal analgesic regimen. We hypothesized that adductor canal block (ACB) would reduce pain in this patient...... moderate, movement-related pain. Clinical trial registration www.clinicaltrials.gov, NCT01549704....

  5. Experimental quadriceps muscle pain impairs knee joint control during walking

    DEFF Research Database (Denmark)

    Henriksen, Marius; Alkjaer, Tine; Lund, Hans; Simonsen, Erik B; Graven-Nielsen, Thomas; Danneskiold-Samsøe, Bente; Bliddal, Henning

    2007-01-01

    the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy...

  6. Experimental knee joint pain during strength training and muscle strength gain in healthy subjects

    DEFF Research Database (Denmark)

    Sørensen, T J; Langberg, Henning; Hodges, P W;

    2012-01-01

    Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and...... thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals....

  7. Pain management in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Cathia Gachago; Peter V Draganov

    2008-01-01

    Abdominal pain is a major clinical problem in patients with chronic pancreatitis.The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and,therefore,a rigid standardized approach for pain control tends to lead to suboptimal results.Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations,low fat diet,alcohol and smoking cessation are encouraged.Analgesics alone are needed in almost all patients.Maneuvers aimed at suppression of pancreatic secretion are routinely tried.Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy,and resective or drainage surgery.The role of pain modifying agents (antidepressants,gabapentin,peregabalin),celiac plexus block,antioxidants,octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.

  8. Fibromyalgia and Chronic Pain Syndromes

    Science.gov (United States)

    Choy, Ernest; Clauw, Daniel J.; Goldenberg, Don L.; Harris, Richard E.; Helfenstein, Milton; Jensen, Troels Staehelin; Noguchi, Koichi; Silverman, Stuart L.; Ushida, Takahiro; Wang, Guochun

    2016-01-01

    This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients’ lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general. PMID:27022674

  9. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... but we may be looking in the wrong time. And what I mean by that is that ... pain problem which exists for some period of time can actually change the nervous system so that ...

  10. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... and it’s the first gender-specific knee replacement system that was designed in this country. It’s called a “gender knee replacement system,” and we’ve probably already done around 350 ...

  11. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... me, Phil. Then we can get a little irrigation through this knee and we can see what’s ... and it’s the first gender-specific knee replacement system that was designed in this country. It’s called ...

  12. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the knee with minimal interference in the patient’s life. What ’m doing right now is I’m ... this particular patient was extremely active throughout his life, he probably puts into his knee around five ...

  13. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... a camera-insertion-type procedure in the knee joint. Can everybody see the knee joint down here? So what I have outlined here ... slides back and forth here. This is the joint line. This is where the actual joint it. ...

  14. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... on your knee joint, that’s a fairly good indication. Okay. So would it be fair to say ... cartilage is worn out, that is a perfect indication for a knee replacement. It’s one of the ...

  15. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... our patient’s knee. And this is a 26-year-old gentlemen who has a meniscus tear, we ... next door getting a knee replacement in 25 years. So that’s the kind of thing we’re ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... some number have because they have had prior injuries. Exactly. Some of them may have had an injection to the knee or some of them may have had, you know, therapy to the knee or other things, but, no, ...

  17. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... not seen one of these break. So the technology to withstand the forces of these implants see on a regular basis is terrific. We have patients that use these knees, artificial knees, five to six million times a year, and like I said, as long as you don’t impact load them, they should last you a good ...

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... walking with a limp, that can cause more stress on your back. It can cause more stress on your hips. If you have a knee ... bowlegged or knock- kneed, that can cause undue stress on a very specific part of your knee ...

  19. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... of the knee here. This is called a “diagnostic arthroscopy of the knee,” and we do this ... that’s kind of what we do with a diagnostic arthroscopy. We look around. We make sure there’s ...

  20. The Knee Clinical Assessment Study – CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population

    OpenAIRE

    Hay Elaine; Duncan Rachel; Wilkie Ross; Myers Helen; Dziedzic Krysia; Wood Laurence; Handy June; Thomas Elaine; Peat George; Hill Jonathan; Croft Peter

    2004-01-01

    Abstract Background Knee pain affects an estimated 25% of the adult population aged 50 years and over. Osteoarthritis is the most common diagnosis made in older adults consulting with knee pain in primary care. However, the relationship between this diagnosis and both the current disease-based definition of osteoarthritis and the regional pain syndrome of knee pain and disability is unclear. Expert consensus, based on current evidence, views the disease and the syndrome as distinct entities b...

  1. Microcirculation of the juvenile knee in chronic arthritis

    DEFF Research Database (Denmark)

    Bünger, Cody; Bülow, J; Tøndevold, E;

    1986-01-01

    In order to investigate pathogenetic factors in growth abnormalities of the knee in hemophilic arthropathy and juvenile rheumatoid arthritis, the hemodynamic changes of the knee following chronic synovial inflammation and elevated joint pressure were studied in puppies. Unilateral arthritis was....... The growth plates formed borders for the extension of these changes. The increased permeability and surface area between blood and bone in arthritis may accelerate the resorption and subsequent destruction of subchondral bone in chronic arthropathies of the juvenile knee....

  2. Continuous Femoral Nerve Block versus Intravenous Patient Controlled Analgesia for Knee Mobility and Long-Term Pain in Patients Receiving Total Knee Replacement: A Randomized Controlled Trial

    OpenAIRE

    Lihua Peng; Li Ren; Peipei Qin; Jing Chen; Ping Feng; Haidan Lin; Min Su

    2014-01-01

    Objectives. To evaluate the comparative analgesia effectiveness and safety of postoperative continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) and their impact on knee function and chronic postoperative pain. Methods. Participants were randomly allocated to receive postoperative continuous femoral nerve block (group CFNB) or intravenous patient controlled analgesia (group PCIA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scor...

  3. Low back pain - chronic

    Science.gov (United States)

    ... over time. If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal ... not improve with medicine and physical therapy include: Spinal surgery, only if you have nerve damage or the cause of your pain does ...

  4. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt;

    2014-01-01

    BACKGROUND: Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is...... unknown how these exercise variables influence knee pain after TKA. OBJECTIVE: To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. DESIGN: Cross-sectional study. SETTING: Consecutive sample of patients from the Copenhagen area, Denmark......, receiving a TKA, between November 2012 and April 2013. PARTICIPANTS: Seventeen patients, no more than 3 weeks after their TKA. MAIN OUTCOME MEASURES: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and...

  5. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacement. At the end, we'll try and go over some questions of some common topics that come up when talking about partial knee replacements. So, let's get to our patient. She's a 42-year- ...

  6. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... 10 hospitals in America by "US News and World Report." New York Presbyterian is affiliated with two ... implant itself. And again, this is when only one part of the knee, what we call a ...

  7. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... and holds the bones together. The knee replacement design that I utilize replaces and takes care of ... and you learned a little bit from our website and our webinar today, and hopefully we can ...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Today we're going to be discussing several topics. First, we're going to introduce our patient. ... and go over some questions of some common topics that come up when talking about partial knee ...

  9. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... two individuals who were very committed to the educational opportunities that we could offer through this live ... my viewers any time that I do an educational program is that if you have a knee ...

  10. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Don't you think that doing a certain number of these a year is kind of important ... t happen as it can happen in small numbers of total knee replacement patients. And do you ...

  11. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... through Partial Knee Replacement NewYork-Presbyterian New York City, New York May 4, 2010 I've always ... out every single day. Located in New York City, New York Presbyterian is ranked among the top ...

  12. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... cementation, which, as Dr. McCauley mentioned before, basically acts as a gout to hold the components into ... training is that partial knee replacements don’t work in people with high body mass indexes or ...

  13. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... quadriceps and your hamstrings in good tone and strength, they will not glide properly, and they will wear out early. So the knee replacement mandates a lifetime of physical therapy on your own. Patients are instructed how ...

  14. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... old woman who I'm sure in your practice is on the extremely young side for perhaps ... full knee replacement. Now Dr. McCauley, in your practice have you seen many people that have had ...

  15. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... all practice components. Now how important is this stage, Dr. McCauley, during the knee replacement? Well, it's ... m wondering, you know, one of the classic teachings that we grew up on as surgeons in ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the cartilage is worn out, that is a perfect indication for a knee replacement. It’s one of ... are still working. I follow them in my practice. And something most important that I like to ...

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... the knee has become more deformed, there's more limited range of motion. And when somebody has damaged ... replacement in general, right? Yeah, that's right on, Bill. So the kneecap, you will see, is just ...

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... had have your viewers that ties into this issue is whether or not most people who end ... have to total knee replacement, also have alignment issues of the leg. Can those alignment issues also ...

  19. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... patient. She's a 42-year-old female, a mother of two young children who had several years ... is gone through the skin and we're working our way down to the knee joint capsule ...

  20. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... diagnosed based on a doctor taking a medial history, physical exam, and other modalities such as x- ... Jeff, just to remind the audience, you're operating on the left knee. And so, your incision ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... hospitals in America by "US News and World Report." New York Presbyterian is affiliated with two Ivy ... that we grew up on as surgeons in training is that partial knee replacements don’t work ...

  2. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... to the tendon. The smallest incision about that big. On this side, somewhere between here and here ... knee joint through a small skin incision just big enough for that cannula. Okay. So now what ...

  3. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... re showing us the cartilage and the ligaments. 3 Yeah. That is the synovium of the knee, ... they project that we’ll be doing approximately 3 to 5 million in about six years. That’s ...

  4. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is a younger woman who's had many different treatments attempted on her knee. She started out simply ... and anti-inflammatories, as well as some physical therapy. Continuing with other non-operative treatment modalities, she ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... can do the operation through a much smaller hole, and we can actually get to the knee ... the proper cuts, I’m now drilling a hole on the inside portion of the femur bone, ...

  6. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... younger patients this can be caused by either fractures or just natural wear and tear and excessive ... prior surgery on the knee, any sort of fracture surgery or any sort of osteotomy, which is ...

  7. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... this grouting agent is polymethyl methacrylate. It’s a substance that we have had a tremendous experience with ... some of the knee replacements done with this substance 25 years ago are still working. I follow ...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... remove a little bit of excess cement that creeps out. Generally, we remove this to make sure ... come into the office who ask about different types of partial knee replacements? Are there any other ...

  9. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... but very often they have a local visiting nurse service or something take out the clips and ... reconstruction. What about the overall knee alignment? How critical do you think that is in choosing your ...

  10. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... it's the rehab, as you know, is pretty standard. Almost all the physical therapists out there have ... metal to help reduce friction. And that's pretty standard with just about any knee replacement system that ...

  11. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... it today. Now having said that, the whole concept of minimally invasive knee surgery for replacement is ... their experience, both in the prevention, in the management, and the care they’re after of the ...

  12. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... the medial compartment of her knee, she's got bone-on-bone arthritis. What makes her a good candidate for ... full healthy layer of articular cartilage lining the bone within the joint. That compares and contrasts to ...

  13. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... that medial partial knee replacements don't really work. So they come in with the idea that ... would expect, on average, those to continue to work for another 10 to 15 years. So, just ...

  14. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... about partial knee replacement due to her young age. Specifically with her symptoms, she was unable to ... them that if I had this procedure at age 42, I probably would not use it to ...

  15. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... year-old female, a mother of two young children who had several years worth of debilitating left ... the arthritic knee that we see on the right where the cartilage is starting to break down ...

  16. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... at about one month and three-month time intervals, as you know, because I think you do ... that we grew up on as surgeons in training is that partial knee replacements don’t work ...

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Jeff, just to remind the audience, you're operating on the left knee. And so, your incision ... soon. What's your rationale for that? In this system, the way the guides are for the distal ...

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... affiliated with two Ivy League medical schools: Columbia University College of Physicians and Surgeons, and Wilde Cornell ... Knee Replacement at New York Presbyterian Hospital, Columbia University. Today we're going to be discussing several ...

  19. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... and holds the bones together. The knee replacement design that I utilize replaces and takes care of ... re live in the operating room at Mercy Hospital. I’m Dr. Manuel Anton, the medical director ...

  20. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... condyle. This is the tibial plateau, a little soft. Okay. A little bit bouncy, kind of like ... it were another type of injury of the soft tissues of the knee that arthroscopy might be ...

  1. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... walk with a walker. So it sounds like movement and the ability to flex the knee occurs ... they’re asking is there a point at women it would be recommendable to go ahead and ...

  2. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... room you’re going to see the end-stage or what happens to the knees that end ... tear from being pulled apart in the early stages of healing. And Dr. Hommen, probably the last ...

  3. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... and holds the bones together. The knee replacement design that I utilize replaces and takes care of ... that block in, and he does a great job with these blocks, we work together, at least ...

  4. Knee Pain and the Weekend Warriors

    Science.gov (United States)

    ... care. “OR-Live,” the vision of improving health. Hello, and welcome to Mercy Hospital. We’re in ... knee arthroscopy. Let me introduce first, Dr. Lavernia. Hello there. Dr. Lavernia Is the chief of the ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... as Latin patients. So we have found a gender and an ethnicity disparity in the results of ... side to this implant, and it’s the first gender-specific knee replacement system that was designed in ...

  6. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... end up needing a knee replacement. All that beautiful cartilage and ligaments that you saw on that ... look over here, you can see a very beautiful example of the process of arthritis. This medial ...

  7. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... soon. What's your rationale for that? In this system, the way the guides are for the distal ... pretty standard with just about any knee replacement system that you use. At this point what I ...

  8. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... we’re not sure. Right now for every man that gets a knee, three females get a ... the hospital? These things are much like cars, man, you have to take care of them. It’s ...

  9. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... 50 years, so we have quite a good track record. The other very common question that patients ... in knee surgery today have just an outstanding track record. One of the things that people ask ...

  10. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... some of them may have had, you know, therapy to the knee or other things, but, no, ... the patient would or would not require other treatment? Well, the meniscus is going to take several ...

  11. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... to the knee. Is that something related to exercise, lack of exercise? Is there anything that that an individual could ... while participating in weekend activities or sports? Well exercise is always good, but a meniscus tear itself ...

  12. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... are interested in this, or physicians who are thinking about referring their patients to this kind of ... McCauley, during the knee replacement? Well, it's definitely critical because, as you mentioned before, you've made ...

  13. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... diagnosed based on a doctor taking a medial history, physical exam, and other modalities such as x- ... to get back to a normal way of life with the partial knee. And most of my ...

  14. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... people that are out there doing the weekend wars are going to end up needing knee replacements. ... not seen one of these break. So the technology to withstand the forces of these implants see ...

  15. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... individuals who were very committed to the educational opportunities that we could offer through this live webcast. ... webcast from Mercy Hospital, where you had the opportunity to witness a knee arthroscopy and a total ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... little redness here as it comes in and feeds the meniscus to about right here. The rest ... orthopedics for approximately 35, 40 years. So these materials that we’re using in knee surgery today ...

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... do these with as little exposure to the muscles and to the ligaments as possible. And so, ... the inner aspect of the knee. The quadriceps muscle is just to the top left aspect of ...

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... wispy filaments that one can see in the background as you’re showing us the cartilage and ... their job. These knees carry sometimes ten times body weight, and on an active person this particular patient ...

  19. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... viewers any time that I do an educational program is that if you have a knee replacement ... living like that. And having the ability to exercise gives them an even higher and longer quality ...

  20. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... on these knee replacements, but you can play tennis. You can actually ride bikes. You can play ... swim. But you cannot jog. You cannot play tennis on them or you’ll destroy them earlier. ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... felt that the mission of helping somebody with healthcare when they're in trouble is as wonderful, ... about partial knee replacement due to her young age. Specifically with her symptoms, she was unable to ...

  2. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... they have to give up, which include jogging, impact- type sports like football or racquetball. They’re not something that’s very a very good thing to do for these knee replacements. Now I’ ...

  3. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... some of them may have had, you know, therapy to the knee or other things, but, no, ... as far as the patient doing well? The therapy on these operations is critical. We have a ...

  4. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... re going to start to make a little skin incision here, take a little cannula and put ... put into the knee joint through a small skin incision just big enough for that cannula. Okay. ...

  5. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... patient. We're going to go into the definition of arthritis. We're going to talk a ... the arthritic knee that we see on the right where the cartilage is starting to break down ...

  6. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... walker. So it sounds like movement and the ability to flex the knee occurs very quickly after ... to continue living like that. And having the ability to exercise gives them an even higher and ...

  7. Experimental knee pain evoke spreading hyperalgesia and facilitated temporal summation of pain

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Henriksen, Marius; Danneskiold-Samsøe, Bente; Bliddal, Henning; Graven-Nielsen, Thomas

    2013-01-01

    was induced in the infrapatellar fat pad by injection of hypertonic saline and the contralateral infrapatellar fat pad was injected with isotonic saline as control. OUTCOME MEASURES: Pressure pain thresholds, temporal summation of pressure pain, and cutaneous mechanosensitivity were assessed on three...... sensitivity. The study showed that acute knee joint pain leads to hyperalgesia and facilitated temporal summation in the infrapatellar fat pad and in muscles located distant to the injection site, in subjects with no history of knee pain....... occasions: baseline, immediately after the injection, and when pain had vanished. Assessments sites were located in the peripatellar region, vastus lateralis, and tibialis anterior muscles. RESULTS: The experimental knee pain model demonstrated 1) hyperalgesia to pressure stimulation on the infrapatellar...

  8. Melatonin in Chronic Pain Syndromes.

    Science.gov (United States)

    Danilov, Andrei; Kurganova, Julia

    2016-06-01

    Melatonin is a neurohormone secreted by epiphysis and extrapineal structures. It performs several functions including chronobiotic, antioxidant, oncostatic, immune modulating, normothermal, and anxiolytic functions. Melatonin affects the cardiovascular system and gastrointestinal tract, participates in reproduction and metabolism, and body mass regulation. Moreover, recent studies have demonstrated melatonin efficacy in relation to pain syndromes. The present paper reviews the studies on melatonin use in fibromyalgia, headaches, irritable bowel syndrome, chronic back pain, and rheumatoid arthritis. The paper discusses the possible mechanisms of melatonin analgesic properties. On one hand, circadian rhythms normalization results in sleep improvement, which is inevitably disordered in chronic pain syndromes, and activation of melatonin adaptive capabilities. On the other hand, there is evidence of melatonin-independent analgesic effect involving melatonin receptors and several neurotransmitter systems. PMID:26984272

  9. The burden of chronic pain

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per; Juel, Knud; Højsted, Jette; Ekholm, Kim Ola Michael

    2012-01-01

    the adult Danish population and to analyze associated factors such as diseases, immigration, and opioid use. This cross-sectional survey combines individual-based information from the Danish Health Survey (2010) and official Danish health and socioeconomic, individual-based registers. The simple...... random sample consisted of 25,000 individuals (≥16 years old) living in Denmark. In all, 60.7% completed a mailed or online questionnaire. Associations were examined with multiple logistic regression analysis. The study population consisted of 14,925 individuals in whom a high prevalence of chronic pain...... (26.8%, 95% confidence interval: 26.1 to 27.5) and a high prevalence of opioid consumption (4.5%) were observed. Other aspects of particular note: (1) a higher prevalence of chronic pain occurred among individuals with cardiovascular and chronic pulmonary diseases than among individuals with cancer...

  10. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... ll have successful repair here. What is the improvement, the expected improvement related to the pain that the patient was ... to the intervention? Oh, she should have significant improvements of pain relief with this type of repair ...

  11. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... Oh, she should have significant improvements of pain relief with this type of repair if the meniscus ... in orthopedics and really gives patients wonderful pain relief; whereas an arthroscopy in that setting alone is ...

  12. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... ll do a femoral nerve block, which helps control pain for about 24 hours or so. These ... around the incision, is quite effective in helping control pain. So most patients are maintained on oral ...

  13. Systematic Analysis of Painful Total Knee Prosthesis, a Diagnostic Algorithm

    Directory of Open Access Journals (Sweden)

    Oliver Djahani

    2013-12-01

    Full Text Available   Remaining pain after total knee arthroplasty (TKA is a common observation in about 20% of postoperative patients; where in about 60% of these knees require early revision surgery within five years. Obvious causes of this pain could be identified simply with clinical examinations and standard radiographs. However, unexplained painful TKA still remains a challenge for the surgeon. The management should include a multidisciplinary approach to the patient`s pain as well as addressing the underlying etiology. There are a number of extrinsic (tendinopathy, hip, ankle, spine, CRPS and so on and intrinsic (infection, instability, malalignment, wear and so on causes of painful knee replacement. On average, diagnosis takes more than 12 months and patients become very dissatisfied and some of them even acquire psychological problems. Hence, a systematic diagnostic algorithm might be helpful. This review article aims to act as a guide to the evaluation of patients with painful TKA described in 10 different steps. Furthermore, the preliminary results of a series of 100 consecutive cases will be discussed. Revision surgery was performed only in those cases with clear failure mechanism.

  14. One case of herb rehabilitation for knee joints swelling and pain%膝关节肿痛中药康复治疗1例

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Background: Most middle-aged and aged patients with knee joints swelling and pain (knee joints degeneration is shown by X ray) are obese, the knee joints are chronically damaged by heavy load and much walk or extra exercises. According to the Chinese medicine theories: the middle-aged and the aged have weak liver and kidney, their sinews and bones are not well nourished, when damaged by too much labor, they are attacked by wind and moist and it is the main cause of the disease. Objective: To discuss the treating effects of Chinese herb on knee joints swelling and pain. Unit: Chinese Medicine Hospital of Huzhou City.

  15. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the knee. Again, that’s the posterior cruciate ligament. Let’s go in there and look at that meniscus. So ... things that we have here at Mercy Hospital -- let’s go with a six -- which is that we have ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... enhanced our success of repair by putting little holes in the bone called “micro fracture” to put more blood in the knee joint to allow for like a clot formation in the meniscus tear. Very good. Thank you, ...

  17. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... torn your anterior cruciate ligament at the same time, that can cause this as well. But preventing ... what’s called the “figure-four position” at this time. We’re going to have the knee brought ...

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... you can do in life. And I think we're fortunate to have a greet staff who ... of medicine. At the end of the day, we can all walk away and say, "This is ... Geller. I'm here with Dr. William McCauley. We're here to talk about partial knee replacements. ...

  19. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... like you said, they have to be the right candidate. Turns out that probably fewer than 10 or 15 percent of the knee surgery candidates that come into my office are real good patients who are good candidates for this ...

  20. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... 000 of these operations a year, and they project that we’ll be doing approximately 3 to ... the knee with minimal interference in the patient’s life. What ’m doing right now is I’m ...

  1. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... meniscal tears in the young and athletic-type population like this gentleman, you know, very active, obviously ... you would, of knee arthritis in the female population. So, Dr. Lavernia, you’re saying that there’s ...

  2. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... or just natural wear and tear and excessive exercise, ultimately leading to arthritis. Again, this is just ... maybe what we would have appreciated with our physical exam during the office ... to more high impact activities, what do you tell them about partial knee ...

  3. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... all walk away and say, "This is our team and it's a great team." Welcome to this OR Live Webcast presentation live ... that medial partial knee replacements don't really work. So they come in with the idea that ...

  4. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacement. One of the things I had in mind is I'm wondering, you know, one of the classic teachings that we grew up on as surgeons in training is that partial knee replacements don’t work in people with high body mass indexes or people who are overweight. What ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... care. “OR-Live,” the vision of improving health. Hello, and welcome to Mercy Hospital. We’re in ... knee arthroscopy. Let me introduce first, Dr. Lavernia. Hello there. Dr. Lavernia Is the chief of the ...

  6. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... than 10 or 15 percent of the knee surgery candidates that come into my office are real good patients who are good candidates for this particular ... essentially the fixation of these implants are as good on the first day of the surgery as they'll ever be, right? So you ...

  7. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... Is there a rehabilitation period that’s done with physical therapy after one leaves the hospital? These things are ... So the knee replacement mandates a lifetime of physical therapy on your own. Patients are instructed how to ...

  8. [Imaging of brain changes in chronic pain].

    Science.gov (United States)

    Vartiainen, Nuutti; Forss, Nina

    2014-01-01

    Modern methods of brain imaging have enabled objective measurements of functional and structural brain changes associated with chronic pain conditions. According to recent investigations, chronic pain is not only associated with abnormally strong or prolonged activity of regions processing acute pain, but also with activation of brain networks that are characteristic for each pain state, changes in cortical remodeling, as well as local reduction of grey matter in several regions of the brain. Brain changes associated with chronic pain facilitate the understanding of mechanisms of various chronic pain conditions. PMID:25211820

  9. 153Sm-HM for arthritic knee pain. Estimated dosimetry

    International Nuclear Information System (INIS)

    Osteoarthritis is the most common type of arthropathy and after cardiovascular diseases is the most disabling disease in developing countries. The dosimetry for the clinical application of 153-samarium-hydroxymacroaggregates (153Sm-HM) for radiation synovectomy (RSV) and palliative treatment for arthritic pain, as far as we know, has not been reported. The aim of this research was to estimate the radiation dose necessary for synovial ablation and pain palliation with minimum risk to the patient. 153Sm-HM (370 MBq) was administered intra-articularly in a patient with severe knee pain and hindered motility. Regions of interest drawn on sequential, conjugated, anterior and posterior scintigraphy images were used to obtain the respective activity. The data was entered into a knee joint histological-geometric model designed with micrometric dimensions to represent the synovial cell layers. The Monte Carlo code was used to calculate the absorbed dose in each of the 12 model-cells representing the distance from the synovial liquid to the cartilage or bone. The absorbed dose in the synovial cavity was 114 Gy which is sufficient energy for RSV. The treated patient referred little pain and higher motility with no adverse reactions. 153Sm-HM is a potentially valid radiopharmaceutical for RSV, which effectively palliates knee pain.

  10. Alexithymia in Chronic Pain Disorders.

    Science.gov (United States)

    Di Tella, Marialaura; Castelli, Lorys

    2016-07-01

    This review proposes a critical discussion of the recent studies investigating the presence of alexithymia in patients suffering from different chronic pain (CP) conditions. The term CP refers to pain that persists or progresses over time, while alexithymia is an affective dysregulation, largely observed in psychosomatic diseases. Overall, the examined studies showed a high prevalence of alexithymia, especially difficulties in identifying feelings, in all the different CP conditions considered. However, the association between alexithymia and pain intensity was not always clear and in some studies this relationship appeared to be mediated by negative effect, especially depression. The role of alexithymia in CP should be clarified by future studies, paying particular attention to two aspects: the use of additional measures, in addition to the Toronto Alexithymia Scale, to assess alexithymia, and the analysis of the potential differences in the evolution of different CP conditions with reference to the presence or absence of alexithymia. PMID:27215759

  11. Chronic pain and invasive therapy

    OpenAIRE

    Alessandro Rocco; Pierangelo Di Marco; Marta Luzi; Alessandra Canneti; Carlo Reale

    2009-01-01

    The chronic pain “three-step” OMS ladder is likely to be revised, in order to introduce a “fourth step” including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development. Most of invasive approaches include central (spinal neuromodulation) and peripheral (gangliar neurolysis, percutaneous vertebral reduction) techniques, as well as pharmacological (opioi...

  12. Hypnotherapy for the Management of Chronic Pain

    OpenAIRE

    Elkins, Gary; Jensen, Mark P.; Patterson, David R.

    2007-01-01

    This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than ...

  13. Electronic momentary assessment in chronic pain 1: psychological pain responses as predictors of pain intensity

    OpenAIRE

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J. J.; Verhaak, P.F.M.; BENSING, J

    2006-01-01

    Objectives and Methods: Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed...

  14. Gonyautoxins: First evidence in pain management in total knee arthroplasty.

    Science.gov (United States)

    Hinzpeter, Jaime; Barrientos, Cristián; Zamorano, Álvaro; Martinez, Álvaro; Palet, Miguel; Wulf, Rodrigo; Barahona, Maximiliano; Sepúlveda, Joaquín M; Guerra, Matias; Bustamante, Tamara; Del Campo, Miguel; Tapia, Eric; Lagos, Nestor

    2016-09-01

    Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids. PMID:27317871

  15. Neurophysiology of pain and hypnosis for chronic pain

    OpenAIRE

    Dillworth, Tiara; Mendoza, M. Elena; Jensen, Mark P.

    2011-01-01

    In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiologica...

  16. Chronic widespread pain in spondyloarthritis

    Directory of Open Access Journals (Sweden)

    F. Atzeni

    2014-06-01

    Full Text Available The pain associated with spondyloarthritis (SpA can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP that characterises fibromyalgia (FM. The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

  17. SPECT/CT in patients with painful knee arthroplasty - what is the evidence?

    Energy Technology Data Exchange (ETDEWEB)

    Hirschmann, Michael T. [Kantonsspital Baselland-Bruderholz, Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Henckel, Johann [Imperial College London, London (United Kingdom); Rasch, Helmut [Kantonsspital Baselland-Bruderholz, Institute for Radiology and Nuclear Medicine, Bruderholz (Switzerland)

    2013-09-15

    SPECT/CT is increasingly recognized as a promising imaging modality for the investigation of patients with a painful knee after knee arthroplasty. In this review article, we give an overview of the clinical value and current and future applications of SPECT/CT for patients with knee pain following joint arthroplasty. A detailed evidence-based literature review is performed and presented. (orig.)

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... is so severe that they can’t even sleep due to the pain. Now if we look ... repairs -- suture cutter -- of this type of repair pattern. These do work and they do cause the ...

  19. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... more than four to five blocks at a time. She had difficulty going up and down stairs, ... other, leading to pain, stiffness and inflammation. At times in younger patients this can be caused by ...

  20. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... exercise gives them an even higher and longer quality of life, and I think that, again, the ... so must faster these days with the pain management protocol and the smaller incisions that it’s almost ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... completely excised and removed. It can be a source of pain in the replaced joint if it ... to our office. And we can get that information to you. Thank you. Good night. Thank you ...

  2. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... prevent arthritis in if you have good quadricep control and good hamstring power and you’re not ... proper preparation for the surgery, the proper pain control, so that once the surgery is concluded the ...

  3. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... was caused by bones grinding against each other, leading to pain, stiffness and inflammation. At times in ... natural wear and tear and excessive exercise, ultimately leading to arthritis. Again, this is just the picture ...

  4. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... pain receptors in the meniscus along the capsular edge, along the outer. This is the outer edge here of the meniscus. This is the inner edge here of the meniscus. That’s the inner edge. ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... seven years, and that has been shown in studies. Whether or not that patient has pain from ... arthritis when you run. And we have longitudinal studies from a great number of different cities across ...

  6. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... from the arthritis is different, but the whole goal here is to save this guy’s meniscus and ... wonderful pain relief; whereas an arthroscopy in that setting alone is probably not your best answer and ...

  7. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the pain that the patient was having in relationship to the intervention? Oh, she should have significant ... with the majority of the patients’ anatomy in mind. But we have also created a female side ...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... bottom of the femur. In order to obtain optimal alignment of our components, we use various aspects ... ll do a femoral nerve block, which helps control pain for about 24 hours or so. These ...

  9. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... I would definitely being a little bit more aggressive or an 24-year-old who’s active, because ... the pain that the patient was having in relationship to the intervention? Oh, she should have significant ...

  10. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... Dr. Peter Hommen. Dr. Hommen was the team physician for the professional soccer team here in Miami, ... drives a lot of folks to visit their physicians and orthopedists. Is the pain and the condition ...

  11. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... the pain that the patient was having in relationship to the intervention? Oh, she should have significant ... opposed to men. Are there any factors that affect how females do in recovering from the surgery ...

  12. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... is so severe that they can’t even sleep due to the pain. Now if we look ... opposed to men. Are there any factors that affect how females do in recovering from the surgery ...

  13. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... which is that we have here a tremendous inventory of parts in back in case we need ... proper preparation for the surgery, the proper pain control, so that once the surgery is concluded the ...

  14. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... so must faster these days with the pain management protocol and the smaller incisions that it’s almost indistinguishable in terms of the total time that it takes the patient to get back ...

  15. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... The damaged joint was caused by bones grinding against each other, leading to pain, stiffness and inflammation. ... where that metal cutting guide is lined up against. We take our time in really establishing how ...

  16. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... pain? Absolutely. You know, alignment issues, you know, overall joint alignment issues, if you’re talking about ... bone to re-heal itself in a different overall alignment. So kind of like changing the alignment ...

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... patient. We're going to go into the definition of arthritis. We're going to talk a ... ll do a femoral nerve block, which helps control pain for about 24 hours or so. These ...

  18. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... so must faster these days with the pain management protocol and the smaller incisions that it’s almost indistinguishable in terms of the total time that it takes the patient to get ...

  19. Pregabalin in Chronic Post–thoracotomy Pain

    OpenAIRE

    Mishra, Atul; Nar, Amandeep Singh; Bawa, Ashvind; Kaur, Mrs. Gurinder; Bawa, Sayesha; Mishra, Seema

    2013-01-01

    Introduction: Chronic post–thoracotomy pain (CPP) has very high incidence and therefore it needs attention. Usually, it is burning, dysaesthetic and aching in nature and it displays many features of neuropathic pain. No one technique of thoracotomy has been shown to reduce the incidence of chronic post thoracotomy pain.

  20. Diacerein: a treatment option in painful primary knee osteoarthritis

    International Nuclear Information System (INIS)

    To identify the efficacy and side effects of Diacerein in patients with mild to moderate knee osteoarthritis. Study Design: Quasi experimental study. Place and Duration of Study: Outpatient Department of Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from June 2012 to June 2013. Material and Methods: Ninety cases fulfilling American College of Rheumatology criteria for diagnosis of Knee Osteoarthritis and falling in Grades III of Kellgren-Lawrence Radiological Classification for Knee Osteoarthritis were included. Pre-treatment associated symptoms, complete blood count, renal and liver function tests were documented. After a baseline pain assessment on a 10-Point Visual Analogue Scale, 50 mg of Diacerein was given orally for 4 months followed by pain assessment and inquiry about adverse effects at 6th week, 3rd and 6th months. Post-treatment labs were repeated. Reduction in pain was analyzed by paired-sample t-test using SPSS version 17. Chi-Square test was used to assess the frequency of adverse effects. A p-value < 0.05 was considered significant. Results: Mean age was 61.5 ± 7.8 years. Majority 77 (85.6%) were females. Mean Visual Analogue Scale at start was 6.1 ± 0.87. Significant pain reduction measured on Visual Analogue Scale was observed at six weeks (4.6 ± 1.2) (p < 0.001), three months (2.37 ± 0.91) (p < 0.001) and six months (2.2 ± 0.85) (p < 0.001). Very few patients developed diarrhea 3.3% and nausea 4.4%. Conclusion: Diacerein is effective drug with minimal side effects for treatment of mild to moderate painful Knee Osteoarthritis. (author)

  1. CHRONIC PAIN AFTER INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-09-01

    Full Text Available : BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of chronic pain. MATERIAL AND METHODS: Patients undergoing elective inguinal hernioplasty in Victoria hospital from November2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for follow up at end of six months. A detailed preoperative, intraoperative and post-operative details of cases were recorded according to proforma. The postoperative pain and pain at two, seven days and at end of six months were recorded on a VAS scale. RESULTS: Chronic pain at six month follow up was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7 % of patients with preoperative pain developed chronic pain. Patients with significant preoperative pain had higher chances of developing chronic pain (p<.0001. Preemptive analgesia failed to show statistical significance in development of chronic pain (p=0.079. Nerve injury were present in 22 of cases it was found that nerve injury significantly affected development of chronic pain (p=0.001.Post-operative infiltration of local anesthesia was practiced in 16.3 % of cases and it was found that local infiltration at incision site significantly reduced incidence of chronic pain (p=0.001.Postoperative complications in the form of hematoma, seroma or infection was present in 8.5 % of cases. It was found that post-operative complication not only increased early post-operative pain

  2. Chronic pain and invasive therapy

    Directory of Open Access Journals (Sweden)

    Alessandro Rocco

    2009-05-01

    Full Text Available The chronic pain “three-step” OMS ladder is likely to be revised, in order to introduce a “fourth step” including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development. Most of invasive approaches include central (spinal neuromodulation and peripheral (gangliar neurolysis, percutaneous vertebral reduction techniques, as well as pharmacological (opioids and adiuvants, chemical (alcohol and physical (electrical stimulation, thermic neurolysis means. Rarely effective as unique therapies, invasive procedures have to be accurately patient-selected and considered supplementary to conservative approaches, in order to minimize the adverse events deriving from a long term opioid therapy. In the near future, the development of both pain science and biomedical technology will probably be accompanied by the improvement of the knowledge regarding the recourse to invasive analgesic procedures.

  3. Perioperative pain management in hip and knee replacement surgery.

    Science.gov (United States)

    Barrington, John W; Halaszynski, Thomas M; Sinatra, Raymond S; Expert Working Group On Anesthesia And Orthopaedics Critical Issues In Hip And Knee Replacement Arthroplasty, For The

    2014-04-01

    Many patients who undergo hip or knee replacement surgery today experience high levels of postoperative pain. Data from clinical studies and analyses of hospital records have demonstrated that severe postoperative pain is associated with an increased risk for complications, slowing of the rehabilitation process, delayed return to normal functioning, progression to persistent pain states, prolonged length of hospital stay, elevated rates of readmission, and higher overall costs. Orthopedic surgeons may now play a more active role in reducing the severity of pain following surgery, decreasing both opioid use and the incidence of opioid-related adverse events, and eliminating breakthrough pain and analgesic gaps. The benefits of multimodal regimens that include a combination of agents acting synergistically have been established unequivocally, and many analgesic and anesthetic agents are now available, as well as treatment options that differ according to route of administration. It is therefore possible to individualize treatment based on the type of procedure and patient need. One exciting advance that offers effective, safe, and efficient analgesia for many kinds of surgical procedures is the introduction of an extended-release local anesthetic (liposomal bupivacaine) for infiltration. This new option, which can be administered directly into the knee or hip by an orthopedic surgeon, is an example of the changing paradigm in perioperative analgesia, where commitment, communication, and coordination across all members of the clinical care team- including the surgeon, anesthesiologist, pharmacist, physical therapist, and nursing staff-are fundamental elements of an improved standard of care. An Expert Working Group on Anesthesia and Orthopaedics: Critical Issues in Hip and Knee Replacement Arthroplasty (April 13, 2013; Dallas, Texas) evaluated current approaches to perioperative pain management and proposed new regimens to help achieve optimal outcomes in these

  4. Mindfulness, acceptance and catastrophizing in chronic pain.

    Directory of Open Access Journals (Sweden)

    Maaike J de Boer

    Full Text Available OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center. RESULTS: The results show that general psychological acceptance (measured with the AAQ-II is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS did not predict levels of pain-related catastrophizing. DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of "acting with awareness" is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

  5. Chronic pain after open inguinal hernia repair.

    Science.gov (United States)

    Nikkolo, Ceith; Lepner, Urmas

    2016-01-01

    Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient's quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. PMID:26567717

  6. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... all walk away and say, "This is our team and it's a great team." Welcome to this OR Live Webcast presentation live ... inject in and around the incision, is quite effective in helping control pain. So most patients are ...

  7. Mindfulness, Acceptance and Catastrophizing in Chronic Pain

    OpenAIRE

    de Boer, Maaike J.; Steinhagen, Hannemike E.; Versteegen, Gerbrig J.; Struys, Michel M.R.F.; Sanderman, Robbert

    2014-01-01

    Objectives: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. Methods: A cross-sectional survey was conducted, including 87 chr...

  8. Ehlers-Danlos syndrome and chronic pain.

    Science.gov (United States)

    Hsu, Lanny

    2012-06-01

    Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are Ehlers-Danlos syndrome and associated chronic pain; the information is meant to help readers understand the mechanisms for pain in this connective tissue disorder as well as general treatment principles for chronic pain management. PMID:22616833

  9. Chronic Pain Syndromes and Borderline Personality

    OpenAIRE

    Sansone, Randy A.; Sansone, Lori A.

    2012-01-01

    The assessment and management of chronic pain is challenging and, according to the existing literature, oftentimes associated with various forms of psychopathology, including borderline personality disorder. Since 1994, eight studies have explored the relationship between chronic pain syndromes and borderline personality disorder. In averaging the prevalence rates in these studies, 30 percent of participants with chronic pain harbor this Axis II disorder. Related studies suggest that individu...

  10. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris;

    2007-01-01

    the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions of...... document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr...

  11. Electronic momentary assessment in chronic pain (I): pain and psychological pain responses as predictors of pain intensity.

    OpenAIRE

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J. J.; Verhaak, P.F.M.; Bensing, J M

    2006-01-01

    Objectives and Methods: Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed...

  12. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Okuno, Yuji, E-mail: how-lowlow@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan); Korchi, Amine Mohamed, E-mail: amine.korchi@gmail.com [Geneva University Hospitals, Department of Diagnostic and Interventional Radiology (Switzerland); Shinjo, Takuma, E-mail: shin.takuma@a7.keio.jp [Keio University, Institute for Integrated Sports Medicine, School of Medicine (Japan); Kato, Shojiro, E-mail: shojiro7@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan)

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  13. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    International Nuclear Information System (INIS)

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function

  14. Effect of Grade 1 Mobilization on Osteoarthritic Knee Pain

    Directory of Open Access Journals (Sweden)

    Tavakkoli Mehdi

    2010-03-01

    Full Text Available Background: Knee osteoarthritis (OA is one of the common disabling conditions in human. Joint mobilization is a passive rhythmic accessory movement therapy that is used in the treatment of OA. In this study, the effect of grade one mobilization, on pain reduction of knee OA has been investigated.Materials and Methods: This study was an unidirectional blind clinical trial with random sampling from patients admitted to Sarcheshme physiotherapy clinic in 2007. Thirty participants were divided into 3 groups randomly: group 1: Mobilization + Exercise therapy, group 2: Exercise therapy and group 3: Mobilization. Ultrasound with the intensity below 0.2 W/Cm2 was used for all groups as placebo. The treatment was done in 10 sessions during 3 weeks. Outcome was measured using was WOMAC questionnaire form (Likert Type. Measurements were done before and after treatment and one week after final treatment session. Friedman, Wilcoxon and Kruskal-Wallis tests were used for data analysis included.Results: Comparison of pain between before and after treatment showed significant differences in group 1 (P=0.01 and group 3 (P=0.04 but was not significant in group 2 (P=0.135. The difference of pain at follow up visit was significant only in group 1 in comparison to before treatment (P=0.007. Pain reduction between before and after treatment (P=0.504 and before treatment and follow up session (P=0.18, showed no significant differences, between 3 groups.Conclusion: This study showed that grade 1 mobilization can decrease the pain of knee OA. If exercise therapy is used combined with mobilization, the effect of treatment will continue at least for about one week.

  15. Multivariate Radiological-Based Models for the Prediction of Future Knee Pain: Data from the OAI

    Directory of Open Access Journals (Sweden)

    Jorge I. Galván-Tejada

    2015-01-01

    Full Text Available In this work, the potential of X-ray based multivariate prognostic models to predict the onset of chronic knee pain is presented. Using X-rays quantitative image assessments of joint-space-width (JSW and paired semiquantitative central X-ray scores from the Osteoarthritis Initiative (OAI, a case-control study is presented. The pain assessments of the right knee at the baseline and the 60-month visits were used to screen for case/control subjects. Scores were analyzed at the time of pain incidence (T-0, the year prior incidence (T-1, and two years before pain incidence (T-2. Multivariate models were created by a cross validated elastic-net regularized generalized linear models feature selection tool. Univariate differences between cases and controls were reported by AUC, C-statistics, and ODDs ratios. Univariate analysis indicated that the medial osteophytes were significantly more prevalent in cases than controls: C-stat 0.62, 0.62, and 0.61, at T-0, T-1, and T-2, respectively. The multivariate JSW models significantly predicted pain: AUC = 0.695, 0.623, and 0.620, at T-0, T-1, and T-2, respectively. Semiquantitative multivariate models predicted paint with C-stat = 0.671, 0.648, and 0.645 at T-0, T-1, and T-2, respectively. Multivariate models derived from plain X-ray radiography assessments may be used to predict subjects that are at risk of developing knee pain.

  16. Chronic pain after childhood groin hernia repair

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Kehlet, Henrik

    2007-01-01

    BACKGROUND: In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased...... pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown. METHODS: This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075). RESULTS: The response...... the age of 3 months (n = 122) did not report groin pain more often or with higher intensity than other patients did. CONCLUSIONS: Groin pain in adult patients operated on for a groin hernia in childhood is uncommon and usually mild and occurs in relation to physical activity. Operation before the age...

  17. Clinical Holistic Medicine: Chronic Pain in the Locomotor System

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Most pains from the locomotor system arise due to involuntary, chronic tensions in the muscles or other tissues. When the patient is motivated, the pain is easily cured in most of the cases by using the tools of consciousness-based medicine, primarily therapeutic touch, conversation, and coaching the patient in a positive philosophy of life. The pains are often caused by “blockages” that may cause problems other than just pain. Often it turns out that the blocked areas develop actual physical damage over time: a slipped disk in the back, articular degeneration, or osteoarthritis when the cartilage is affected, can often be explained in this way. Apparently, the exact areas where the blockage is situated cause cellular problems, disrupting cellular order. The holistic process theory of healing and the related quality of life theories state that return to the natural state of being is possible, whenever the person gets the resources needed for existential healing. The resources needed are “holding” in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for holistic healing are trust and the intention for the healing to take place. Case stories of holistic treatment of patients with chronic back pain, low back pain, muscle problems, knee pain, and symptoms of rheumatoid arthritis are discussed with exercises relevant for patients with these conditions in the holistic clinic.

  18. Chronic Pain in the Classroom: Teachers' Attributions about the Causes of Chronic Pain

    Science.gov (United States)

    Logan, Deirdre E.; Catanese, Sarah P.; Coakley, Rachael M.; Scharff, Lisa

    2007-01-01

    Background: School absenteeism and other impairments in school function are significant problems among children with chronic pain syndromes; yet, little is known about how chronic pain is perceived in the school setting. The purpose of this study was to examine teachers' attributions about the causes of chronic pain in adolescent students.…

  19. Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain.

    Science.gov (United States)

    Rio, E; Kidgell, D; Moseley, G L; Cook, J

    2016-09-01

    Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P < 0.001), but no differences were detected between AKP and controls (P = 0.47). CSE appears to be greater in PT than controls and other AKP. An improved understanding of the corticospinal responses in different sources of knee pain may direct better treatment approaches. PMID:26369282

  20. Knee pain and swelling: An atypical presentation of metastatic colon cancer to the patella

    Directory of Open Access Journals (Sweden)

    Bethany Gasagranda, DO

    2014-01-01

    Full Text Available Knee pain is a common reason for a patient to seek medical evaluation. Of the many causes of knee pain, malignancy is one of the least common. When malignancy is the etiology of the pain, it is usually due to a primary tumor of the osseous structures or soft tissues of the knee joint. Metastatic disease involving the knee joint is uncommon, with few cases reported in the literature. Of these reported cases, metastatic colon cancer is exceedingly rare. However, in a patient with new onset knee pain and the proper clinical history, metastatic disease should be considered as a potential explanation of symptoms. We report a case of knee pain and swelling due to metastatic colon cancer to the patella.

  1. Prevalence of knee pain and knee OA in southern Sweden and the proportion that seeks medical care

    DEFF Research Database (Denmark)

    Turkiewicz, Aleksandra; Gerhardsson de Verdier, Maria; Engström, Gunnar; Nilsson, Peter M; Mellström, Carl; Lohmander, Stefan; Englund, Martin

    2015-01-01

    OBJECTIVE: The aim of this study was to estimate the prevalence of frequent knee pain in radiographic, symptomatic and clinically defined knee OA in middle-aged and elderly patients and the proportion that seeks medical care. METHODS: In 2007 a random sample of 10 000 56- to 84-year-old residents...... knee OA or pain. RESULTS: The 10 000 subjects had a mean age of 70 years (s.d. 7.6), a mean BMI of 27.1 kg/m(2) and 62% were women. The prevalence of frequent knee pain was 25.1% (95% CI 24.1, 26.1), higher in women and similar across age groups. The prevalence of radiographic knee OA was 25.4% while...... 15.4% had either symptomatic or clinically defined knee OA. Of these, 68.9% consulted a physician for knee OA or pain during 2004-11. CONCLUSION: Fifteen per cent of middle-aged or elderly individuals have knee OA and symptoms. About one in three of those do not consult a physician. Inefficient care...

  2. Intravenous infusions in chronic pain management.

    Science.gov (United States)

    Kosharskyy, Boleslav; Almonte, Wilson; Shaparin, Naum; Pappagallo, Marco; Smith, Howard

    2013-01-01

    In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. PMID:23703410

  3. Nonspecificity of Chronic Soft Tissue Pain Syndromes

    Directory of Open Access Journals (Sweden)

    Eldon Tunks

    1997-01-01

    Full Text Available Persistent (or chronic pain occurs with a prevalence of about 10% in the adult population, and chronic soft tissue pain is especially problematic. Criteria for diagnosis of these soft tissue pain disorders appear to suffer from specificity problems, even though they appear to be sensitive in distinguishing normal from soft tissue pain sufferers. A few decades ago the term 'neuraesthenia' was used as a diagnosis in individuals who now would probably be diagnosed as suffering from fibromyalgia, chronic fatigue and anxiety disorders with fatigue. Soft tissue pain provokes skepticism, especially among third-party payers, and controversy among clinicians. Recent epidemiological studies have demonstrated sex differences in the prevalence of widespread pain and multiple tender points, which are distributed variably throughout the adult population and tend to be correlated with subjective symptoms. Although there is a tendency for these syndromes to persist, follow-up studies show that they tend to vary in extent and sometimes show remissions over longer follow-up, casting doubt about the distinctions between chronic diffuse pains and localized chronic soft tissue pains. Because both accidents and soft tissue pains are relatively prevalent problems, the possibility of chance coincidence of accident and chronic soft tissue pain in an individual creates the need to be cautious in attributing these syndromes to specific accidents in medicolegal situations. At the same time, the available evidence does not support a generally dismissive attitude towards these patients.

  4. Analysis of stem tip pain in revision total knee arthroplasty.

    Science.gov (United States)

    Kimpton, Christine I; Crocombe, Andrew David; Bradley, William Neil; Gavin Huw Owen, Brigstocke

    2013-06-01

    Stem tip pain following revision total knee arthroplasty is a significant cause of patient dissatisfaction, which in the presence of an aseptic well-fixed component has no widely accepted surgical solution. A definitive cause of stem tip pain remains elusive, however it has been suggested that high stress concentrations within the region of the stem tip may play a role. This paper reports a finite element study of a novel clinical technique where a plate is attached to the tibia within the region of the stem tip to reduce stem tip pain. The results demonstrate that the plate reduces stress concentrations in the bone at the stem tip of the implant. The magnitude of stress reduction is dependent upon plate location, material and attachment method. PMID:23523204

  5. Counseling Adult Clients Experiencing Chronic Pain

    Science.gov (United States)

    Burns, Stephanie T.

    2010-01-01

    Chronic pain affects 35% to 57% of the adult population in the United States and results in billions of dollars spent annually in direct health-care costs and lost productivity. Extensive research confirms the considerable role psychological factors play in the experience and expression of chronic pain. The author discusses implications for…

  6. The effects of music on chronic pain

    OpenAIRE

    Vaarala, Oula

    2014-01-01

    The purpose of this study was to find out what kind of music has been used to manage chronic pain, to identify in what kind of conditions music is listened to and to figure out the influence of music on different psychological or physiological variables among patients with chronic pain. The aim of the study was to gain information about the analgesic properties of music on chronic pain, in order to give nurses new ideas on how they can ease their patients’ pain. In this thesis a literatu...

  7. The Knee Clinical Assessment Study – CAS(K. A prospective study of knee pain and knee osteoarthritis in the general population

    Directory of Open Access Journals (Sweden)

    Hay Elaine

    2004-02-01

    Full Text Available Abstract Background Knee pain affects an estimated 25% of the adult population aged 50 years and over. Osteoarthritis is the most common diagnosis made in older adults consulting with knee pain in primary care. However, the relationship between this diagnosis and both the current disease-based definition of osteoarthritis and the regional pain syndrome of knee pain and disability is unclear. Expert consensus, based on current evidence, views the disease and the syndrome as distinct entities but the clinical usefulness of these two approaches to classifying knee pain in older adults has not been established. We plan to conduct a prospective, population-based, observational cohort study to investigate the relative merits of disease-based and regional pain syndrome-based approaches to classification and prognosis of knee pain in older adults. Methods All patients aged 50 years and over registered with three general practices in North Staffordshire will be invited to take part in a two-stage postal survey. Respondents to this survey phase who indicate that they have experienced knee pain within the previous 12 months will be invited to attend a research clinic for a detailed assessment. This will consist of clinical interview, physical examination, digital photography, plain x-rays, anthropometric measurement and a brief self-complete questionnaire. All consenting clinic attenders will be followed up by (i general practice medical record review, (ii repeat postal questionnaire at 18-months.

  8. Acute and chronic lumbosacral pain: Topical problems

    Directory of Open Access Journals (Sweden)

    Ekaterina Vladimirovna Podchufarova

    2012-03-01

    Full Text Available The paper gives an account of approaches to treating patients with acute and chronic back pain in the context of evidence-based medicine and current clinical guidelines. In the vast majority, acute back pain is a benign self-limiting condition (nonspecific musculoskeletal pain and most patients need additional instrumental examinations. An active approach to treatment is considered to be optimal. It is expedient to apply a more differential approach involving the refinement of mechanisms for development of the pain syndrome and the elaboration of treatment strategy in relation to the leading pathophysiological mechanism when examining the patients with chronic back pain.

  9. Review of occupational therapy for people with chronic pain.

    LENUS (Irish Health Repository)

    Robinson, Katie

    2011-04-01

    Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.

  10. Imaging Brain Mechanisms in Chronic Visceral Pain

    OpenAIRE

    Mayer, Emeran A.; Gupta, Arpana; Kilpatrick, Lisa A.; Hong, Jui-Yang

    2015-01-01

    Chronic visceral pain syndromes are important clinical problems with largely unmet medical needs. Based on the common overlap with other chronic disorders of visceral or somatic pain, mood and affect, and their responsiveness to centrally targeted treatments, an important role of central nervous system in their pathophysiology is likely. A growing number of brain imaging studies in irritable bowel syndrome, functional dyspepsia and bladder pain syndrome/interstitial cystitis has identified ab...

  11. Respiratory Dysfunction in Chronic Neck Pain

    OpenAIRE

    Dimitriadis, Zacharias

    2011-01-01

    Background: Patients with chronic neck pain have a number of factors that could constitute a predisposition for respiratory dysfunction. However, the existing evidence is limited and not well established, and many questions such as the association of neck pain deficits with respiratory function remain unanswered. Thus, the aim of this study was to investigate whether patients with chronic neck have accompanying respiratory dysfunction and which are the neck pain deficits which principally pre...

  12. [Chronic pain and regional anesthesia in children].

    Science.gov (United States)

    Dadure, C; Marec, P; Veyckemans, F; Beloeil, H

    2013-10-01

    Chronic pain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronic pain causes a physical, psychological, emotional, social, and financial burden for the child and his family. Practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of these techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents, but it often goes undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in phantom limb pain after limb amputation, but they remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of postdural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of the patient's blood, called a blood-patch. Finally, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety. PMID:23953871

  13. Intrathecal drug administration in chronic pain syndromes.

    Science.gov (United States)

    Ver Donck, Ann; Vranken, Jan H; Puylaert, Martine; Hayek, Salim; Mekhail, Nagy; Van Zundert, Jan

    2014-06-01

    Chronic pain may recur after initial response to strong opioids in both patients with cancer and patients without cancer or therapy may be complicated by intolerable side effects. When minimally invasive interventional pain management techniques also fail to provide satisfactory pain relief, continuous intrathecal analgesic administration may be considered. Only 3 products have been officially approved for long-term intrathecal administration: morphine, baclofen, and ziconotide. The efficacy of intrathecal ziconotide for the management of patients with severe chronic refractory noncancer pain was illustrated in 3 placebo-controlled trials. A randomized study showed this treatment option to be effective over a short follow-up period for patients with pain due to cancer or AIDS. The efficacy of intrathecal opioid administration for the management of chronic noncancer pain is mainly derived from prospective and retrospective noncontrolled trials. The effect of intrathecal morphine administration in patients with pain due to cancer was compared with oral or transdermal treatment in a randomized controlled trial, which found better pain control and fewer side effects with intrathecal opioids. Other evidence is derived from cohort studies. Side effects of chronic intrathecal therapy may either be technical (catheter or pump malfunction) or biological (infection). The most troublesome complication is, however, the possibility of granuloma formation at the catheter tip that may induce neurological damage. Given limited studies, the evidence for intrathecal drug administration in patients suffering from cancer-related pain is more compelling than that of chronic noncancer pain. PMID:24118774

  14. Chronic pain and the thoracic spine.

    Science.gov (United States)

    Louw, Adriaan; Schmidt, Stephen G

    2015-07-01

    In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2-4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7-10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7-10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed - hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in the

  15. The association between chronic pain and obesity

    Directory of Open Access Journals (Sweden)

    Okifuji A

    2015-07-01

    Full Text Available Akiko Okifuji, Bradford D HarePain Research and Management Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USAAbstract: Obesity and pain present serious public health concerns in our society. Evidence strongly suggests that comorbid obesity is common in chronic pain conditions, and pain complaints are common in obese individuals. In this paper, we review the association between obesity and pain in the general population as well as chronic pain patients. We also review the relationship between obesity and pain response to noxious stimulation in animals and humans. Based upon the existing research, we present several potential mechanisms that may link the two phenomena, including mechanical/structural factors, chemical mediators, depression, sleep, and lifestyle. We discuss the clinical implications of obesity and pain, focusing on the effect of weight loss, both surgical and noninvasive, on pain. The literature suggests that the two conditions are significant comorbidities, adversely impacting each other. The nature of the relationship however is not likely to be direct, but many interacting factors appear to contribute. Weight loss for obese pain patients appears to be an important aspect of overall pain rehabilitation, although more efforts are needed to determine strategies to maintain long-term benefit.Keywords: comorbidity, BMI, chronic pain, obesity, lifestyle, weight loss, headaches, fibromyalgia

  16. MR Imaging of Knee Osteoarthritis and Correlation of Findings with Reported Patient Pain

    Institute of Scientific and Technical Information of China (English)

    艾飞; 余铖; 张炜; John; N; Morelli; Kacher; D; 李小明

    2010-01-01

    To evaluate lesion detection of MRI in knee joint osteoarthritis in patients with symptoms of pain,the correlation between MRI findings and varying degrees of reported pain was assessed.Twenty-eight patients(31 knees) with osteoarthritis were recruited for this study.The degree of knee pain was assessed by VRS scores.The knees were evaluated by plain film radiograph utilizing Kellgren-Lawrence scores.Multiple MR sequences were performed on a 1.5T MR-system,including sagittal and coronal dual fast spin echo(...

  17. [The relevance of muscle strength--extensors of the knee on pain relief in elderly people with knee osteoarthritis].

    Science.gov (United States)

    Slivar, Senka Rendulić; Peri, Dusan; Jukić, Igor

    2011-01-01

    The main aim of this study was to evaluate muscle strength after short-term exercise program by elderly people with knee osteoarthritis that usually non exercising and to estimate if this change have influence on decrease of the pain. This study was longitudinal experiment that involved thirty participants aged 61-80 years with clinical signs and radiographic evidence of knee OA stage Kellgren II and III. They completed individual strengthening program knee muscle stabilisator and hydrotherapy in the pool during two weeks. Muscle strength and pain was estimated pre and post experimental time. The results are analysed by SPSS programme, version 15.0 for Windows. Values demonstrated decreasing degrees of the pain and increasing of muscle strength. The pain decreased 33% in advance, final pain oposite initial estimated 2.4 degrees smaller by VAS. Muscle strength for stronger leg was (initial/final) 93.10/106.33 kg/cm2 (t-test 3.584*, p coefficient (R2 of 0.014-0.081) and regression coefficient (B of 0.004-0.015) for stronger and weaker leg. Exercises produced significant increase in muscle strength and decrease in pain in OA of the knee. Hypothesis that increase of muscle quadriceps strength have influence on decrease of the pain in the knee is not confirmed. PMID:21751572

  18. Intra-Articular Hyaluronic Acid Injections Vs. Dextrose Prolotherapy in the Treatment of Osteoarthritic Knee Pain

    OpenAIRE

    S Nasiripour; F Hassanzadeh Kiyabi; M Nikooseresht; Razavi, S; F Madadi; SM Hashemi

    2012-01-01

    Background: Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. Methods: In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010...

  19. Chronic pain, substance abuse and addiction.

    Science.gov (United States)

    Compton, Peggy; Athanasos, Peter

    2003-09-01

    Health care professionals face numerous challenges in assessing and treating chronic pain patients with a substance abuse history. Societal perspectives on morality and criminality, imprecise addiction terminology, litigation fears, and genuine concern for a patient's relapse into or escalation of substance abuse result in unrelieved and under-relieved pain in precisely the population that--as increasing evidence indicates--is generally intolerant of pain. Before adequate pain relief can occur in chronic pain patients with current or past substance abuse issues, it is imperative that the clinician recognize addiction as a disease with known symptoms and treatments. Further, the clinician must realize the difference between true addiction and similar conditions, so the patient's condition can be monitored and regulated properly. Although clinicians are often reluctant to medicate with opioids, it is always best to err on the side of adequate pain relief. Withholding opioids from chronic pain patients in order to avoid the onset or relapse of addiction is contrary to the growing body of evidence and results only in unnecessary pain for the patient. Chronic pain in patients with a history of addictive disease can be treated successfully with opiate analgesia; it just requires caution and careful monitoring of medication use. If addiction is treated as a known risk when providing opioid analgesia to a recovering addict, its development can be minimized while pain relief is provided. PMID:14567207

  20. MRI EVALUATION OF PAINFUL KNEE: A STUDY AT KATURI TERTIARY REFERRAL CENTER

    Directory of Open Access Journals (Sweden)

    Bhimeswarao Pasupuleti

    2015-02-01

    Full Text Available INTRODUCTION: Normal knee joint functional activity is essential for day to day life . The number of patients with complaints of painful knee joint is quite significant and therefore magnetic resonance imaging (MRI of the knee is of great value in understanding and to diagnose the varied pathologies causing painful knee joint. The information obtained from conventional radiographs of the knee is limited, and by CT scans is limited to bone pathog l y with limited information about ligaments and synovium. AIMS AND OBJECTIVES : a To describe the MRI features in various types of traumatic and non - traumatic knee pain . b To identify the common lesions seen in the knee joint . METHODOLOGY : The study population included 100 patients who underwent MR imaging of the knee who presented with knee pain to the DEPARTMENT OF RADIOLOGY, KATURI MEDICALCOLLEGE referred by the clinician. STUDY PERIOD: Nov 2010 to Oct 2012 . STUDY DESIGN : Descriptive study . All the MRI scans of the knee in this study were performed using GE Signa Profile EXCITE MR machine with a 0.2 tesla field strength magnet in a closely coupled extremity coil. RESULTS AND DISCUSSION : The pathology of knee joint is broadly classified as traumatic and non - traumatic. Traumatic pathol o gy mainly included the ligament injuries and non - traumatic included arthritis, cysts and neoplastic lesions

  1. Runner's Knee

    Science.gov (United States)

    ... Without Pain? Jumper's Knee Knee Injuries Anterior Cruciate Ligament (ACL) Injuries Knee Injury: Caroline's Story Medial Collateral Ligament (MCL) Injuries Sports and Exercise Safety Repetitive Stress Injuries Bursitis ...

  2. Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability.

    Science.gov (United States)

    Jørgensen, U; Bak, K; Ekstrand, J; Scavenius, M

    2001-05-01

    We performed combined internal and external anterior cruciate ligament (ACL) reconstruction with the iliotibial band autograft in 169 consecutive patients with chronic ACL insufficiency who were followed up for 24-61 months. Of these, 155 (91%) agreed to an additional independent observer follow-up after 24-92 months. Eight patients (5%) had sustained a rerupture/elongation of the graft and were operated on again; nine (6%) had sustained a tear of the contralateral ACL. Knee function and activity increased after the reconstruction. Lysholm scores improved from median 81 preoperatively to 99 at follow-up and Tegner scores from median 4 to 7. At follow-up 97 (71%) were active at the same level as prior to injury. In 17 of the 40 patients (12%) dropping to a lower activity level this was due to knee problems. The side-to-side difference in anterior-posterior knee laxity was more than 3 mm in 18 knees (13%) and more than 5 mm in 3 knees (2%). Including eight reruptures, this results in a "stability" failure rate of 8.8%. The overall IKCD rating showed normal knee function in 88 (73%) and nearly normal knee function in 30 (25%). Anterior knee pain was present in 14 (10%) of the patients at follow-up. Patients with isolated ACL injury had higher Lysholm scores and Tegner scores than patients with associated injuries. No clinical signs of varus knee development were seen. Of the 155 patients 94% would have the procedure repeated if necessary with the knowledge that they have today. The combined internal and external iliotibial band procedure can restore knee stability and function in the majority of chronic ACL-insufficient knees. PMID:11420786

  3. Auricular Acupressure for Managing Postoperative Pain and Knee Motion in Patients with Total Knee Replacement: A Randomized Sham Control Study

    Directory of Open Access Journals (Sweden)

    Ling-hua Chang

    2012-01-01

    Full Text Available Background. Postoperative pain management remains a significant challenge for all healthcare providers. A randomized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement (TKR. Method. Sixty-two patients who had undergone a TKR were randomly assigned to the acupressure group and the sham control group. The intervention was delivered three times a day for 3 days. A visual analog scale (VAS and the Short-Form McGill Pain Questionnaire were used to assess pain intensity. Pain medication consumption was recorded, and the knee motion was measured using a goniometer. Results. The patients experienced a moderately severe level of pain postoperatively (VAS 58.66 ± 20.35 while being on the routine PCA. No differences were found in pain scores between the groups at all points. However, analgesic drug usage in the acupressure group patients was significantly lower than in the sham control group (<0.05, controlling for BMI, age, and pain score. On the 3rd day after surgery, the passive knee motion in the acupressure group patients was significantly better than in the sham control group patients (<0.05, controlling for BMI. Conclusion. The application of auricular acupressure at specific therapeutic points significantly reduces the opioid analgesia requirement and improves the knee motion in patients with TKR.

  4. Effect of Mild and Severe Unilateral Knee Joint Pain on Gait in Elderly Females

    OpenAIRE

    Hiroki Sugiura; Shinichi Demura

    2014-01-01

    Gait change in the elderly may be a strategy to maintain postural stability while walking. However, gait laterality is accompanied by back pain or an increased risk of a fall. This study aimed to examine group-related differences and gait laterality in elderly females with mild or severe unilateral knee pain. Seventy-five elderly females (66–87 years old) were included, which comprised the following groups: 47 with mild unilateral knee pain and 28 with severe unilateral knee pain. They comple...

  5. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function☆

    Science.gov (United States)

    Almeida, Gabriel Peixoto Leão; Silva, Ana Paula de Moura Campos Carvalho e; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2016-01-01

    Objective To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). Methods This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. Results The q-angle did not present any significant correlation with severity of knee pain (r = −0.29; p = 0.19), functional capacity (r = −0.08; p = 0.72), FPPA (r = −0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = −0.21; p = 0.35). Conclusion The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS. PMID:27069887

  6. Cognitive Variables Implicated In Chronic Pain

    Directory of Open Access Journals (Sweden)

    Moretti, Luciana Sofía

    2010-12-01

    Full Text Available Since the creation of gate control theory, the importance of psychological variables in chronic pain has emerged. Thus, the cognitive variables are emphasized in between behaviors, emotions and social factors for the explanation of chronic pain. Considering the gate control theory, cognitive variables modulate the other two dimensions of the chronic pain experience: the motivational-afective dimension and the sensory-discriminative dimension (Camacho Martel & Anarte Ortiz, 2001; Gatchel, Peng, Peters, Fuchs & Turk, 2007. The aim of this work is to review the main cognitive variables implicated in the chronic pain experience. Moreover, empirical evidence that support the importance of these variables is presented. Furthermore, it is discussed the clinical implications and the importance of this area in the local context.

  7. Predictors of Postoperative Movement and Resting Pain following Total Knee Replacement

    OpenAIRE

    Rakel, Barbara A.; Blodgett, Nicole Petsas; Zimmerman, M. Bridget; Logsden-Sackett, Nyla; Clark, Charles; Noiseux, Nicolas; Callaghan, John; Herr, Keela; Geasland, Katharine; Yang, Xiaoyan; Sluka, Kathleen A

    2012-01-01

    This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery and that predictors would be similar for resting pain. Demographics, analgesic intake, an...

  8. Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period

    OpenAIRE

    Harato, Kengo; YOSHIDA, Hiroki

    2015-01-01

    Background Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. Methods A total of 100 pa...

  9. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults

    OpenAIRE

    Jordan, JL; Holden, MA; Mason, EE; Foster, NE

    2010-01-01

    BACKGROUND: Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness. OBJECTIVES: To assess the effects of interventions to improve adherence to exercise and physical activity for peopl...

  10. Driving Ability in Patients with Severe Chronic Low Back or Osteoarthritis Knee Pain on Stable Treatment with Tapentadol Prolonged Release: A Multicenter, Open-label, Phase 3b Trial

    OpenAIRE

    Sabatowski, Rainer; Scharnagel, Rüdiger; Gyllensvärd, Anne; Steigerwald, Ilona

    2014-01-01

    Introduction Strong centrally acting analgesics, including tapentadol prolonged release (PR), have demonstrated efficacy for the management of non-malignant, chronic pain. Maintaining patient independence, including the ability to drive safely, is a key goal of long-term analgesic therapy. This multicenter, open-label, phase 3b trial evaluated the effects of tapentadol PR on driving ability. Methods This study included patients who had completed previous tapentadol PR trials for severe low ba...

  11. Chronic pain: Model of psychosomatic disorder (review

    Directory of Open Access Journals (Sweden)

    Chernus N.P.

    2011-12-01

    Full Text Available The article presents a detailed review on epidemiology, pathogenesis and interrelation of serotonin neuromedia-tor metabolism in the central nervous system in state of chronic pain and depression. It has been demonstrated that neurophysiological conditions serve as psychological defense of an individual. That mechanism has been proved to «transform» serious emotions onto the inner level (body and it assists in the development of psychosomatic disorders — chronic pain syndrome

  12. Prevention of chronic pain after whiplash

    OpenAIRE

    Ferrari, R.

    2002-01-01

    The acute whiplash injury is a significant health burden for patients and the healthcare system. Traditional approaches to treatment fail to resolve this ever growing medicolegal and social problem. A new biopsychosocial model of whiplash disorder encourages new ways of treating and preventing of the chronic disability. This biopsychosocial model takes into account the mechanism by which acute pain becomes chronic pain, and how this can be prevented. Specific education and treatments encourag...

  13. Imaging studies in chronic low back pain

    International Nuclear Information System (INIS)

    Imaging brings to difficult problems in chronic low back pain incomplete data showing that it will need a lot of time to find therapeutic solutions. Some comparisons are made between tomodensitometry, nuclear magnetic imaging, the disco-scanner, these technologies allow to find small lesions but the problem is complete when it is not possible to find anything with persistent pains. 125 refs

  14. Neuroimaging revolutionizes therapeutic approaches to chronic pain

    Directory of Open Access Journals (Sweden)

    Borsook David

    2007-09-01

    Full Text Available Abstract An understanding of how the brain changes in chronic pain or responds to pharmacological or other therapeutic interventions has been significantly changed as a result of developments in neuroimaging of the CNS. These developments have occurred in 3 domains : (1 Anatomical Imaging which has demonstrated changes in brain volume in chronic pain; (2 Functional Imaging (fMRI that has demonstrated an altered state in the brain in chronic pain conditions including back pain, neuropathic pain, and complex regional pain syndromes. In addition the response of the brain to drugs has provided new insights into how these may modify normal and abnormal circuits (phMRI or pharmacological MRI; (3 Chemical Imaging (Magnetic Resonance Spectroscopy or MRS has helped our understanding of measures of chemical changes in chronic pain. Taken together these three domains have already changed the way in which we think of pain – it should now be considered an altered brain state in which there may be altered functional connections or systems and a state that has components of degenerative aspects of the CNS.

  15. Origin of chronic right upper quadrant pain.

    OpenAIRE

    Kingham, J G; Dawson, A. M.

    1985-01-01

    We have studied 22 consecutive patients referred for investigation of severe chronic right upper quadrant pain. The majority were women whose symptoms had been present for many years. All had undergone repeated investigations of the pancreatico-biliary, gastro-intestinal, urinary, and even gynaecological systems without a satisfactory diagnosis. Most had undergone at least one abdominal operation in an unsuccessful attempt to cure their pain. In 21 of 22 patients the customary pain was comple...

  16. [Hypnosis for chronic pain of children].

    Science.gov (United States)

    Célestin-Lhopiteau, Isabelle

    2014-01-01

    A child or adolescent can suffer from chronic pain. Whatever the causes, it can trap the child in a specific process whereby they focus on the pain, fearing that it will appear and experiencing anxiety. Hypno-analgesia and hypnotherapy enable them to escape this process and find within themselves the capacity to face up to the pain. Moreover, these techniques offer them an autonomy which they can use in all areas of their life. PMID:24779171

  17. Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review

    OpenAIRE

    Phyomaung, Pyae P; Dubowitz, Julia; Cicuttini, Flavia M; Fernando, Sanduni; Wluka, Anita E.; Raaijmaakers, Paul; Wang, Yuanyuan; Urquhart, Donna M

    2014-01-01

    Background While it is recognized that psychosocial factors are important in the development and progression of musculoskeletal pain and disability, no systematic review has specifically focused on examining the relationship between psychosocial factors and knee pain. We aimed to systematically review the evidence to determine whether psychosocial factors, specifically depression, anxiety and poor mental health, are risk factors for knee pain. Methods Electronic searches of MEDLINE, EMBASE an...

  18. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Huang, Ambrose J.; Chang, Connie Y.; Smith, Maximilian; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Gill, Thomas J. [Boston Sports Medicine and Research Institute, Boston, MA (United States)

    2014-12-20

    To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome. (orig.)

  19. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis

    International Nuclear Information System (INIS)

    To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome. (orig.)

  20. Effects of mild and severe knee joint pain on various activities of daily living in the female elderly

    OpenAIRE

    Sugiura, Hiroki; Demura, Shinichi

    2013-01-01

    This study aimed to examine the differences in the ability to perform various activities of daily living (ADLs) among groups with various knee problems. The participants consisted of 328 elderly females (age 60-94; mean age 76.1 years; standard deviation 6.2). The subjects were classified into three groups: those without knee pain, those with mild knee pain, and those with severe knee pain. ADLs with markedly higher (>97%) and lower (

  1. Effects of Mild and Severe Knee Joint Pain on Various Activities of Daily Living in the Female Elderly

    OpenAIRE

    Hiroki Sugiura; Shinichi Demura

    2013-01-01

    This study aimed to examine the differences in the ability to perform various activities of daily living (ADLs) among groups with various knee problems. The participants consisted of 328 elderly females (age 60–94; mean age 76.1 years; standard deviation 6.2). The subjects were classified into three groups: those without knee pain, those with mild knee pain, and those with severe knee pain. ADLs with markedly higher (>97%) and lower (

  2. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions

    OpenAIRE

    Staud, Roland

    2012-01-01

    The intensity of acute and chronic pain depends on interactions between peripheral impulse input and CNS pain mechanisms, including facilitation and inhibition. Whereas tonic pain inhibition is a characteristic of most pain-free individuals, pain facilitation can be detected in many chronic pain patients. The capability to inhibit pain is normally distributed along a wide continuum in the general population and can be used to predict chronic pain. Accumulating evidence suggests that endogenou...

  3. TMD and chronic pain: A current view

    Directory of Open Access Journals (Sweden)

    Bruno D'Aurea Furquim

    2015-02-01

    Full Text Available This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs. While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-α and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation.

  4. Spiritual Coping with Chronic Pain

    OpenAIRE

    Henderson, Kevin

    2008-01-01

    Intro The object of this study was to investigate the relationship between an individual’s spiritual beliefs and how that affected their pain in those with arthritis. It focused mainly on the coping strategies they chose and how their personality influenced this. Method 113 people with various forms of arthritis completed a questionnaire which included scales measuring spiritual perspective (SPS), pain levels and pain interference (BPI), personality factors (Big 5 Domain), coping st...

  5. Neurophysiology of pain and hypnosis for chronic pain.

    Science.gov (United States)

    Dillworth, Tiara; Mendoza, M Elena; Jensen, Mark P

    2012-03-01

    In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available. PMID:24073099

  6. Does knee replacement surgery lead to chronic limb ischemia?

    Science.gov (United States)

    Dawson, Alan G; Bachoo, Paul; Sutherland, Alasdair G

    2010-12-01

    Total knee replacement (TKR) may be associated with chronic limb ischemia (CLI) due to arterial injury intraoperatively. The aim of this study was to determine the incidence of CLI after TKR surgery. Patients who received a unilateral TKR in 2003-2004 were identified from our database. Patients with diabetes mellitus and preexisting peripheral arterial disease were excluded. Patient assessment was by collection of demographic details, completion of the Oxford Knee Score, Short Form-12 Health Survey, and King's College Hospital's Vascular Quality of Life Questionnaire, and measurement of the ankle brachial pressure index (ABPI). Of the 209 eligible patients, 86 (41%) participated (median age, 73 years; 50% male). Five (5.8%) patients had a reduced ABPI compared with population norms of 4.6 to 7%. Patients with reduced ABPI measurements had higher Oxford Knee Scores, but no relationships between other variables were demonstrated. TKR surgery does not appear to increase the risk of CLI. PMID:21446628

  7. Anxiety and Related Factors in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Gordon JG Asmundson

    2002-01-01

    Full Text Available Clinicians often encounter patients who present with both chronic pain and elevated levels of anxiety. In some cases, the source of the anxiety is vague and diffuse. For others, there is an identifiable precipitating object, event or situation. For example, some patients with chronic pain are able to attribute their anxiety to the possibility of not regaining lost functional abilities, financial difficulties, feelings of social inadequacy, or uncertainty about the meaning and consequences of pain. The association between chronic pain and anxiety may not be particularly surprising when one considers that, in the acute phase, both pain and target-oriented anxiety (or fear motivate actions that serve to minimize the threat and maximize the likelihood of successful escape. As well, their neurobiology, while distinct, interacts in the reticular system (1. Evaluations of the association between chronic pain and fear-relevant constructs were initiated in the 1960s and 1970s (2,3. It has only been of late, however, that theorists and researchers have begun to focus their attention on delineating the precise nature of the relationship and its specific implications for the assessment and management of pain.

  8. Hypnosis treatment for chronic low back pain.

    Science.gov (United States)

    Tan, Gabriel; Fukui, Tenley; Jensen, Mark P; Thornby, John; Waldman, Karen L

    2010-01-01

    Chronic low back pain (CLBP) is a significant healthcare problem, and many individuals with CLBP remain unresponsive to available interventions. Previous research suggests that hypnosis is effective for many chronic pain conditions; however, data to support its efficacy for CLBP are outdated and have been limited primarily to case studies. This pilot study indicated that a brief, 4-session standardized self-hypnosis protocol, combined with psycho-education, significantly and substantially reduced pain intensity and pain interference. Significant session-to-session improvements were also noted on pain ratings and mood states; however, follow-up data suggest that these benefits may not have been maintained across time in this sample. These findings need to be replicated and confirmed in a larger clinical trial, which could also assess the long-term effects of this treatment. PMID:20183738

  9. Association of exercise therapy and reduction of pain sensitivity in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Klokker, Louise; Graven-Nielsen, Thomas;

    2014-01-01

    , participants were assigned to 12 weeks of supervised exercise therapy (ET; 36 sessions) or a no attention control group (CG). Pressure-pain sensitivity was assessed by cuff pressure algometry on the calf of the most symptomatic leg. The coprimary outcomes were pressure-pain thresholds (PPTs) and cumulated......OBJECTIVE: Exercise has beneficial effects on pain in knee osteoarthritis (OA), yet the underlying mechanisms are unclear. The purpose of this study was to investigate the effects of exercise on pressure-pain sensitivity in patients with knee OA. METHODS: In a randomized controlled trial...... visual analog scale pain scores during constant pressure for 6 minutes at 125% of the PPT as a measure of temporal summation (TS) of pressure-pain. Secondary outcomes included self-reported pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Analyses were based on the "per...

  10. Painful locking of the knee due to bucket handle tear of mediopatellar plica

    Institute of Scientific and Technical Information of China (English)

    HE Rui; YANG Liu; GUO Lin

    2011-01-01

    A case of swelling and anterior painful knee due to tear of mediopatellar plica is reported. The patient also felt clunk of the patellofemoral joint and knee locking. Under arthroscopic examination, a thick and fibrous plica was found medial to patellar, and a bucket tear along the plica fi.om medial patellar retinaculum to infrapatellar fat pad. Polarized microscopic examination showed collagen fiber fragment and loss of light reflecting property. Neuroimmunohistology suggested up-regulation of synovial plica innervation in the area around the crack. This may be related to the pain. The bucket tear of mediopatellar plicacaused pain and lock of knee are more common than previously reported.

  11. Knee pain during strength training shortly following fast-track total knee arthroplasty: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Thomas Bandholm

    Full Text Available Loading and contraction failure (muscular exhaustion are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA. It is unknown how these exercise variables influence knee pain after TKA.To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA.Cross-sectional study.Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013.Seventeen patients, no more than 3 weeks after their TKA.In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM, and ended with 1 single set to contraction failure (14 RM load. The individual loadings (kilograms were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10.Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006, and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001. Resting knee pain 60 seconds after the final repetition (2.7±2.4 points was not different from that recorded before strength training (2.7±1.8 points, P = 0.88.Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived.ClinicalTrials.gov NCT01729520.

  12. Biopsychosocial model of chronic recurrent pain

    Directory of Open Access Journals (Sweden)

    Zlatka Rakovec-Felser

    2009-07-01

    Full Text Available Pain is not merely a symptom of disease but a complex independent phenomenon where psychological factors are always present (Sternberg, 1973. Especially by chronic, recurrent pain it's more constructive to think of chronic pain as a syndrome that evolves over time, involving a complex interaction of physiological/organic, psychological, and behavioural processes. Study of chronic recurrent functional pain covers tension form of headache. 50 suffering persons were accidentally chosen among those who had been seeking medical help over more than year ago. We tested their pain intensity and duration, extent of subjective experience of accommodation efforts, temperament characteristics, coping strategies, personal traits, the role of pain in intra- and interpersonal communication. At the end we compared this group with control group (without any manifest physical disorders and with analyse of variance (MANOVA. The typical person who suffers and expects medical help is mostly a woman, married, has elementary or secondary education, is about 40. Pain, seems to appear in the phase of stress-induced psychophysical fatigue, by persons with lower constitutional resistance to different influences, greater irritability and number of physiologic correlates of emotional tensions. Because of their ineffective style of coping, it seems they quickly exhausted their adaptation potential too. Through their higher level of social–field dependence, reactions of other persons (doctor, spouse could be important factors of reinforcement and social learning processes. In managing of chronic pain, especially such as tension headache is, it's very important to involve bio-psychosocial model of pain and integrative model of treatment. Intra- and inter-subjective psychological functions of pain must be recognised as soon as possible.

  13. Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey

    OpenAIRE

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-01-01

    Background Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pa...

  14. Opioid Therapy for Chronic Nonmalignant Pain

    Directory of Open Access Journals (Sweden)

    Russell K Portenoy

    1996-01-01

    Full Text Available Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

  15. Mechanism for chronic pain generation

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopic distribution of proteins related to Na+, K+ and Ca2+ channels as well as of receptors on both membranes of injured axon and its cell body becomes a main pacemaker from which spontaneous ectopic afferent of primary sensatory neurons and crosstalk between neurons occur. Abnormal ectopic afferent activities lead to disorders of the sensation, such as hyperalgesia, allodynia, spontaneous pain and paraesthesia. Administration of some ion channel agents and/or α2-adrenergic blockers has shown efficiency in preventing neuropathic pain development and in relieving neuropathic pain.

  16. ACUPUNCTURE TREATMENT OF CHRONIC STRAIN OF THE MEDIAL ACCESSARY LIGAMENT OF THE KNEE-JOINT WITH RELAXING NEEDLING

    Institute of Scientific and Technical Information of China (English)

    WEN Jinzhi

    2002-01-01

    @@ Chronic strain of the medial accessory liga ment of the knee-joint is a common disease in clinic and constitutes about 40 % of the soft tis sue injury of the knee-joint. The patient feels pain in the topical focus and has difficulty in walking. In the treatment of this disease, medication possesses a poor effect, acupuncture therapy works but the therapeutic effect is not so ideal. In recent 10 years, the author of the present paper treats it with self-created relaxing needling and has achieved satisfied results. Following is the report.

  17. Association between chronic pain and the sperm motion characteristics

    DEFF Research Database (Denmark)

    Dardmeh, Fereshteh; Alipour, Hiva; Nielsen, Hans Ingolf;

    2015-01-01

    Sex hormones play an important role in pain in many chronic pain conditions. Relationship between chronic pain and sperm quality has not been investigated thoroughly and may provide an insight to better understanding, management and treatment of cases where chronic pain and male sub-fertility co-...

  18. Chronic Pain: The Impact on Academic, Social, and Emotional Functioning

    Science.gov (United States)

    Parkins, Jason M.; Gfroerer, Susan D.

    2009-01-01

    Chronic pain is persistent and recurrent pain that tends to fluctuate in severity, quality, regularity, and predictability. It can occur in a single or multiple body regions or organ systems. Some of the most frequently reported types of chronic pain include headaches, recurrent abdominal pain (RAP), and musculoskeletal pain. In contrast to acute…

  19. Prevalence of chronic low back pain: systematic review

    OpenAIRE

    Rodrigo Dalke Meucci; Anaclaudia Gastal Fassa; Neice Muller Xavier Faria

    2015-01-01

    OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pai...

  20. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

    2004-01-01

    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chro

  1. [Behavioral aspects of chronic pain syndromes].

    Science.gov (United States)

    Oliveira, J T

    2000-06-01

    The knowledge of biological pain mechanisms are not sufficient for the understanding of patients with chronic pain syndromes such as low back, cervicobrachial and muscle pain. Psychological and psychosocial aspects play important roles in the setting and perpetuation of symptoms. Mood and anxiety disorders, secondary gains such as early retirement and financial compensations, must all be acknowledged by the physician as possible contributors to the symptoms. Abnormal illness behavior may better characterize patients with chronic pain syndromes. Behavior observation, which is akin to medical practice, is therefore a powerful tool in the diagnosis and management of these syndromes. Physicians ought be very careful in not reinforcing the patients already strong organic convictions regarding their symptoms, avoiding making decisions based on patients complaints and alleged disabilities, and assigning poorly defined and disputable diagnosis labels. Society needs also to refrain from policies that encourage abnormal illness behaviors. PMID:10849642

  2. Effects of Mindfulness Meditation on Chronic Pain

    DEFF Research Database (Denmark)

    la Cour, Peter; Petersen, Marian

    2015-01-01

    OBJECTIVE: This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain. DESIGN: A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR...... of the 109 randomized patients completed the mindfulness program, while 47 remained in the control group. Data were compared at three time points: at baseline, after completion of the course/waiting period, and at the 6-month follow-up. RESULTS: Significant effect (Cohen's d = 0.39) was found on the......]) or to a wait list control. METHODS: Pain, physical function, mental function, pain acceptance, and health-related quality of life were measured. The SF36 vitality scale was chosen as the primary outcome measure; the primary end point was after completing the MBSR course. Within a 2.5-year period, 43...

  3. Knee and hip radiographic osteoarthritis features: differences on pain, function and quality of life.

    Science.gov (United States)

    Pereira, Duarte; Severo, Milton; Santos, Rui A; Barros, Henrique; Branco, Jaime; Lucas, Raquel; Costa, Lúcia; Ramos, Elisabete

    2016-06-01

    The association between radiographic osteoarthritis (OA) and symptoms is inconsistent and variable according to each joint. The purpose of this study is to understand the relation between radiographic OA features, pain, function and quality of life, in knee and hip joints. A cross-sectional study was performed using information from EPIPorto cohort. Data was obtained by interview using a structured questionnaire on social, demographic, behavioural and clinical data. Pain was assessed using a pain frequency score (regarding ever having knee pain, pain in the last year, in the last 6 months and in the last month). Quality of life was evaluated with Short Form 36 (SF-36) and function disability with the Lequesne knee and hip indexes. Radiographic knees and hips were classified using the Kellgren-Lawrence score (KL 0-4). Linear regression and proportional odds ratios estimated the association between radiographic features, pain, function and quality of life. In our study, symptomatic OA (KL ≥ 2 plus joint pain) was 26.0 % in knee and 7.0 % hip joints. In knee, the increase on radiographic score increased the odds to have a higher pain frequency score [1.58 (95 % CI = 1.27, 1.97)] and was associated [adjusted β (95 % CI)] with worst general health [-3.05 (-5.00, -1.09)], physical function [-4.92 (-7.03, -2.80)], role-physical [-4.10 (-8.08, -0.11)], bodily pain [-2.96 (-5.45, -0.48)] and limitations in activities of daily living [0.48 (0.08, 0.89)]. Regarding hip, no significant associations were found between the severity of radiographic lesions and these measures. Radiographic lesions in knee were associated with higher complaints, as far as pain and functional limitations are concerned, compared with hip. PMID:26445941

  4. Surgical treatment of pain in chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Stefanović Dejan

    2006-01-01

    Full Text Available INTRODUCTION: The principal indication for surgical intervention in chronic pancreatitis is intractable pain. Depending upon the presence of dilated pancreatic ductal system, pancreatic duct drainage procedures and different kinds of pancreatic resections are applied. OBJECTIVE: The objective of the study was to show the most appropriate procedure to gain the most possible benefits in dependence of type of pathohistological process in chronic pancreatitis. METHOD: Our study included 58 patients with intractable pain caused by chronic pancreatitis of alcoholic genesis. The first group consisted of 30 patients with dilated pancreatic ductal system more than 10 mm. The second group involved 28 patients without dilated pancreatic ductal system. Pain relief, weight gain and glucose tolerance were monitored. RESULTS: All patients of Group I (30 underwent latero-lateral pancreaticojejunal - Puestow operation. 80% of patients had no pain after 6 month, 13.6% had rare pain and 2 patients, i.e. 6.4%, who continued to consume alcohol, had strong pain. Group II consisting of 28 patients was without dilated pancreatic ductal system. This group was subjected to various types of pancreatic resections. Whipple procedure (W was done in 6 patients, pylorus preserving Whipple (PPW in 7 cases, and duodenum preserving cephalic pancreatectomy (DPCP was performed in 15 patients. Generally, 89.2% of patients had no pain 6 month after the operation. An average weight gain was 1.9 kg in W group, 2.8 kg in PPW group and 4.1 kg in DPCP group. Insulin-dependent diabetes was recorded in 66.6% in W group, 57.1% in PPW group and 0% in DPCP group. CONCLUSION: According to our opinion, DPCP may be considered the procedure of choice for surgical treatment of pain in chronic pancreatitis in patients without dilatation of pancreas ductal system because of no serious postoperative metabolic consequences.

  5. Ketamine for chronic pain: risks and benefits

    OpenAIRE

    Niesters, Marieke; Martini, Christian; Dahan, Albert

    2014-01-01

    The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during ...

  6. Auricular Acupressure for Managing Postoperative Pain and Knee Motion in Patients with Total Knee Replacement: A Randomized Sham Control Study

    OpenAIRE

    Ling-hua Chang; Chung-Hua Hsu; Gwo-Ping Jong; Shungtai Ho; Shiow-luan Tsay; Kuan-Chia Lin

    2012-01-01

    Background. Postoperative pain management remains a significant challenge for all healthcare providers. A randomized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement (TKR). Method. Sixty-two patients who had undergone a TKR were randomly assigned to the acupressure group and the sham control group. The intervention was delivered three times a...

  7. The relationship between pain and dynamic knee joint loading in knee osteoarthritis varies with radiographic disease severity. A cross sectional study

    DEFF Research Database (Denmark)

    Henriksen, Marius; Aaboe, Jens; Bliddal, Henning

    2012-01-01

    OBJECTIVE: In a cross sectional study, we investigated the relationships between knee pain and mechanical loading across the knee, as indicated by the external knee adduction moment (KAM) during walking in patients with symptomatic knee OA who were distinguished by different radiographic disease...... severities. METHODS: Data from 137 symptomatic medial knee OA patients were used. Based on Kellgren/Lawrence (K/L) grading, the patients were divided into radiographically less severe (K/L=2, n=68) or severe (K/L>2, n=69) medial knee OA. Overall knee pain was rated on a 10cm visual analog scale, and peak KAM...... may have a large potential interest for strategies of treatment in knee OA....

  8. MRI findings in renal transplant recipients with hip and knee pain

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, Fuldem Yildirim [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: fuldemyildirim@yahoo.com; Basaran, Ceyla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: ceylab@baskent-ank.edu.tr; Ulu, Esra Meltem Kayahan [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: emkayahanulu@yahoo.com; Uyusur, Arzu [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: arzuuyusur@yahoo.com; Tarhan, Nefise Cagla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: caglat@baskent-ank.edu.tr; Muhtesem Agildere, A. [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: amuhtesem@superonline.com

    2009-09-15

    Purpose: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. Materials and methods: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. Results: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. Conclusion: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be Second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

  9. MRI findings in renal transplant recipients with hip and knee pain

    International Nuclear Information System (INIS)

    Purpose: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. Materials and methods: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. Results: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. Conclusion: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be Second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

  10. Medication Treatment Efficacy and Chronic Orofacial Pain.

    Science.gov (United States)

    Clark, Glenn T; Padilla, Mariela; Dionne, Raymond

    2016-08-01

    Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful. PMID:27475515

  11. Effectiveness and Tolerability of Tapentadol Prolonged Release Compared With Prior Opioid Therapy for the Management of Severe, Chronic Osteoarthritis Pain

    OpenAIRE

    Steigerwald, Ilona; Schenk, Michael; Lahne, Uwe; Gebuhr, Peter; Falke, Dietmar; Hoggart, Barbara

    2013-01-01

    Background Tapentadol prolonged release (PR; 100–250 mg twice daily) has been efficacious and well tolerated for managing moderate-to-severe, chronic osteoarthritis hip or knee pain in phase 3 studies with washout of previous analgesic treatment. Objective The objective of this study was to evaluate the effectiveness and tolerability of tapentadol PR (50–250 mg twice daily) after direct rotation from World Health Organization (WHO) step III opioids in patients with severe osteoarthritis knee ...

  12. Exercise in children with joint hypermobility syndrome and knee pain: a randomised controlled trial comparing exercise into hypermobile versus neutral knee extension

    OpenAIRE

    Pacey, Verity; Tofts, Louise; Adams, Roger D; Munns, Craig F; Nicholson, Leslie L

    2013-01-01

    Background Knee pain in children with Joint Hypermobility Syndrome (JHS) is traditionally managed with exercise, however the supporting evidence for this is scarce. No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes. This study aimed to (i) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is effective in reducing knee pain in children with JHS compared to no treatment, and (ii) wh...

  13. Circadian Rest/Activity Rhythms in Knee Osteoarthritis with Insomnia: A Study of Osteoarthritis Patients and Pain-Free Controls with Insomnia or Normal Sleep

    OpenAIRE

    Spira, Adam P.; Runko, Virginia T.; Finan, Patrick H.; Kaufmann, Christopher N.; Bounds, Sara C; Liu, Lianqi; Buenaver, Luis F.; McCauley, Lea M.; Ancoli-Israel, Sonia; Smith, Michael T

    2014-01-01

    Aberrant circadian rest/activity rhythms (RARs) may promote poor aging-related health outcomes. Osteoarthritis and chronic insomnia are common age-related conditions, but the circadian RARs of each group have not been well characterized or compared. We evaluated actigraphic RARs in individuals with: (1) knee osteoarthritis (KOA) only; (2) chronic insomnia only; (3) KOA + insomnia; and (4) pain-free good sleepers. Compared to participants with KOA only, those with KOA + insomnia had less robus...

  14. Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee.

    Science.gov (United States)

    Courtney, Carol A; Steffen, Alana D; Fernández-de-Las-Pñas, César; Kim, John; Chmell, Samuel J

    2016-03-01

    Study Design An experimental laboratory study with a repeated-measures crossover design. Background Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia. Objective To examine the effect of joint mobilization on impaired CPM. Methods An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing. Results Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention. Conclusion Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis. J Orthop Sports Phys Ther 2016

  15. Calcific tendinitis of biceps femoris: an unusual site and cause for lateral knee pain.

    Science.gov (United States)

    Chan, Warwick; Chase, Helen Emily; Cahir, John G; Walton, Neil Patrick

    2016-01-01

    A 37-year-old man presented to the acute knee and sports medicine clinic with atraumatic lateral knee pain. He had point tenderness over the lateral aspect of his knee which had not settled with anti-inflammatory medications. Imaging revealed a large opaque lesion lateral to the knee and although there was no clear mechanism, injury to the posterolateral corner was considered. An MRI subsequently revealed a rare case of calcific tendinitis to the biceps femoris tendon insertion. This condition was self-limiting and did not require interventions such as steroid injections. This is the first reported case of calcific tendinitis of biceps femoris as a cause of acute knee pain. PMID:27473032

  16. Biceps tenodesis with Clancy method for chronic posterolateral rotary instability of the knee

    Directory of Open Access Journals (Sweden)

    Motamedi M.

    2008-03-01

    Full Text Available Background: Posterolateral rotatory instability is one of the most complex problems in ligamentous injuries of the knee. It represents a challenging diagnostic and therapeutic problem for the orthopaedic surgeon. We present the results of biceps tenodesis in chronic posterolateral rotatory instabilily of the knee.Methods: In this case series we included all of the patients with positive reverse pivot shift test and prone external rotation test at least 3 weeks after their trauma. We excluded the patients with varus malalignment of the knee and concomitant anterior cruciate ligament (ACL rupture. Biceps tenodesis (Clancy method was performed. We did not reconstruct posterior cruciate ligament (PCL if its insufficiency was diagnosed in addition to posterolateral rotatory instability. Knee scoring scale of Lysholm was used during and after follow ups. The results were statistically compared using Wilcoxon signed rank test (WSRT, paired samples t-test and friedman test. Data analysis was done using SPSS (version 11.5 and Stata (version 8 computer softwares.Results: Our series consists of 13 patients (12 male and one female. 31% of the patients had isolated posterolateral injury and 69% of the patients had combined posterolateral and PCL injuries. The patients were between 17 to 45 years old (mean 30.25 years. Follow up was between 4 to 44 months (mean: 31 months. At the end of follow up 85% of patients had negative reverse pivot shift test. Prone external rotation test at 30° of knee flexion was negative in 92% of patients. In 92% of patients giving way was negative and in 77% of patients pain was decreased. Before operation the average Knee scoring scale of Lysholm was 73 and at the end of the follow up it increased to 85 (p value<0.001.Conclusions: Biceps tenodesis using Clancy method is a safe, effective and reliable method in management of chronic posterolateral rotatory instability of the knee. During surgery careful exploration of the common

  17. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2015-01-01

    Full Text Available The majority of patients with hip or knee osteoarthritis (OA report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475. When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P<0.01 of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement.

  18. Imaging brain mechanisms in chronic visceral pain.

    Science.gov (United States)

    Mayer, Emeran A; Gupta, Arpana; Kilpatrick, Lisa A; Hong, Jui-Yang

    2015-04-01

    Chronic visceral pain syndromes are important clinical problems with largely unmet medical needs. Based on the common overlap with other chronic disorders of visceral or somatic pain, mood and affect, and their responsiveness to centrally targeted treatments, an important role of central nervous system in their pathophysiology is likely. A growing number of brain imaging studies in irritable bowel syndrome, functional dyspepsia, and bladder pain syndrome/interstitial cystitis has identified abnormalities in evoked brain responses, resting state activity, and connectivity, as well as in gray and white matter properties. Structural and functional alterations in brain regions of the salience, emotional arousal, and sensorimotor networks, as well as in prefrontal regions, are the most consistently reported findings. Some of these changes show moderate correlations with behavioral and clinical measures. Most recently, data-driven machine-learning approaches to larger data sets have been able to classify visceral pain syndromes from healthy control subjects. Future studies need to identify the mechanisms underlying the altered brain signatures of chronic visceral pain and identify targets for therapeutic interventions. PMID:25789437

  19. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study.

    Directory of Open Access Journals (Sweden)

    Kimihiko Murase

    Full Text Available Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population.Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS score and a Roland-Morris disability questionnaire (RDQ score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality.Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01 and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01. The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01 Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01 and poor sleep quality (either of knee or low back pain: OR

  20. Spinal cord stimulation in chronic pain syndromes

    NARCIS (Netherlands)

    ten Vaarwerk, IAM; Staal, MJ

    1998-01-01

    Spinal cord stimulation (SCS) has been used for more than 30 years now, and although it has shown to be effective under certain well-described conditions of chronic pain, conclusive evidence on its effectiveness is still sparse. There is a need for more prospective and methodological good studies, i

  1. Family-oriented Treatment of Chronic Pain.

    Science.gov (United States)

    Hudgens, Alletta Jervey

    1979-01-01

    Describes the outcome of a short-term, family-centered, behavioral approach to chronic pain at the University of Minnesota Hospitals. Family members were taught operant conditioning techniques which rewarded nonpain-oriented behavior in patients. By treating the total family, 75 percent of the patients and families were able to lead satisfactory…

  2. Painful locking of the knee due to bucket handle tear of

    Directory of Open Access Journals (Sweden)

    HE Rui

    2011-04-01

    Full Text Available 【Abstract】 A case of swelling and anterior painful knee due to tear of mediopatellar plica is reported. The patient also felt clunk of the patellofemoral joint and knee locking. Under arthroscopic examination, a thick and fibrous plica was found medial to patellar, and a bucket tear along the plica from medial patellar retinaculum to infrapatellar fat pad. Polarized microscopic examination showed collagen fiber fragment and loss of light reflecting property. Neuroimmunohistology suggested up-regulation of synovial plica innervation in the area around the crack. This may be related to the pain. The bucket tear of mediopatellar plicacaused pain and lock of knee are more common than previously reported. Key words: Knee injuries; Arthroscopy; Patellofemoral joint

  3. Fracture of the Anterior Locking Flange of a Total Knee Arthroplasty Polyethylene Liner Presenting with Pain following Knee Replacement

    Science.gov (United States)

    Jeavons, Richard; Dowen, Daniel; Rushton, Paul; Ryan, Daniel; Gill, Peter

    2014-01-01

    Introduction: Fracture of the modern polyethylene insert of a total knee arthroplasty is rare. We describe the first case of a fractured anterior locking flange of the commonly used Depuy Press-fit Condylar (PFC) Sigma prosthesis. Case Report: The 80 year old Caucasian gentleman presented 8 years following previously uncomplicated and successful primary total knee replacement with pain, swelling and symptoms of instability of the knee. He was able to sublux his knee posteriorly using his hamstrings. Dissociation of the liner was evident on radiographs. He underwent revision of the polyethylene liner. It was evident during the revision that the anterior locking flange of the polyethylene liner had fractured allowing it to dissociate from the tibial tray. At 12 months following this revision he continues to do well and has similar range of movement and function to prior to the episode. This cause of the failure is not clear. Conclusion: Surgeons should be aware of this rare complication when assessing a painful or unstable total knee replacement. PMID:27298962

  4. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome.

    Science.gov (United States)

    Ellen, M I; Jackson, H B; DiBiase, S J

    1999-01-01

    The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations. PMID:10418845

  5. Art Therapy for Chronic Pain: Applications and Future Directions

    Science.gov (United States)

    Angheluta, Anne-Marie; Lee, Bonnie K.

    2011-01-01

    Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing…

  6. Chronic pain, social withdrawal, and depression

    Directory of Open Access Journals (Sweden)

    Harris RA

    2014-09-01

    Full Text Available Rebecca Arden Harris Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USAWallace et al1 used an effective combination of qualitative methods, ie, photographs taken by patients with accompanying narratives, interviews, and focus group sessions, to elicit descriptions of the daily realities of living with chronic pain from the patient perspective. The details are intimate and poignant. Patients tell of how they must curtail everyday activities in order to cope with the discomfort, of their frustration in trying to relay their situation to others, and of their despair at the thick-skinned reception they sometimes get because pain presents differently from other ailments. Primary care physicians will learn a lot from these images, particularly with regard to depression as a comorbidity of chronic pain.View orginal paper by Wallace et al

  7. ["Coping... and the person with chronic pain"].

    Science.gov (United States)

    Ribeiro, Leonor Ana; Santos, Céila

    2008-01-01

    We intend to present some aspects related with the coping process in a person with chronic pain. The presence of pain has implications in daily life activities, such as eating, drinking, sleeping or selfcare. Pain can unchain responses in the person, namely depression, anxiety, isolation, fear of pain and pessimistic thoughts. Thus we verify that in his/her adaptation process to the condition of chronic pain the person needs to integrate some strategies to manage his/her day by day activities. In this article we try to systematize the process where nurses based on Lazarus and Folkman's Model: Stress processing and Coping, can systematize care. In fact, nurses try to help people in the identification of their personal resources as well as the socio-ecological resources. The sense the care process has as a goal is the improvement of the quality of life through pain control and the person's adaptation of his/her condition of health, through development of his/her knowledge and capacities to use the resources, be they personal as instrumental or social. PMID:19341045

  8. Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain

    DEFF Research Database (Denmark)

    Sandal, L F; Roos, E M; Bøgesvang, S J;

    2016-01-01

    acute exercise-induced pain flares in persons with knee or hip pain. DESIGN: Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint......OBJECTIVE: Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together with...... stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. RESULTS: Joint pain was reduced from baseline (NRS 3.6; 95...

  9. Alexithymia and anxiety in female chronic pain patients

    OpenAIRE

    Saatcioglu Omer; Celikel Feryal

    2006-01-01

    Abstract Objectives Alexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain) female patients and to examine the relationship between alexithymia and the self-reporting of pain. Methods Thirty adult females (mean age: 34,63 ± 10,62 years), who applied to the outpatient p...

  10. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial

    OpenAIRE

    O Reilly, S.; Muir, K.; Doherty, M

    1999-01-01

    OBJECTIVE—To assess the effect of a home based exercise programme, designed to improve quadriceps strength, on knee pain and disability.
Methods—191 men and women with knee pain aged 40-80 were recruited from the community and randomised to exercise (n=113) or no intervention (n=78). The exercise group performed strengthening exercises daily for six months. The primary outcome measure was change in knee pain (Western Ontario McMaster Osteoarthritis index (WOMAC)). Secondary measures included ...

  11. Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models

    OpenAIRE

    Wolff, Brandy; Burns, John W.; Quartana, Phillip J.; Lofland, Kenneth; Bruehl, Stephen; Chung, Ok Y.

    2008-01-01

    Catastrophizing about pain is related to elevated pain severity and poor adjustment among chronic pain patients, but few physiological mechanisms by which pain catastrophizing maintains and exacerbates pain have been explored. We hypothesized that resting levels of lower paraspinal muscle tension and/or lower paraspinal and cardiovascular reactivity to emotional arousal may: (a) mediate links between pain catastrophizing and chronic pain intensity; (b) moderate these links such that only pati...

  12. Psychosocial assessment and self-management of chronic pain

    OpenAIRE

    Voerman, Jessica

    2015-01-01

    markdownabstractAbstract Chronic pain is prevalent in both children and adults and has major negative consequences for their daily life, e.g. reduced participation in activities and depressive and anxious feelings. Therefore, it is important to early signal and treat chronic pain. This thesis aimed to provide answers to two important questions: 1. How to improve early signaling and assessment of chronic pain in adolescents? and 2. How to improve self-management of chronic pain in both adolesc...

  13. Meeting the occupational needs of people with chronic pain

    OpenAIRE

    Robinson, Catherine T; Harmon, Dominic

    2012-01-01

    peer-reviewed This thesis comprises eight papers that aim to explore the relationship between occupation and chronic pain, augment the evidence available to occupational therapists working with people with chronic pain, and to develop occupational therapy services for people with chronic pain in Ireland. The practice of occupational therapists with people with chronic pain appears to reflect the profession wide theory-practice gap. A lack of evidence for occupationbased p...

  14. Reflex responses to combined hip and knee motion in human chronic spinal cord injury

    OpenAIRE

    Ming Wu, PhD; Brian D. Schmit, PhD

    2010-01-01

    The relative contributions of hip and knee proprioceptors to the origination of extensor spasms were examined in 11 subjects with chronic spinal cord injury (SCI). Ramp and hold extension and combined hip and knee oscillation movements were imposed to the right leg while the ankle was held in a static position by a custom-designed robot. Isometric joint torques of the hip, knee, and ankle and surface electromyograms (EMGs) from seven leg muscles were recorded following controlled hip and knee...

  15. [Chronic pancreatitis: nutrition and pain therapy].

    Science.gov (United States)

    Mössner, J

    1998-11-11

    Therapy of chronic pancreatitis rests on five arms: Avoidance of alcohol, treatment of pain, replacement therapy for exocrine and endocrine insufficiency and adequate nutrition. Alcohol withdrawal improves pain and the patient's compliance. It also seems to retard the chronic inflammatory process. Therapy of pain depends on the pathomechanism of pain. There is a lack of prospective, controlled studies comparing various treatment regimens. Thus, treatment options are partly dependent on the experience of the physician taking care of the patient and include i.e. for pseudocysts: surgical vs percutaneous or endoscopic drainage; for stenosis of the main pancreatic duct close to the papilla: surgical vs endoscopic drainage (stents); for distal bile duct stenosis: endoscopic stents vs biliodigestive anastomosis vs pancreatic head resection; for pancreatic stones: extracorporal shock wave lithotripsy followed by endoscopic stone extraction vs surgery (pancreaticojejunostomy), finally for inflammatory tumor of the pancreatic head combined with pain with or without compression of the distal bile duct or duodenum: duodenum-preserving pancreatic head resection vs Whipple resection. Patients with pain resistant to medical treatment may be candidates for a transcutaneous blockade of the plexus coeliacus or for epidural nerve blockade before one choses a surgical procedure. Application of pancreatic enzymes does not seem to have a major beneficial effect on pancreatic pain. Modification of nutrition has become less restrictive. Thanks to improved substitution with acid resistant porcine pancreatic extracts with high lipase activity, fat restriction is no longer of paramount importance. However, supply with sufficient calories is still difficult due to pain, inadequate compliance and hypermetabolism. PMID:9857767

  16. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

    Directory of Open Access Journals (Sweden)

    Samantha D. Outcalt, PhD

    2014-07-01

    Full Text Available Chronic pain and posttraumatic stress disorder (PTSD co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF Veterans with chronic pain only (n = 173 were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68. Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality, and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.

  17. Adductor canal blockade for moderate to severe pain after arthroscopic knee surgery

    DEFF Research Database (Denmark)

    Espelund, M; Grevstad, U; Jaeger, P;

    2014-01-01

    BACKGROUND: The analgesic effect of the adductor canal block (ACB) after knee surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic knee surgery. METHODS: Fifty...... opposite study medication, according to randomization. Primary outcome was pain during 45 degrees active flexion of the knee at 45 min after the first block, assessed on a 0-100 mm visual analogue scale. Secondary outcome measures were: pain at rest and during flexion of the knee, worst pain experienced...... subjects with moderate to severe pain after arthroscopic knee surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB with the...

  18. Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Labronici Pedro

    2011-12-01

    Full Text Available Abstract Background The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail. Findings The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Twenty patients (68.9% presented the proximal screw crossing the proximal tibiofibular joint and 13 (44.8% had already removed the nail and/or screw. Four patients (13.7% reported complaint of knee pain. However, the screw did not reach the proximal tibiofibular joint. Five patients (17.2% complained of knee pain although the screw toward the joint did not affect the proximal tibiofibular joint. Conclusion When using nails with oblique proximal lock, surgeons should be careful not to cause injury in the proximal tibiofibular joint, what may be one of the causes of knee pain. Thus, the authors suggest postoperative evaluation performing computed tomography when there is complaint of pain.

  19. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain

    Directory of Open Access Journals (Sweden)

    Natalia Egorova

    2015-01-01

    Full Text Available Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG, medial frontal cortex (MFC and bilateral hippocampus (Hpc. We demonstrate that the PAG–MFC and PAG–Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham is related to the modulation of PAG–MFC and PAG–Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory.

  20. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain.

    Science.gov (United States)

    Egorova, Natalia; Gollub, Randy L; Kong, Jian

    2015-01-01

    Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG), medial frontal cortex (MFC) and bilateral hippocampus (Hpc). We demonstrate that the PAG-MFC and PAG-Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham) is related to the modulation of PAG-MFC and PAG-Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory. PMID:26594625

  1. Electronic momentary assessment in chronic pain (II): pain and psychological pain responses as predictors of pain disability.

    NARCIS (Netherlands)

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J.J.; Verhaak, P.F.M.; Bensing, J.M.

    2006-01-01

    Objectives and Methods: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain r

  2. Sarah's Knee: A Famous Actress With Chronic, Inflammatory Monoarthritis.

    Science.gov (United States)

    Pinals, Robert S

    2004-02-01

    Sarah Bernhardt had a recurrent and later persistent inflammatory arthritis of her right knee for more than 25 years. She probably had pulmonary tuberculosis, starting a dozen years before the arthritis, and her chronic synovitis may have been tuberculous. Several months in a cast led to deterioration and later amputation of the leg, an outcome that might have been prevented by surgical arthrodesis. Despite the loss of her limb and progressive renal failure, she continued an active theatrical career until her death at age 78. PMID:17043454

  3. Pain Management in the Elderly: Transdermal Fentanyl for the Treatment of Pain Caused by Osteoarthritis of the Knee and Hip

    Directory of Open Access Journals (Sweden)

    Sylwester Mordarski

    2014-01-01

    Full Text Available This study was designed to evaluate the utility of transdermal fentanyl (transdermal fentanyl, TDF for the treatment of pain due to osteoarthritis (osteoarthritis, OA of the knee and hip, which was not adequately controlled by nonopioid analgesics or weak opioids. WOMAC is a reliable, valid, and responsive multidimensional, self-administrated outcome measure designed specifically to evaluate patients with OA of the knee or hip. TDF significantly increased pain control and improved functioning and quality of life. Metoclopramide appeared to be of limited value in preventing nausea and vomiting.

  4. Immune mediators of chronic pelvic pain syndrome.

    Science.gov (United States)

    Murphy, Stephen F; Schaeffer, Anthony J; Thumbikat, Praveen

    2014-05-01

    The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease. PMID:24686526

  5. Pain trajectory groups in persons with, or at high risk of, knee osteoarthritis: findings from the Knee Clinical Assessment Study and the Osteoarthritis Initiative

    OpenAIRE

    Nicholls, E.; Thomas, E.; van der Windt, D.A.; Croft, P. R.; Peat, G

    2014-01-01

    Summary Objective The authors aimed to characterize distinct trajectories of knee pain in adults who had, or were at high risk of, knee osteoarthritis using data from two population-based cohorts. Method Latent class growth analysis was applied to measures of knee pain severity on activity obtained at 18-month intervals for up to 6 years between 2002 and 2009 from symptomatic participants aged over 50 years in the Knee Clinical Assessment Study (CAS-K) in the United Kingdom. The optimum laten...

  6. Behavioral Concepts in the Analysis of Chronic Pain Syndromes.

    Science.gov (United States)

    Keefe, Francis J.; Gil, Karen M.

    1986-01-01

    Reviews behavioral and psychological concepts currently applied to the assessment and treatment of chronic pain syndromes, including operant conditioning and psychophysiologic concepts such as the stress-pain hypothesis, the pain-muscle spasm-pain cycle, and the neuromuscular pain model. Discusses relaxation and biofeedback training and concepts…

  7. Smoking Cessation and Chronic Pain: Patient and Pain Medicine Physician Attitudes

    OpenAIRE

    Hooten, W. Michael; Vickers, Kristin S.; Shi, Yu; Ebnet, Kaye L.; Townsend, Cynthia O.; Patten, Christi A.; Warner, David O.

    2011-01-01

    Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain ...

  8. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain. PMID:27208716

  9. Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

    OpenAIRE

    Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P.; Smith, Douglas G.

    2009-01-01

    Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These...

  10. Chronic Pain: Where the Body Meets the Brain

    OpenAIRE

    Crofford, Leslie J

    2015-01-01

    Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Central pain amplification is perceived pain that cannot be fully explained on the basis of somatic or neuropathic processes and is due to physiologic alterations in pain transmission or descending pain modulatory pathways. In any individual, central pain amplification may complicate nociceptive or neuropathic pain. Furthermore, patients with somatic symptom d...

  11. Altered central sensitization and pain modulation in the CNS in chronic joint pain

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Skou, Søren Thorgaard; Nielsen, Thomas Arendt;

    2015-01-01

    Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral and ...... mechanisms, available tools are important for patent profiling and providing the basic knowledge for development of new drugs and for developing pain management regimes....

  12. The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty.

    Science.gov (United States)

    Pongcharoen, Boonchana; Reutiwarangkoon, Chaivet

    2016-01-01

    In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arthritis of the lateral facet of the patella following mobile bearing UKA. We have prospectively evaluated 104 patients (114 knees) who had undergone an Oxford mobile bearing UKA. The mean follow-up was 19.05 months (range 12.30-29.70 months). The patients were divided into two groups: group I consisted of eighty patients (88 knees) who did not have severe arthritis of the lateral facet (Outerbridge grade 0-2) and group II had twenty-four patients (26 knees) who had severe arthritis of the lateral facet (Outerbridge grade 3, 4). We recorded the incidence of anterior knee pain, knee scores, pain scores, and functional scores in comparison of the two groups. The visual analog scale (VAS) and incidence of post-operative anterior knee pain had not shown any significant differences. The VAS for post-operative anterior knee pain was 0.11 (SD 0.56, range 0-3 point) versus 0.12 (SD 0.59, range 0-3 point) for group I and group II patients, respectively (P = 0.98). The incidence of post-operative anterior knee pain was 4.5 versus 3.8 % for group I and group II patients, respectively (P = 0.88). The pain scores and functional scores had not exhibited any differences. However, the knee scores of patients with severe arthritis of the lateral facet of the patella was worse than those seen in patients without severe arthritis of the lateral facet of the patella with a statistical significance. It was scored as 96.78 (SD 4.56, range 85-100) versus 94.43 (SD 4.50, range 81-100) for group I

  13. Serum Levels of Proinflammatory Cytokines in Painful Knee Osteoarthritis and Sensitization

    Science.gov (United States)

    Imamura, Marta; Ezquerro, Fernando; Marcon Alfieri, Fábio; Vilas Boas, Lucy; Tozetto-Mendoza, Tania Regina; Chen, Janini; Özçakar, Levent; Arendt-Nielsen, Lars

    2015-01-01

    Osteoarthritis (OA) is the most common joint disorder in the world. Among the mechanisms involved in osteoarthritis, biomarkers (cytokines profile) may be related to pain and pain intensity, functional capacity, and pressure pain thresholds (PPT). Thus, the study of these relationships may offer useful information about pathophysiology and associated mechanisms involved in osteoarthritis. Therefore, the objective of this study was to investigate the seric concentration of pro (IL-6, IL-8, and TNF-α) and anti-inflammatory (IL-10) cytokines in patients with painful knee osteoarthritis and to correlate the levels of these biomarkers with the patients' functional capacity and pressure pain threshold (PPT) values. PMID:25821631

  14. Psychoneuroimmunology: Potential Relevance to Chronic Orofacial Pain

    OpenAIRE

    Schleifer, Steven J.; Marbach, Joseph; Keller, Steven E.

    1990-01-01

    Studies undertaken over the past ten years have demonstrated that stress and depression can induce immune alterations, including decreased numbers of immunocompetent cells and impaired lymphocyte and natural killer cell activity. Factors such as age and severity of symptomatology influence these effects. The substantial stress and depression associated with chronic pain syndromes and the evidence for opioid involvement in immunomodulation suggest that immune system changes may occur in some p...

  15. Chronic pain, social withdrawal, and depression

    OpenAIRE

    Harris RA

    2014-01-01

    Rebecca Arden Harris Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USAWallace et al1 used an effective combination of qualitative methods, ie, photographs taken by patients with accompanying narratives, interviews, and focus group sessions, to elicit descriptions of the daily realities of living with chronic pain from the patient perspective. The details are intimate and poignant. Patients tell of how they must curtail ever...

  16. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review

    OpenAIRE

    Thomas Martin J; Wood Laurence; Selfe James; Peat George

    2010-01-01

    Abstract Background Patellofemoral osteoarthritis (PFOA) is a common form of knee OA in middle and older age, but its relation to PF disorders and symptoms earlier in life is unclear. Our aim was to conduct a systematic review to investigate the strength of evidence for an association between anterior knee pain (AKP) in younger adults and subsequent PFOA. Methods The search strategy included electronic databases (Pubmed, EMBASE, AMED, CINAHL, Cochrane, PEDro, SportDiscus: inception to Decembe...

  17. Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis

    OpenAIRE

    Mutlu, Ebru Kaya; Ozdincler, Arzu Razak

    2015-01-01

    [Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 cl...

  18. Chronic pain: the burden of disease and treatment innovations

    OpenAIRE

    S. Monti; Caporali, R

    2015-01-01

    Musculoskeletal conditions are the most frequent cause of chronic pain and affect around 1 in 5 adults in Europe. When chronic pain occurs, it becomes disease itself, with substantial clinical, social and economic impact. Effi cacy and tolerability problems are encountered with all therapeutic strategies available to treat musculoskeletal pain. This often limits effective analgesia and patients’ long term compliance, with the result that chronic pain is persistently underestimated and undertr...

  19. Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study

    Science.gov (United States)

    Helminen, Eeva-Eerika; Sinikallio, Sanna H; Valjakka, Anna L; Väisänen-Rouvali, Rauni H; Arokoski, Jari PA

    2016-01-01

    Objective: To identify predictors of pain and disability in knee osteoarthritis. Design: A one-year prospective analysis of determinants of pain and functioning in knee osteoarthritis. Study setting: Primary care providers in a medium-sized city. Patients: A total of 111 patients aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2–4) of knee osteoarthritis who participated in a randomized controlled trial. Main measures: The outcome measures were self-reported pain and function, which were recorded at 0, 3 and 12 months. Disease-specific pain and functioning were assessed using the pain and function subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Generic physical and mental functioning were assessed using the RAND-36 subscales for function, and physical and mental component summary scores. Possible baseline predictors for these outcomes were 1) demographic, socioeconomic and disease-related variables, and 2) psychological measures of resources, distress, fear of movement and catastrophizing. Results: Multivariate linear mixed model analyses revealed that normal mood at baseline measured with the Beck Anxiety Inventory predicted significantly better results in all measures of pain (WOMAC P=0.02) and function (WOMAC P=0.002, RAND-36 P=0.002) during the one-year follow-up. Psychological resource factors (pain self-efficacy P=0.012, satisfaction with life P=0.002) predicted better function (RAND-36). Pain catastrophizing predicted higher WOMAC pain levels (P=0.013), whereas fear of movement (kinesiophobia) predicted poorer functioning (WOMAC P=0.046, RAND-36 P=0.024). Conclusions: Multiple psychological factors in people with knee osteoarthritis pain are associated with the development of disability and longer term worse pain. PMID:27496698

  20. Efficacy of Radiation Synovectomy with Y-90 in chronic knee joint synovitis

    International Nuclear Information System (INIS)

    Aim: To evaluate the efficiency of Radiation Synovectomy (RSO) with Y-90 in knee joints of patients with chronic synovitis (CS) resistant to classical conventional therapy, and assess its long-term prognosis. Material and Methods: 22 patients (7 males,15 females, mean age 50, range 12-81) with CS of the knees, of a duration ranging from 2 to 48 years, were included in the study. All patients had suffered from CS for more than 6 months, and were resistant to anti-inflammatory drugs, immunosuppressants and intraarticular (IA) steroid therapy. The cases included:10 patients with rheumatoid arthritis (RA), 5 psoriatic arthritis (PA), 3 pigmented villonodular synovitis, 2 seronegative oligo-polyarthritis and 2 chronic mono arthritis. We used an IA dose of 3 to 5 mCi (37-185 MBq)of Y-90. The effect of the therapy with Y-90 on 22 knees was evaluated from 3 to 12 months after the RSO. Patients' response was assess and classified according to the results of plain radiology and following conventional rheumatological criteria as: A) Excellent (E) with a visual improvement (VI) of 80-100mm, no pain in motion, little or no palpable swelling, no inflammation; B) Good (G) VI of 60-90mm, minimal pain in motion, little palpable swelling; C) Mild (M) VI of 20-59mm, moderate reduction of pain, obvious swelling; D) Bad (B) VI of only 0-19 mm, no changes or an increase of pain in the swollen joints. Results: The response observed was classified as: E in 5 patients (23%); G in 10 patients (45%); M in 3 patients (14%); and B in 4(18%). The 4 patients with a response B, had all of them joint erosion on plain radiology. Furthermore, one of the patients was a failure from prior surgical synovectomy (SS). The other 3 patients subsequently had SS. In contrast, all the responses E and G were obtained exclusively in patients with RA or PA. No short or long-term adverse side effects were noted. Conclusion: RSO is an effective treatment for patients with persistent CS, specially in RA and PA. The

  1. Chronic pain disrupts the reward circuitry in multiple sclerosis.

    Science.gov (United States)

    Seixas, Daniela; Palace, Jacqueline; Tracey, Irene

    2016-08-01

    Pain commonly affects multiple sclerosis (MS) patients, and has the potential to become chronic and burden an already damaged central nervous system. Imaging studies are providing insights into brain restructuring associated with chronic pain and different chronic pain conditions seem to evoke distinct plasticity patterns. Our objective was to study the structural and functional brain changes of chronic neuropathic pain of MS. Employing structural and resting functional magnetic resonance imaging we compared MS patients with chronic central pain with MS patients without pain matched with respect to age, gender, subtype and duration of MS and disability. Mean duration of pain was 7.6 years. Comparing the pain and no-pain groups, brain functional default-mode network differences were found. There was decreased coactivation in the caudate nucleus and nucleus accumbens bilaterally. Also, for the relapsing-remitting subgroup of patients, grey matter thickness changes predominated in the pain group in the mesial region of the temporal lobes, caudate, putamen, thalami and the fronto-parietal cortex; in the group without pain, changes predominated in the frontopolar and orbitofrontal cortices and in the occipital areas. A dysfunction in the reward system in chronic pain of MS was found, particularly in the brain areas involved in its motivational aspects, as such probably reflecting the maladaptive physiology of chronic pain, and possibly the signature of pain in MS, in a disease where reward impairment seems to be already one of its features. PMID:27178661

  2. Heritability of chronic pain in 2195 extended families.

    Science.gov (United States)

    Hocking, L J; Morris, A D; Dominiczak, A F; Porteous, D J; Smith, B H

    2012-08-01

    Chronic pain is pathological, persisting beyond normal tissue healing time. Previous work has suggested ∼50% variation in chronic pain development is heritable. No data are currently available on the heritability of pain categorized using the Chronic Pain Grade (CPG). Furthermore, few existing studies have accounted for potential confounders that may themselves be under genetic control or indeed 'heritable' non-genetic traits. This study aimed to determine the relative contributions of genetic, measured and shared environmental and lifestyle factors to chronic pain. Chronic pain status was determined and CPG measured in participants from Generation Scotland: the Scottish Family Health Study, a large cohort of well-characterized, extended families from throughout Scotland, UK. Heritability estimates (h (2) ) for 'any chronic pain' and 'severe' chronic pain (CPG 3 or 4) were generated using SOLAR software, with and without adjustment for shared household effects and measured covariates age, body mass index, gender, household income, occupation and physical activity. Data were available for 7644 individuals in 2195 extended families. Without adjustment, h (2) for 'any chronic pain' was 29% [standard errors (SE) 6%; p study supports the use of chronic pain as a phenotype in genetic studies, with adequate correction for confounders to specifically identify genetic risk factors for chronic pain. PMID:22337623

  3. Lower sex hormone levels are associated with more chronic musculoskeletal pain in community-dwelling elderly women.

    Science.gov (United States)

    de Kruijf, Marjolein; Stolk, Lisette; Zillikens, M Carola; de Rijke, Yolanda B; Bierma-Zeinstra, Sita M A; Hofman, Albert; Huygen, Frank J P M; Uitterlinden, Andre G; van Meurs, Joyce B J

    2016-07-01

    Chronic pain is more prevalent in women than in men, with increasing differences between sexes in advanced age. This could be caused by differences in sex hormone levels. We therefore studied the relationship between sex hormones and the prevalence and incidence of chronic pain. The association between sex hormone levels and chronic pain was examined in 9717 participants aged 45 years and older from the Rotterdam Study, a population-based study. Chronic pain was defined as pain in the lower back, hands, knees and/or hips for at least 3 months. Sex hormone levels included estrogen, testosterone, androstenedione, and 17-hydroxyprogesterone. Relationships between hormones and prevalent and new onset chronic pain were analyzed using linear and logistic regression, stratified by gender. Women with androstenedione or estradiol levels in the lowest tertile had more chronic pain (odds ratio, 1.20; 95% CI, 1.03-1.39 and odds ratio, 1.27; 95% CI, 1.10-1.48, respectively). Mean estradiol levels were lower among men with chronic pain (mean difference -3.88 pmol/L; P = 0.005). Lowest tertile 17-hydroxyprogesterone in women was associated with 38% more new onset pain. All these associations were independent from age, body mass index, health and lifestyle factors, and osteoarthritis. Lower sex hormone levels are associated with chronic musculoskeletal pain, independent from lifestyle and health-related factors, in community-dwelling elderly women. These results suggest that sex hormones play a role in chronic pain and should be taken into account when a patient presents with chronic pain. Therefore, sex hormones may be a potential treatment target for these patients. PMID:27331348

  4. Neuroimmune interactions in itch: Do chronic itch, chronic pain, and chronic cough share similar mechanisms?

    Science.gov (United States)

    Ji, Ru-Rong

    2015-12-01

    Itch and pain are closely related but also clearly distinct sensations. Pain is known to suppress itch, while analgesics such as morphine can provoke itch. However, in pathological and chronic conditions, pain and itch also have similarities. Dysfunction of the nervous system, as manifested by neural plastic changes in primary sensory neurons of the peripheral nervous system (peripheral sensitization) and spinal cord and brain stem neurons in the central nervous system (central sensitization) will result in chronic pain and itch. Importantly, these diseases also result from immune dysfunction, since inflammatory mediators can directly activate or sensitize nociceptive and pruriceptive neurons in the peripheral and central nervous system, leading to pain and itch hypersensitivity. In this mini-review, I discuss the roles of Toll-like receptors (TLRs), transient receptor potential ankyrin 1 (TRPA1) ion channel, and Nav1.7 sodium channel in regulating itch and inflammation, with special emphasis of neuronal TLR signaling and the interaction of TLR7 and TRPA1. Chronic pain and chronic itch are debilitating diseases and dramatically impact the life quality of patients. Targeting TLRs for the control of inflammation, neuroinflammation (inflammation restricted in the nervous system), and hyperexcitability of nociceptors and pruriceptors will lead to new therapeutics for the relief of chronic pain and chronic itch. Finally, given the shared mechanisms among chronic cough, chronic pain, and chronic itch and the demonstrated efficacy of the neuropathic pain drug gabapentin in treating chronic cough, novel therapeutics targeting TRPA1, Nav1.7, and TLRs may also help to alleviate refractory cough via modulating neuron-immune interaction. PMID:26351759

  5. A bibliometric approach to the Alternative Medicine in chronic pain

    Directory of Open Access Journals (Sweden)

    Ennio Cocco

    2009-03-01

    Full Text Available The aim of this study is to investigate the interest of science for the Complementary and Alternative Medicine (CAM in the chronic pain treatment using the number of articles registered by PubMed as an indicator. On Medline system with the key words: CAM and Pain 11.671 papers are available; 2.167 with the key words: CAM and chronic pain; 192 papers deal with the topic chronic pain and dementia. The interest of science for CAM in chronic pain is increasing, but few studies deal with the epidemiological and psychosocial side of this phenomenon. Analogously, more and more studies deal with CAM utilization in dementia. More studies deal with the specific problem of chronic pain in dementia, but few include CAM referral for this topic. A different vision should be dedicated to CAM in chronic pain especially for a better understanding of patients’ (and their families’ needs.

  6. Research design considerations for chronic pain prevention clinical trials

    DEFF Research Database (Denmark)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C;

    2015-01-01

    , outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues...... potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.......Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations...

  7. Current understanding of the neuropathophysiology of pain in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Amporn; Atsawarungruangkit; Supot; Pongprasobchai

    2015-01-01

    Chronic pancreatitis(CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure.Traditionally, researchers believed that the pain was caused by anatomical changes in pancreatic structure. However, treatment outcomes based on such beliefs are considered unsatisfactory. The emerging explanations of pain in CP are trending toward neurobiological theories. This article aims to review current evidence regarding the neuropathophysiology of pain in CP and its potential implications for the development of new treatments for pain in CP.

  8. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    chronic pain after THA in relation to pre-operative pain and early post-operative pain. METHODS: A questionnaire was sent to 1231 consecutive patients who had undergone THA 12-18 months previously, and whose operations had been reported to the Danish Hip Arthroplasty Registry. RESULTS: The response rate...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  9. Catastrophizing, Functional Disability and Pain Reports in Adults with Chronic Low Back Pain

    OpenAIRE

    1999-01-01

    OBJECTIVE: To test the hypothesis that subjective reports of pain severity, pain intensity and functional disability correlate positively with catastrophizing.PATIENTS: Adults with chronic low back pain for six months or longer presenting to a tertiary care Pain Management Unit.METHODS: Catastrophizing was measured with the Pain Catastrophizing Scale (PCS) in 40 subjects (23 males, 17 females). Functional disability was measured with the Pain Disability Index and pain severity/intensity was q...

  10. Combined nuclear and digital subtraction contrast arthrography in painful knee prosthesis

    International Nuclear Information System (INIS)

    The evaluation of a painful knee prosthesis remains a difficult problem for both orthopaedic surgeons and radiologists. We have compared digital subtraction arthrography with nuclear-arthrography in 7 patients with a painful knee prosthesis. Three patients showed a loose tibial component, demonstrated by both digital subtraction and nuclear arthrography. All 3 underwent revision of their prosthesis. One patient had an equivocal digital subtraction arthrogram and negative nuclear arthrogram, while both studies were negative in the 3 remaining patients. Nuclear arthrography is a simple procedure and can provide useful additional information when combined with digital subtraction arthrography. (orig.)

  11. The Effect of Tai Chi on Knee Osteoarthritis Pain in Cognitively Impaired Elders: Pilot Study

    OpenAIRE

    Tsai, Pao-Feng; Beck, Cornelia; Chang, Jason Y.; Hagen, Jody; Yong-Fang, Kuo; Roberson, Paula K.; Rosengren, Karl; Beuscher, Linda; Doan, Cathy; Anand, K. J. S.

    2008-01-01

    This article reports a pilot study of the effect of tai chi (TC), a pharmacological adjunct and mild aerobic exercise, on osteoarthritic knee pain in elders with cognitive impairment (CI). The TC program included a warm-up, 12-form Sun-style TC, and a cool-down period, for a total of 20-40 minutes per session, twice a week for 15 weeks. The results showed no significant differences in knee pain after the TC intervention in 7 elders with CI. However, more minutes of TC attendance were related ...

  12. Cognitive function in patients with chronic pain treated with opioids

    DEFF Research Database (Denmark)

    Kurita, G P; de Mattos Pimenta, C A; Braga, P E;

    2012-01-01

    The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated...

  13. Cortical plasticity as a new endpoint measurement for chronic pain

    Directory of Open Access Journals (Sweden)

    Zhuo Min

    2011-07-01

    Full Text Available Abstract Animal models of chronic pain are widely used to investigate basic mechanisms of chronic pain and to evaluate potential novel drugs for treating chronic pain. Among the different criteria used to measure chronic pain, behavioral responses are commonly used as the end point measurements. However, not all chronic pain conditions can be easily measured by behavioral responses such as the headache, phantom pain and pain related to spinal cord injury. Here I propose that cortical indexes, that indicate neuronal plastic changes in pain-related cortical areas, can be used as endpoint measurements for chronic pain. Such cortical indexes are not only useful for those chronic pain conditions where a suitable animal model is lacking, but also serve as additional screening methods for potential drugs to treat chronic pain in humans. These cortical indexes are activity-dependent immediate early genes, electrophysiological identified plastic changes and biochemical assays of signaling proteins. It can be used to evaluate novel analgesic compounds that may act at peripheral or spinal sites. I hope that these new cortical endpoint measurements will facilitate our search for new, and more effective, pain medicines, and help to reduce false lead drug targets.

  14. Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort.

    Science.gov (United States)

    Attal, Nadine; Masselin-Dubois, Anne; Martinez, Valéria; Jayr, Christian; Albi, Aline; Fermanian, Jacques; Bouhassira, Didier; Baudic, Sophie

    2014-03-01

    It is well established that chronic pain impairs cognition, particularly memory, attention and mental flexibility. Overlaps have been found between the brain regions involved in pain modulation and cognition, including in particular the prefrontal cortex and the anterior cingulate cortex, which are involved in executive function, attention and memory. However, whether cognitive function may predict chronic pain has not been investigated. We addressed this question in surgical patients, because such patients can be followed prospectively and may have no pain before surgery. In this prospective longitudinal study, we investigated the links between executive function, visual memory and attention, as assessed by clinical measurements and the development of chronic pain, its severity and neuropathic symptoms (based on the 'Douleur Neuropathique 4' questionnaire), 6 and 12 months after surgery (total knee arthroplasty for osteoarthritis or breast surgery for cancer). Neuropsychological tests included the Trail-Making Test A and B, and the Rey-Osterrieth Complex Figure copy and immediate recall, which assess cognitive flexibility, visuospatial processing and visual memory. Anxiety, depression and coping strategies were also evaluated. In total, we investigated 189 patients before surgery: 96% were re-evaluated at 6 months, and 88% at 12 months. Multivariate logistic regression (stepwise selection) for the total group of patients indicated that the presence of clinical meaningful pain at 6 and 12 months (pain intensity ≥ 3/10) was predicted by poorer cognitive performance in the Trail Making Test B (P = 0.0009 and 0.02 for pain at 6 and 12 months, respectively), Rey-Osterrieth Complex Figure copy (P = 0.015 and 0.006 for pain at 6 and 12 months, respectively) and recall (P = 0.016 for pain at 12 months), independently of affective variables. Linear regression analyses indicated that impaired scores on these tests predicted pain intensity (P < 0.01) and neuropathic

  15. Multiple faces of pain: effects of chronic pain on the brain regulation of facial expression.

    Science.gov (United States)

    Vachon-Presseau, Etienne; Roy, Mathieu; Woo, Choong-Wan; Kunz, Miriam; Martel, Marc-Olivier; Sullivan, Michael J; Jackson, Philip L; Wager, Tor D; Rainville, Pierre

    2016-08-01

    Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation analyses to study the brain mediators of pain facial expressions and the perception of pain intensity (self-reports) in healthy individuals and patients with chronic back pain (CBP). Behavioral data showed that the relation between pain expression and pain report was disrupted in CBP. In both patients with CBP and healthy controls, brain activity varying on a trial-by-trial basis with pain facial expressions was mainly located in the primary motor cortex and completely dissociated from the pattern of brain activity varying with pain intensity ratings. Stronger activity was observed in CBP specifically during pain facial expressions in several nonmotor brain regions such as the medial prefrontal cortex, the precuneus, and the medial temporal lobe. In sharp contrast, no moderating effect of chronic pain was observed on brain activity associated with pain intensity ratings. Our results demonstrate that pain facial expressions and pain intensity ratings reflect different aspects of pain processing and support psychosocial models of pain suggesting that distinctive mechanisms are involved in the regulation of pain behaviors in chronic pain. PMID:27411160

  16. Prevalence of chronic low back pain: systematic review

    Directory of Open Access Journals (Sweden)

    Rodrigo Dalke Meucci

    2015-01-01

    Full Text Available OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex.METHODS We consulted Medline (PubMed, LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex.RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%.CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

  17. Chronic Low Back Pain: Toward an Integrated Psychosocial Assessment Model.

    Science.gov (United States)

    Strong, Jenny; And Others

    1994-01-01

    Integrated six dimensions of chronic low back pain (pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, illness behavior) to provide multidimensional patient profile. Data from 100 patients revealed presence of three distinct patient groups: patients who were in control, patients who were depressed and…

  18. Percutaneous transluminal angioplasty of chronic arterial occlusive disease below the knee joint

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the safety and efficacy of the percutaneous transluminal angioplasty(PTA) in patients with chronic arterial occlusive disease below the knee joint. We retrospectively analyzed the results of 36 procedures in 16 patients. There were 15 men and one woman, aged 57-75 years(mean, 62 years). Indications were disabling claudication (SVS/ISCVS grade 1, category 3) in five cases, rest pain(grade 2, category 4) in three cases, and non-healing ulceration or gangrene(grade3, category 5) in eight cases. PTA was performed by using small vessel balloon catheter of 2-4 mm and 3 mm monorail balloon catheter in tibioperoneal vessels and 5-6 mm balloon catheter in distal popliteal artery and tibioperoneal trunk. Combined thrombolytic therapy with Urokinase was performed in 14 patients. Involved infrapopliteal vessels were four distal popliteal arteries, 15 tibioperoneal trunks, six anterior tibial arteries, five posterior tibial arteries, and seven peroneal arteries. Technical success was determined when post-PTA angiogram showed less than 30% of residual stenosis. Clinical success was defined as improvement of clinical symptoms, such as disappearance of claudication or rest pain, and healing of ulcereation. Technical success was achieved in 30 of 36 arteries(83%). Clinical success was achieved in 12 of 16 patients(75%) at an average follow-up of 13.3 months(range, 2-46 months). Clinical success rate was 100% in grade 1 category 3 patients, 67% in grade 2 category 4 patients, and 63% in grade 3 category 5 patients. Complication included two distal emboli, one vessel rupture, one vessel thrombosis, and one occluding intimal flap. PTA was an effective method for treatment of chronic arterial occlusive disease below the knee joint and considered as the procedure of first choice. Severe claudicant(grade1) should be included in the indication of the tibioperoneal PTA

  19. Managing Chronic Pain in Children and Adolescents: A Clinical Review.

    Science.gov (United States)

    Landry, Bradford W; Fischer, Philip R; Driscoll, Sherilyn W; Koch, Krista M; Harbeck-Weber, Cynthia; Mack, Kenneth J; Wilder, Robert T; Bauer, Brent A; Brandenburg, Joline E

    2015-11-01

    Chronic pain in children and adolescents can be difficult for a single provider to manage in a busy clinical setting. Part of this difficulty is that pediatric chronic pain not only impacts the child but also the families of these children. In this review article, we discuss etiology and pathophysiology of chronic pain, along with variables that impact the severity of chronic pain and functional loss. We review diagnosis and management of selected chronic pain conditions in pediatric patients, including headache, low back pain, hypermobility, chronic fatigue, postural orthostatic tachycardia syndrome, abdominal pain, fibromyalgia, and complex regional pain syndrome. For each condition, we create a road map that contains therapy prescriptions, exercise recommendations, and variables that may influence pain severity. Potential medications for these pain conditions and associated symptoms are reviewed. A multidisciplinary approach for managing children with these conditions, including pediatric pain rehabilitation programs, is emphasized. Lastly, we discuss psychological factors and interventions for pediatric chronic pain and potential complementary and alternative natural products and interventions. PMID:26568508

  20. Chronic Multiple Knee Ligament Injuries: Epidemiological Analysis of More Than One Hundred Cases

    OpenAIRE

    Rosalvo Zosimo Bispo Júnior; Cezar Teruyuki Kawano; Alexandre Vieira Guedes

    2008-01-01

    INTRODUCTION: Diagnosis and treatment of multiple ligament injuries of the knee remain a real challenge for most surgeons. OBJECTIVE: To find out the epidemiological profile of patients surgically treated at a Reference Service with more than one chronic ligament injury in the knee joint. MATERIALS AND METHODS: Of a total of 978 operated patients, 109 presented at least two associated ligament injuries in the same knee. Demographic and clinical variables were evaluated. RESULTS: The anterior ...

  1. Pain Management for Total Knee Arthroplasty: Single-Injection Femoral Nerve Block versus Local Infiltration Analgesia

    OpenAIRE

    Moghtadaei, Mehdi; Farahini, Hossein; Faiz, Seyed Hamid-Reza; Mokarami, Farzam; Safari, Saeid

    2014-01-01

    Background: Pain is one of the major concerns of patients underwent Total Knee Arthroplasty (TKA); appropriate pain management is a key factor in patient's early physical fitness to move, physiotherapy, and most importantly, patient satisfaction. Objectives: In this study the analgesic effect of single injection femoral nerve block (SFNB) was compared with local infiltration analgesia (LIA). Patients and Methods: Forty patients who underwent TKA under spinal anesthesia were randomized to rece...

  2. Acupuncture for postoperative pain following total knee arthroplasty: a systematic review protocol

    OpenAIRE

    Jung, Jae-Young; Cho, Jae-Heung; Chung, Seok-Hee

    2015-01-01

    Introduction Total knee arthroplasty (TKA) is a common surgical method in orthopaedics; however, pain management after TKA remains a significant challenge. This review provides a comprehensive evaluation of the effects of acupuncture for postoperative pain after TKA. Methods and analysis The following 10 databases will be searched until August 2015: MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, three Chinese databases (the China National Knowledge Infrastructure Database, the Chongqing VIP Chinese ...

  3. TRPV1 Antagonists and Chronic Pain: Beyond Thermal Perception

    OpenAIRE

    Brandt, Michael R.; Beyer, Chad E; Stahl, Stephen M.

    2012-01-01

    In the last decade, considerable evidence as accumulated to support the development of Transient Receptor Potential Vanilloid 1 (TRPV1) antagonists for the treatment of various chronic pain conditions. Whereas there is a widely accepted rationale for the development of TRPV1 antagonists for the treatment of various inflammatory pain conditions, their development for indications of chronic pain, where conditions of tactical, mechanical and spontaneous pain predominate, is less clear. Preclinic...

  4. Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain

    OpenAIRE

    Poleshuck, Ellen L.; Gamble, Stephanie A.; Cort, Natalie; Hoffman-King, Debra; Cerrito, Beth; Rosario-McCabe, Luis A.; Giles, Donna E.

    2010-01-01

    Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other g...

  5. Neural and psychosocial contributions to sex differences in knee osteoarthritic pain

    Directory of Open Access Journals (Sweden)

    Sluka Kathleen A

    2012-12-01

    Full Text Available Abstract People with osteoarthritis (OA can have significant pain that interferes with function and quality of life. Women with knee OA have greater pain and greater reductions in function and quality of life than men. In many cases, OA pain is directly related to sensitization and activation of nociceptors in the injured joint and correlates with the degree of joint effusion and synovial thickening. In some patients, however, the pain does not match the degree of injury and continues after removal of the nociceptors with a total joint replacement. Growth of new nociceptors, activation of nociceptors in the subchondral bone exposed after cartilage degradation, and nociceptors innervating synovium sensitized by inflammatory mediators could all augment the peripheral input to the central nervous system and result in pain. Enhanced central excitability and reduced central inhibition could lead to prolonged and enhanced pain that does not directly match the degree of injury. Psychosocial variables can influence pain and contribute to pain variability. This review explores the neural and psychosocial factors that contribute to knee OA pain with an emphasis on differences between the sexes and gaps in knowledge.

  6. Chronic pain, perceived stress, and cellular aging: an exploratory study

    OpenAIRE

    Sibille Kimberly T; Langaee Taimour; Burkley Ben; Gong Yan; Glover Toni L; King Chris; Riley Joseph L; Leeuwenburgh Christiaan; Staud Roland; Bradley Laurence A; Fillingim Roger B

    2012-01-01

    Abstract Background Chronic pain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL), a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronic pain and chronic pain is experienced as a physical and psychosocial stressor. However, the utility of...

  7. Pain and Personality: Do Individuals with Different Forms of Chronic Pain Exhibit a Mutual Personality?

    Science.gov (United States)

    Gustin, Sylvia M; Burke, Lucinda A; Peck, Chris C; Murray, Greg M; Henderson, Luke A

    2016-04-01

    The role of personality in the experience of chronic pain is a growing field, with endless debate regarding the existence of a "pain personality". This study aims to compare different chronic pain types and consolidate the existence of a common personality. Thirty-two females with chronic orofacial pain and 37 age-matched healthy females were assessed with the Temperament and Character Inventory-Revised. Chronic pain subjects had either trigeminal neuropathy (neuropathic pain) or temporomandibular disorders (nociceptive pain). This study revealed that individuals with different chronic pain types exhibit a mutual personality profile encompassing significantly higher scores in Harm Avoidance and significantly lower scores in Self-Directedness when compared to healthy subjects. In fact, this combination is associated with Cluster C personality disorders. In conclusion, our study reveals that irrespective of type, chronic pain may be associated with Cluster C personality disorders. Indeed, there has never been empirical evidence in the past to suggest that chronic pain as an overall concept is associated with any particular personality disorders. Therefore, a potential future avenue of chronic pain treatment may lie in targeting particular personality aspects and shift the target of pain-relieving treatments from sensory and psychologically state focused to psychologically trait focused. PMID:25858277

  8. Guided Internet-Based Cognitive Behaviour Therapy for Chronic Pain

    OpenAIRE

    Buhrman, Monica

    2012-01-01

    Chronic pain is a one of the most common causes of disability and sick leave. Psychological factors play a central role in the experience of pain and are important in the management of pain. However, for many people with chronic pain CBT is not available. There is a need to develop alternative ways to deliver treatments that reach more individuals with chronic pain. Internet-based treatments have been shown to be effective for several disorders and recent research suggests that internet-based...

  9. Medial release and lateral imbrication for intractable anterior knee pain: diagnostic process, technique, and results

    Directory of Open Access Journals (Sweden)

    Meldrum AR

    2015-01-01

    Full Text Available Alexander R Meldrum,1 Jeremy R Reed,2 Megan D Dash3 1Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada; 2Department of Surgery, University of Saskatchewan College of Medicine, Regina, SK, Canada; 3Department of Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada Purpose: To present two cases of intractable patellofemoral pain syndrome treated with a novel procedure, arthroscopic medial release, and lateral imbrication of the patellar retinaculum. Patients and methods: This case series presents the treatment of three knees in two patients (one bilateral in whom an all-inside arthroscopic medial release and lateral imbrication of the patellar retinaculum was performed. Subjective measurement of pain was the primary outcome measurement, and subjective patellofemoral instability was the secondary outcome measurement. Results: Subjectively the two patients had full resolution of their pain, without any patellofemoral instability. Conclusion: Medial release and lateral imbrication of the patellar retinaculum is a new surgical procedure that has been used in the treatment of intractable patellofemoral pain syndrome. This is the first report of its kind in the literature. While outcome measurements were less than ideal, the patients had positive outcomes, both functionally and in terms of pain. Keywords: anterior knee pain syndrome, chondromalacia patellae, runners knee, patellar chondropathy, patellofemoral dysfunction, patellofemoral tracking disorder

  10. Managing chronic pain with nonopioid analgesics: a multidisciplinary consult.

    Science.gov (United States)

    Clauw, Daniel; McCarberg, Bill H

    2012-05-01

    As detailed in this online CME activity (www.cmeaccess.com/AJM/ChronicPain04), determining pain mechanism is an important aspect guiding treatment selection for chronic musculoskeletal pain states. Although broad classifications provide a framework, any combination of mechanisms may be present in a chronic pain patient, and there is growing evidence that pain states generally considered nociceptive may also involve elements of augmented central nervous system pain processing. Nonopioid analgesics, including serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and alpha-2-delta ligand anticonvulsants, are the treatments of choice for fibromyalgia and other central neuropathic pain states. Additionally, studies have now shown that certain SNRIs can be effective in treating "classic" nociceptive pain states, such as osteoarthritis, and also are effective for low back pain. In addition to considering biological mechanisms, chronic pain management also involves recognizing and evaluating the contribution of psychological and sociocultural factors that can influence pain chronicity and patient prognosis. A multimodal/multidisciplinary approach incorporating pharmacologic and nonpharmacologic therapy into a program that includes more than 1 discipline is important to improve outcomes in patients with chronic pain. PMID:22482859

  11. Knee Pain in Children, Part II: Limb- and Life-threatening Conditions, Hip Pathology, and Effusion.

    Science.gov (United States)

    Wolf, Michael

    2016-02-01

    On the basis of primarily consensus due to lack of relevant clinical studies, the most important evaluative step for knee pain is to identify any emergent conditions, including limb- and life-threatening disorders (septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. (2)(3)(6)(8)(11)(13)(14) PMID:26834226

  12. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jenstrup, M T; Jæger, P; Lund, J; Fomsgaard, J S; Bache, S; Mathiesen, O; Larsen, T K; Dahl, J B

    2012-01-01

    Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We...

  13. Patient-Controlled Oral Analgesia for Postoperative Pain Management Following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Patti Kastanias

    2010-01-01

    Full Text Available PURPOSE: To investigate whether patient-controlled oral analgesia (PCOA used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN-administered oral analgesia.

  14. Reflex responses to combined hip and knee motion in human chronic spinal cord injury

    Directory of Open Access Journals (Sweden)

    Ming Wu, PhD

    2010-04-01

    Full Text Available The relative contributions of hip and knee proprioceptors to the origination of extensor spasms were examined in 11 subjects with chronic spinal cord injury (SCI. Ramp and hold extension and combined hip and knee oscillation movements were imposed to the right leg while the ankle was held in a static position by a custom-designed robot. Isometric joint torques of the hip, knee, and ankle and surface electromyograms (EMGs from seven leg muscles were recorded following controlled hip and knee extension. A stereotypical torque response consisting of hip flexion, knee extension, and ankle plantar flexion was observed following hip and knee perturbations. Further, the hip or knee joint posture modulated the spastic reflexes triggered by the extension movement of the other joint, with larger responses observed with the hip and knee extended. In addition, combined hip and knee oscillation movements were imposed to one leg with four different phasing conditions. The phasing between the hip and knee modulated the reflex activity triggered by hip and knee oscillations. The EMG patterns of the spastic reflexes were generally consistent with muscle timing during locomotion in human SCI. This knowledge may help identify rehabilitation strategies that produce functional movements in human SCI.

  15. The prevalence of chronic knee injury in triathletes

    OpenAIRE

    Clements, K.; Yates, B.; Curran, M

    1999-01-01

    OBJECTIVES: To add to the area of triathlon research by providing much needed prevalence data on knee injury in triathletes. METHOD: An incidental "in field" sampling technique was used to interview 58 triathletes aged between 15 and 55 years about knee injury during a triathlon event. The sample comprised 46 men and 12 women. RESULTS: Most knee injuries occurred during the running event (72%) and affected the lateral side of the knee (38%). In all, 78% of the sample sought treatment fr...

  16. Chronic pain management as a barrier to pediatric palliative care.

    Science.gov (United States)

    Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice

    2013-12-01

    Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083

  17. The Relationship between Strategies of Coping and Perception of Pain in Three Chronic Pain Groups.

    Science.gov (United States)

    Anderson, Louis P.; Rehm, Lynn P.

    1984-01-01

    Examined the relationship between perception of pain, personality, coping, and the reaction of family members in three chronic pain groups (sickle cell anemia, arthritis, and low back pain) (N=60). Analyses suggested that the three groups were not distinguishable in coping, personality, or in their experience of pain. (LLL)

  18. Women in pain : the course and diagnostics of chronic pelvic pain

    NARCIS (Netherlands)

    Weijenborg, Philomena Theodora Maria

    2009-01-01

    The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain persistence. 2. The clinical course of chronic pelvic pain (CPP) and predictors of recovery. 3. The moderat

  19. The association between symptoms, pain coping strategies, and physical activity among people with symptomatic knee and hip osteoarthritis

    Directory of Open Access Journals (Sweden)

    Susan L Murphy

    2012-09-01

    Full Text Available Effective use of coping strategies by people with chronic pain conditions is associated with better functioning and adjustment to chronic disease. Although the effects of coping on pain have been well studied, less is known about how specific coping strategies relate to actual physical activity patterns in daily life. The purpose of this study was to evaluate how different coping strategies relate to symptoms and physical activity patterns in a sample of adults with knee and hip osteoarthritis (N = 44. Physical activity was assessed by wrist-worn accelerometry; coping strategy use was assessed by the Chronic Pain Coping Inventory. We hypothesized that the use of coping strategies that reflect approach behaviors (e.g., Task Persistence, would be associated with higher average levels of physical activity, whereas avoidance coping behaviors (e.g., Resting, Asking for Assistance, Guarding and Pacing would be associated with lower average levels of physical activity. We also evaluated whether coping strategies moderated the association between momentary symptoms (pain and fatigue and activity. We hypothesized that higher levels of approach coping would be associated with a weaker association between symptoms and activity compared to lower levels of this type of coping. Multilevel modeling was used to analyze the momentary association between coping and physical activity. We found that higher body mass index, fatigue, and the use of Guarding were significantly related to lower activity levels, whereas Asking for Assistance was significantly related to higher activity levels. Only Resting moderated the association between pain and activity. Guarding, Resting, Task Persistence, and Pacing moderated the association between fatigue and activity. This study provides an initial understanding of how people with osteoarthritis cope with symptoms as they engage in daily life activities using ecological momentary assessment and objective physical activity

  20. 'Women get this': gendered meanings of chronic pelvic pain.

    Science.gov (United States)

    Grace, Victoria M; MacBride-Stewart, Sara

    2007-01-01

    Chronic pelvic pain in women is a key site through which explorations of the meanings of female gender and pain might further insights into the broader question of the embodied experience of women in relation to pain. A biocultural approach is used to present an analysis of interviews with 40 New Zealand women in which they reflect on 'how come' they have chronic pelvic pain. Women consistently employ a mechanistic rendition of medical discourse and understandings in their constructions of 'how come' they have pain, accompanied by a reiteration of 'not knowing' and a normalizing of their pelvic pain. We explore how this normalizing works within the narratives to establish women's pelvic pain as intrinsically gendered. Etiological meanings that are constructed in medical terms and yet are unable to be interpreted within a dualist frame of normality and pathology, we argue, permeate and shape gendered experience of chronic pain conditions. PMID:17158831

  1. Associations between proinflammatory cytokines in the synovial fluid and radiographic grading and pain-related scores in 47 consecutive patients with osteoarthritis of the knee

    Directory of Open Access Journals (Sweden)

    Yamashita Masaomi

    2011-06-01

    Full Text Available Abstract Background One of the sources of knee pain in osteoarthritis (OA is believed to be related to local chronic inflammation of the knee joints, which involves the production of inflammatory cytokines such as tumor necrosis factor alpha (TNFα, interleukin (IL-6, and nerve growth factor (NGF in the synovial membrane, and these cytokines are believed to promote pathological OA. In the present study, correlations between proinflammatory cytokines in knee synovial fluid and radiographic changes and functional scores and pain scores among OA patients were examined. Methods Synovial fluid was harvested from the knees of 47 consecutive OA patients, and the levels of TNFα, IL-6, and NGF were measured using enzyme-linked immunosorbent assays. Osteoarthritic knees were classified using Kellgren-Lawrence (KL grading (1-4. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC was used to assess self-reported physical function, pain, and stiffness. Results TNFα and IL-6 were detectable in knee synovial, whereas NGF was not. TNFα was not correlated with the KL grade, whereas IL-6 had a significantly negative correlation. We observed differences in the correlations between TNFα and IL-6 with WOMAC scores and their subscales (pain, stiffness, and physical function. TNFα exhibited a significant correlation with the total score and its 3 subscales, whereas IL-6 exhibited a moderately significant negative correlation only with the subscale of stiffness. Conclusions The present study demonstrated that the concentrations of proinflammatory cytokines are correlated with KL grades and WOMAC scores in patients with knee OA. Although TNFα did not have a significant correlation with the radiographic grading, it was significantly associated with the WOMAC score. IL-6 had a significant negative correlation with the KL grading, whereas it had only a weakly significant correlation with the subscore of stiffness. The results suggest that these

  2. Prevalence of pain on palpation of the inferior pole of the patella among patients with complaints of knee pain

    Directory of Open Access Journals (Sweden)

    Leonardo Addêo Ramos

    2009-03-01

    Full Text Available CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39% felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3% received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.

  3. Pain sensitivity and tactile spatial acuity are altered in healthy musicians as in chronic pain patients.

    Directory of Open Access Journals (Sweden)

    Anna M. eZamorano

    2015-01-01

    Full Text Available Extensive training of repetitive and highly skilled movements, as it occurs in professional classical musicians, may lead to changes in tactile sensitivity and corresponding cortical reorganization of somatosensory cortices. It is also known that professional musicians frequently experience musculoskeletal pain and pain-related symptoms during their careers. The present study aimed at understanding the complex interaction between chronic pain and music training with respect to somatosensory processing. For this purpose, tactile thresholds (mechanical detection, grating orientation, two-point discrimination and subjective ratings to thermal and pressure pain stimuli were assessed in 17 professional musicians with chronic pain, 30 pain-free musicians, 20 non-musicians with chronic pain, and 18 pain-free non-musicians. We found that pain-free musicians displayed greater touch sensitivity (i.e. lower mechanical detection thresholds, lower tactile spatial acuity (i.e., higher grating orientation thresholds and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. Moreover, we also found that musicians and non-musicians with chronic pain presented lower tactile spatial acuity and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. The significant increment of pain sensitivity together with decreased spatial discrimination in pain-free musicians and the similarity of results found in chronic pain patients, suggests that the extensive training of repetitive and highly skilled movements in classical musicians could be considered as a risk factor for developing chronic pain, probably due to use-dependent plastic changes elicited in somatosensory pathways.

  4. Mechanism of Chronic Pain in Rodent Brain Imaging

    Science.gov (United States)

    Chang, Pei-Ching

    Chronic pain is a significant health problem that greatly impacts the quality of life of individuals and imparts high costs to society. Despite intense research effort in understanding of the mechanism of pain, chronic pain remains a clinical problem that has few effective therapies. The advent of human brain imaging research in recent years has changed the way that chronic pain is viewed. To further extend the use of human brain imaging techniques for better therapies, the adoption of imaging technique onto the animal pain models is essential, in which underlying brain mechanisms can be systematically studied using various combination of imaging and invasive techniques. The general goal of this thesis is to addresses how brain develops and maintains chronic pain in an animal model using fMRI. We demonstrate that nucleus accumbens, the central component of mesolimbic circuitry, is essential in development of chronic pain. To advance our imaging technique, we develop an innovative methodology to carry out fMRI in awake, conscious rat. Using this cutting-edge technique, we show that allodynia is assoicated with shift brain response toward neural circuits associated nucleus accumbens and prefrontal cortex that regulate affective and cognitive component of pain. Taken together, this thesis provides a deeper understanding of how brain mediates pain. It builds on the existing body of knowledge through maximizing the depth of insight into brain imaging of chronic pain.

  5. Role of Alternative Therapies for Chronic Pain Syndromes.

    Science.gov (United States)

    Thomas, Donna-Ann; Maslin, Benjamin; Legler, Aron; Springer, Erin; Asgerally, Abbas; Vadivelu, Nalini

    2016-05-01

    There is increasing interest in the use of complimentary and alternative medicine (CAM) for the treatment of chronic pain. This review examines alternative and complimentary therapies, which can be incorporated as part of a biopsychosocial approach in the treatment of chronic pain syndromes. In the present investigation, literature from articles indexed on PubMed was evaluated including topics of alternative therapies, complimentary therapies, pain psychology, biofeedback therapy, physical exercise therapies, acupuncture, natural and herbal supplements, whole-body cryotherapy, and smartphone technologies in the treatment of chronic pain syndromes. This review highlights the key role of psychology in the treatment of chronic pain. Cognitive behavior therapy appears to be the most impactful while biofeedback therapy has also been shown to be effective for chronic pain. Exercise therapy has been shown to be effective in short-, intermediate-, and long-term pain states. When compared to that in sham controls, acupuncture has shown some benefit for neck pain immediately after the procedure and in the short term and improvement has also been demonstrated in the treatment of headaches. The role of smartphones and whole-body cryotherapy are new modalities and further studies are needed. Recent literature suggests that several alternate therapies could play a role in the treatment of chronic pain, supporting the biopsychosocial model in the treatment of pain states. PMID:27038968

  6. Effect of exercise therapy on neuromuscular activity and knee strength in female adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael S.; Samani, Afshin; Olesen, Jens L.; Roos, Ewa M.; Rasmussen, Sten; Madeleine, Pascal

    2016-01-01

    random subsample of 57 female adolescents was included and tested at baseline and after 3months. Neuromuscular control of the knee was quantified as the complexity of surface electromyography of the vastus lateralis and vastus medialis during stair descent. Secondary outcomes were complexity of knee...... during stair descent than those receiving patient education alone. This suggest that exercise therapy has an effect not only on self-reported outcome measures but also on objective measures of thigh muscle function in female adolescents with patellofemoral pain....

  7. Psychosocial assessment and self-management of chronic pain

    NARCIS (Netherlands)

    J.S. Voerman (Jessica)

    2015-01-01

    markdownabstractAbstract Chronic pain is prevalent in both children and adults and has major negative consequences for their daily life, e.g. reduced participation in activities and depressive and anxious feelings. Therefore, it is important to early signal and treat chronic pain. This thesis aimed

  8. Classification of chronic orofacial pain using an intravenous diagnostic test

    NARCIS (Netherlands)

    Tjakkes, G. -H. E.; De Bont, L. G. M.; van Wijhe, M.; Stegenga, B.

    2009-01-01

    The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of cond

  9. Epidemiology of chronic pain in Denmark: an update

    DEFF Research Database (Denmark)

    Sjøgren, Per; Ekholm, Ola; Peuckmann, Vera;

    2008-01-01

    rated their health and quality of life as poor. Persons with earlier or present cancer diagnosis were more likely to report chronic pain. A substantial part of persons with chronic pain were not satisfied with the examinations and treatments offered. In conclusion, over a five-year period the prevalence...

  10. Dysfunctional stress responses in chronic pain.

    Science.gov (United States)

    Woda, Alain; Picard, Pascale; Dutheil, Frédéric

    2016-09-01

    Many dysfunctional and chronic pain conditions overlap. This review describes the different modes of chronic deregulation of the adaptive response to stress which may be a common factor for these conditions. Several types of dysfunction can be identified within the hypothalamo-pituitary-adrenal axis: basal hypercortisolism, hyper-reactivity, basal hypocortisolism and hypo-reactivity. Neuroactive steroid synthesis is another component of the adaptive response to stress. Dehydroepiandrosterone (DHEA) and its sulfated form DHEA-S, and progesterone and its derivatives are synthetized in cutaneous, nervous, and adipose cells. They are neuroactive factors that act locally. They may have a role in the localization of the symptoms and their levels can vary both in the central nervous system and in the periphery. Persistent changes in neuroactive steroid levels or precursors can induce localized neurodegeneration. The autonomic nervous system is another component of the stress response. Its dysfunction in chronic stress responses can be expressed by decreased basal parasympathethic activity, increased basal sympathetic activity or sympathetic hyporeactivity to a stressful stimulus. The immune and genetic systems also participate. The helper-T cells Th1 secrete pro-inflammatory cytokines such as IL-1-β, IL-2, IL-6, IL-8, IL-12, IFN-γ, and TNF-α, whereas Th2 secrete anti-inflammatory cytokines: IL-4, IL-10, IGF-10, IL-13. Chronic deregulation of the Th1/Th2 balance can occur in favor of anti- or pro-inflammatory direction, locally or systemically. Individual vulnerability to stress can be due to environmental factors but can also be genetically influenced. Genetic polymorphisms and epigenetics are the main keys to understanding the influence of genetics on the response of individuals to constraints. PMID:27262345

  11. Chronic Pain in Older African American Grandparent Caregivers.

    Science.gov (United States)

    Booker, Staja Q

    2016-06-01

    African American grandparent caregiving is increasing, and evidence shows that grandparent caregiving influences health and its management. As older adults age, their potential of experiencing chronic pain increases, and this is profound given that physiological research shows that African Americans, aside from aging, may have a predisposition for developing chronic pain. Research shows older African Americans experience significant chronic pain, but few have discussed the implications of managing chronic pain in older African Americans who have added parental responsibility. Many older African Americans receive home healthcare services and there is a unique role for home healthcare clinicians in caring for this vulnerable population. This article discusses the impact of pain on caregiving, challenges in pain management, and practice and policy implications to assist home healthcare clinicians maintain the safety and protection of both the older grandparent and grandchildren. PMID:27243429

  12. Chronic Pain and Cognitive Behavioral Therapy: An Integrative Review.

    Science.gov (United States)

    Knoerl, Robert; Lavoie Smith, Ellen M; Weisberg, James

    2016-05-01

    Cognitive behavioral therapy (CBT) is often used to treat chronic pain; however, more information is needed about what are the most efficacious dose and delivery methods. The aims of this review were to determine (a) which CBT doses, delivery methods, strategies, and follow-up periods have been explored in recent intervention studies of individuals with chronic pain and (b) whether the outcomes described in the selected studies were consistent with recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. The CINAHL, EMBASE, PubMed, PsycInfo, and SCOPUS databases were searched for randomized controlled trials published from 2009 to 2015 testing CBT for adults with chronic pain. Thirty-five studies were included in this review. Results revealed that CBT reduced pain intensity in 43% of trials, the efficacy of online and in-person formats were comparable, and military veterans and individuals with cancer-related chronic pain were understudied. PMID:26604219

  13. Treatment of 21 cases with knee pain originated from spine by acupuncture%针刺治疗脊柱源性膝关节痛21例

    Institute of Scientific and Technical Information of China (English)

    高志勇

    2010-01-01

    @@ Knee pain originated from spine is uncommon in clinic. This kind of patients usually manifests as wandering knee pain, and the effect of treatment aiming at knee simply is unobvious. The author treated 21 cases in this type from June 2006 to March 2009,and the condition is as follows.

  14. [Approach to chronic pain by hypnosis: a general practitioner's experience].

    Science.gov (United States)

    Grünenwald, M

    2009-06-17

    Hypnosis is a modified state of consciousness linking the conscious and the unconscious of a person. In the context of chronic pain, hypnosis enables to help controlling the intensity of the pain, managing the pain and the emotions accompanying it and to help the patient finding his own resources allowing him getting involved in his treatment. PMID:19626764

  15. Chronic pain treatment : from psychological predictors to implementation

    NARCIS (Netherlands)

    Samwel, J.J.A.

    2008-01-01

    In this thesis, cognitive-behavioural factors were studied based on the Fear-avoidance model (catastrophizing, fear of pain and avoidance behaviour) and, based on recent literature, helplessness and acceptance. All were studied as predictors of chronic pain outcomes (pain intensity, functional disab

  16. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

    Science.gov (United States)

    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. PMID:26302337

  17. Expression of mu-opioid receptors in human chronic inflamed knee joint synovium tissue

    Institute of Scientific and Technical Information of China (English)

    YUAN Hong-bin; HE Xing-ying; XU Hai-tao; ZHU Qiu-feng; WANG Ya-hua; SHI Xue-yin

    2006-01-01

    Objective:To examine the changes of mu-opioid receptors (MORs) expression in human chronic inflamed knee joint synovium tissue. Methods:Knee joint synovium tissues were taken from 21 patients with chronic arthritis(inflamed group) and 6 fresh bodies with normal knee joints(control group). And the expression of MORs was detected by using immunohistochemistry, flow cytometry (FCM) and reverse-transcription polymerase chain reaction(RT-PCR). Results: The expression of MORs in the inflamed group was significantly higher than that in the normal group by using the 3 techniques(P<0.05).Conclusion: Chronic inflammation enhances the up-regulation of MORs in human knee joint synovium tissue.

  18. Biopsychosocial functioning and pain self-efficacy in chronic low back pain patients

    OpenAIRE

    Alex L. Koenig, MS; Amy E. Kupper, MS; Jay R. Skidmore, PhD; Karly M. Murphy, BA

    2015-01-01

    The aim of this study was to examine the relationship between biopsychosocial functioning and pain severity and to evaluate whether pain self-efficacy (PSE) mediates this relationship. This study used archival data from a multidisciplinary pain management program. Participants were 99 individuals (69% female) with chronic low back pain who completed measures of biological, psychological, and social functioning; pain severity; and PSE at admission. They ranged in age from 18 to 72 yr (mean = 4...

  19. Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Trombini-Souza Francis

    2012-07-01

    Full Text Available Abstract Background Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA after short-term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes— Moleca®—for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca® is a women’s double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention. All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days of paracetamol (500 mg intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention

  20. Psychological therapies for the management of chronic pain

    OpenAIRE

    Sturgeon JA

    2014-01-01

    John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy fo...

  1. Treatment Preferences for CAM in Children with Chronic Pain

    OpenAIRE

    Tsao, Jennie C. I.; Marcia Meldrum; Kim, Su C.; Jacob, Margaret C.; Zeltzer, Lonnie K

    2006-01-01

    CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years ± 2.4; range = 8–18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examin...

  2. Microglia disrupt mesolimbic reward circuitry in chronic pain

    OpenAIRE

    Taylor, AMW; Castonguay, A; Taylor, AJ; Murphy, NP; Ghogha, A; Cook, C.; Xue, L.; Olmstead, MC; De Koninck, Y; Evans, CJ; Cahill, CM

    2015-01-01

    © 2015 the authors. Chronic pain attenuates midbrain dopamine (DA) transmission, as evidenced by a decrease in opioid-evoked DA release in the ventral striatum, suggesting that the occurrence of chronic pain impairs reward-related behaviors. However, mechanisms by which pain modifies DA transmission remain elusive. Using in vivo microdialysis and microinjection of drugs into the mesolimbic DA system, we demonstrate in mice and rats that microglial activation in the VTA compromises not only op...

  3. Chronic pain: The role of learning and brain plasticity

    OpenAIRE

    Mansour, A.R.; Farmer, M.A.; Baliki, M. N.; Apkarian, A. Vania

    2014-01-01

    Based on theoretical considerations and recent observations, we argue that continued suffering of chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain, rendering the pain less somatic and more affective in nature. This theoretical construct is a strong departure from the traditional scientific vie...

  4. Pacing: A Concept Analysis of a Chronic Pain Intervention

    OpenAIRE

    Jamieson-Lega, Kathryn; Berry, Robyn; Brown, Cary A.

    2013-01-01

    BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain manag...

  5. Disability and borderline personality disorder in chronic pain patients

    OpenAIRE

    Sansone, Randy A.; J David Sinclair; Wiederman, Michael W.

    2010-01-01

    BACKGROUND AND OBJECTIVE: Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients.METHODS: In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain...

  6. Evidence for a central mode of action for etoricoxib (COX-2 Inhibitor) in patients with painful knee osteoarthritis

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær

    2016-01-01

    The COX-2 inhibitor etoricoxib modulates the peripheral and central nociceptive mechanisms in animals. This interaction has not been studied in pain patients. This randomized, double-blind, placebo-controlled, 2-way crossover, 4-week treatment study investigated the pain mechanisms modulated by...... etoricoxib in patients with painful knee osteoarthritis.Patients were randomized to group A) (60 mg/day etoricoxib followed by placebo), or B) (placebo followed by 60 mg/day etoricoxib). The quantitative, mechanistic pain biomarkers were pressure pain thresholds (PPTs), temporal summation (TS), and...... conditioning pain modulation (CPM). Clinical readouts were Brief Pain Inventory (BPI), WOMAC, PainDetect Questionnaire (PDQ), time and pain intensity during walking and stair climbing.Etoricoxib as compared with placebo significantly modulated the PPTs (P=0.012, localized sensitization) at the knee and leg...

  7. Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty- a new dimension of diagnostics?

    Directory of Open Access Journals (Sweden)

    Rasch Helmut

    2011-02-01

    Full Text Available Abstract Background The purpose of our study was to evaluate the clinical value of hybrid SPECT/CT for the assessment of patients with painful total knee arthroplasty (TKA. Methods Twenty-three painful knees in patients following primary TKA were assessed using Tc-99m-HDP-SPECT/CT. Rotational, sagittal and coronal position of the TKA was assessed on 3D-CT reconstructions. The level of the SPECT-tracer uptake (0-10 and its anatomical distribution was mapped using a validated localization scheme. Univariate analysis (Wilcoxon-Mann-Whitney, Spearmean`s-rho test, p Results SPECT/CT imaging changed the suspected diagnosis and the proposed treatment in 19/23 (83% knees. Progression of patellofemoral OA (n = 11, loosening of the tibial (n = 3 and loosening of the femoral component (n = 2 were identified as the leading causes of pain after TKA. Patients with externally rotated tibial trays showed higher tracer uptake in the medial patellar facet (p = 0.049 and in the femur (p = 0.051. Patients with knee pain due to patellofemoral OA showed significantly higher tracer uptake in the patella than others (p Conclusions SPECT/CT was very helpful in establishing the diagnosis and guiding subsequent management in patients with painful knees after TKA, particularly in patients with patellofemoral problems and malpositioned or loose TKA.

  8. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Bennell Kim L

    2012-07-01

    Full Text Available Abstract Background Knee osteoarthritis (OA is a prevalent chronic musculoskeletal condition with no cure. Pain is the primary symptom and results from a complex interaction between structural changes, physical impairments and psychological factors. Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST particularly in other chronic pain conditions. Though typically provided separately, there are symptom, resource and personnel advantages of exercise and PCST being delivered together by a single healthcare professional. Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management. No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population. The primary aim of this multisite randomised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA. Methods/design This will be an assessor-blinded, 3-arm randomised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice. Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and randomized into one of three groups: exercise alone, PCST alone, or integrated PCST and exercise. Randomisation will be stratified by city (Melbourne or Brisbane and gender. Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by

  9. Alexithymia and Early Maladaptive Schemas in chronic pain patients.

    Science.gov (United States)

    Saariaho, Anita S; Saariaho, Tom H; Mattila, Aino K; Karukivi, Max; Joukamaa, Matti I

    2015-08-01

    Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale-20, the Finnish version of the Young Schema Questionnaire short form-extended, the Beck Depression Inventory-II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co-occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients. PMID:26040835

  10. Midgut malrotation with chronic abdominal pain

    Directory of Open Access Journals (Sweden)

    Anil K Wanjari

    2012-01-01

    Full Text Available Abnormalities in midgut rotation occur during the physiological herniation of midgut between the 5 th and 10 th week of gestation. The most significant abnormality is narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period, less commonly midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 17-year-old male patient who presented with 10-year history of nonspecific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following computed tomography of abdomen. The patient was treated with a laparoscopic Ladd′s procedure and at 3 months he was gaining weight and had stopped vomiting. A laparoscopic Ladd′s procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. Midgut malrotation is a rare congenital anomaly which may present as chronic abdominal pain. Abdominal CT is helpful for diagnosis.

  11. Management of chronic pain in osteoporosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Paolucci T

    2016-04-01

    Full Text Available Teresa Paolucci,* Vincenzo Maria Saraceni, Giulia Piccinini* Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy *These authors contributed equally to this work Abstract: Osteoporosis (OP is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. Keywords: physical therapy, exercise, pharmacological treatment, posture and balance

  12. Management of chronic pain in osteoporosis: challenges and solutions

    Science.gov (United States)

    Paolucci, Teresa; Saraceni, Vincenzo Maria; Piccinini, Giulia

    2016-01-01

    Osteoporosis (OP) is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. PMID:27099529

  13. MRI findings associated with development of incident knee pain over 48 months: data from the osteoarthritis initiative

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, Gabby B.; Hou, Stephanie W.; Nardo, Lorenzo; Heilmeier, Ursula; Link, Thomas M. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Nevitt, Michael C.; McCulloch, Charles E. [University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA (United States)

    2016-05-15

    The purpose of this nested case-control study was to identify baseline, incident, and progressive MRI findings visible on standard MRI clinical sequences that were associated with development of incident knee pain in subjects at risk for OA over a period of 48 months. We analyzed 60 case knees developing incident pain (WOMAC{sub pain} = 0 at baseline and WOMAC{sub pain} ≥ 5 at 48 months) and 60 control knees (WOMAC{sub pain} = 0 at baseline and WOMAC{sub pain} = 0 at 48 months) from the Osteoarthritis Initiative. 3 T knee MRIs were analyzed using a modified WORMS score (cartilage, meniscus, bone marrow) at baseline and after 48 months. Baseline and longitudinal findings were grouped into logistic regression models and compared using likelihood-ratio tests. For each model that was significant, a stepwise elimination was used to isolate significant MRI findings. One baseline MRI finding and three findings that changed from baseline to 48 months were associated with the development of pain: at baseline, the severity of a cartilage lesion in the medial tibia was associated with incident pain - (odds ratio (OR) for incident pain = 3.05; P = 0.030). Longitudinally, an incident effusion (OR = 9.78; P = 0.005), a progressive cartilage lesion of the patella (OR = 4.59; P = 0.009), and an incident medial meniscus tear (OR = 4.91; P = 0.028) were associated with the development of pain. Our results demonstrate that baseline abnormalities of the medial tibia cartilage as well as an incident joint effusion, progressive patella cartilage defects, and an incident medial meniscus tear over 48 months may be associated with incident knee pain. Clinically, this study helps identify MRI findings that are associated with the development of knee pain. (orig.)

  14. Ziconotide in the treatment of pcoa chronic pain: cases report

    Directory of Open Access Journals (Sweden)

    Sabrina Giusto

    2009-05-01

    Full Text Available Chronic pain related to PCOA is a clinical condition which affects more than 5 percent of the population. This article presents two clinical cases of severe pain related to the disease treated with opioids and epidural SCS with inadequate results. Treatment by intrathecal ziconotide showed, in both cases, a good reduction of pain. These clinical cases represent the first experience of ischemic pain treatment with ziconotide.

  15. Ziconotide in the treatment of pcoa chronic pain: cases report

    OpenAIRE

    Sabrina Giusto; Domenico Quattrone; Placido Calì

    2009-01-01

    Chronic pain related to PCOA is a clinical condition which affects more than 5 percent of the population. This article presents two clinical cases of severe pain related to the disease treated with opioids and epidural SCS with inadequate results. Treatment by intrathecal ziconotide showed, in both cases, a good reduction of pain. These clinical cases represent the first experience of ischemic pain treatment with ziconotide.

  16. AMELOTEX IN THE TREATMENT OF CHRONIC BACK PAIN SYNDROMES

    Directory of Open Access Journals (Sweden)

    Irina Yuryevna Suvorova

    2010-01-01

    Full Text Available Recently there has been a considerable increase in the number of patients with lingering recurrent and chronic pain syndromes of various origin. Forty-one patients with dorsopathies were examined. Two types of pain were identified; these were vertebrogenic and nonvertebrogenic pains. The appropriateness of this identification was confirmed by instrumental studies. Treatment was performed using a selective nonsteroidal antiinflammatory drug (Amelotex. Pain syndrome relief was noted during the therapy

  17. AMELOTEX IN THE TREATMENT OF CHRONIC BACK PAIN SYNDROMES

    Directory of Open Access Journals (Sweden)

    Irina Yuryevna Suvorova

    2010-09-01

    Full Text Available Recently there has been a considerable increase in the number of patients with lingering recurrent and chronic pain syndromes of various origin. Forty-one patients with dorsopathies were examined. Two types of pain were identified; these were vertebrogenic and nonvertebrogenic pains. The appropriateness of this identification was confirmed by instrumental studies. Treatment was performed using a selective nonsteroidal antiinflammatory drug (Amelotex. Pain syndrome relief was noted during the therapy

  18. Could stress contribute to pain-related fear in chronic pain?

    Directory of Open Access Journals (Sweden)

    Sigrid Elsenbruch

    2015-12-01

    Full Text Available Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that (1 extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favour overgeneralization; (2 acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories, (3 stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4 these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such as depression or anxiety in patients with chronic pain.

  19. Announcing the CDC guideline for prescribing opioids for chronic pain.

    Science.gov (United States)

    Houry, Debra; Baldwin, Grant

    2016-06-01

    This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death (Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.). PMID:27178083

  20. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    , incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain...... patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid...... treatment as addiction may result in poor pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability. Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer pain management are...

  1. Rethinking chronic pain in a primary care setting.

    Science.gov (United States)

    Stanos, Steven; Brodsky, Marina; Argoff, Charles; Clauw, Daniel J; D'Arcy, Yvonne; Donevan, Sean; Gebke, Kevin B; Jensen, Mark P; Lewis Clark, Evelyn; McCarberg, Bill; Park, Peter W; Turk, Dennis C; Watt, Stephen

    2016-06-01

    Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings. PMID:27166559

  2. Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty

    DEFF Research Database (Denmark)

    Lunn, Troels H; Gaarn-Larsen, Lissi; Kehlet, Henrik

    2013-01-01

    logistic regressions analyses were carried out including 8 potential preoperative explanatory variables (among these anxiety,depression, preoperative pain and pain catastrophizing) to assess pain response to preoperative heat pain stimulation as independent predictor for postoperative pain. 100 patients...... the linear and logistic regression analyses, where only anxiety, preoperative pain and pain catastrophizing were significant explanatory variables (but with low R-Squares;0.05-0.08). Pain responses to 2 types of preoperative heat stimuli were not independent clinical relevant predictors for......It has been estimated that up to 54% of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli, with suprathreshold heat pain as the most consistent test modality. We aimed to explore if 2 heat test paradigms could predict...

  3. Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging

    International Nuclear Information System (INIS)

    Avulsion fractures and chronic avulsion injuries of the knee are common lesions in sports-related trauma, especially among adolescents. Magnetic resonance imaging may prove useful in detecting and characterizing such lesions, and has several advantages with regard to other imaging modalities. We review, illustrate, and discuss the MR imaging features of some of the more frequent avulsion fractures and chronic avulsion injuries of the knee, including avulsion fractures of the cruciate ligaments, avulsion fractures of lateral and medial stabilizers, avulsion fractures and chronic avulsion injuries of the extensor mechanism, and avulsive cortical irregularities of the distal femur. The role of MR imaging in evaluating such lesions is emphasized. (orig.)

  4. Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mellado, J.M.; Ramos, A.; Salvado, E.; Camins, A.; Sauri, A. [Institut de Diagnostic per la Imatge, Hospital Universitari de Tarragona Joan XXIII, 43007 Tarragona (Spain); Calmet, J. [Department of Orthopaedic Surgery, Hospital Universitari de Tarragona Joan XXIII, 43007 Tarragona (Spain)

    2002-10-01

    Avulsion fractures and chronic avulsion injuries of the knee are common lesions in sports-related trauma, especially among adolescents. Magnetic resonance imaging may prove useful in detecting and characterizing such lesions, and has several advantages with regard to other imaging modalities. We review, illustrate, and discuss the MR imaging features of some of the more frequent avulsion fractures and chronic avulsion injuries of the knee, including avulsion fractures of the cruciate ligaments, avulsion fractures of lateral and medial stabilizers, avulsion fractures and chronic avulsion injuries of the extensor mechanism, and avulsive cortical irregularities of the distal femur. The role of MR imaging in evaluating such lesions is emphasized. (orig.)

  5. Effect of saphenous nerve block for postoperative pain on knee surgery: a meta-analysis

    OpenAIRE

    Jin, Shu-Qing; Ding, Xi-Bing; Tong, Yao; Ren, Hao; Chen, Zhi-Xia; Wang, Xin; Li, Quan

    2015-01-01

    Early post-operative mobilization is important both to reduce immobility-related complications and to get the best functional result following surgery on knee. We hypothesized that saphenous nerve block would reduce pain in this patient category compared with placebo injection. In this study, two reviewers independently searched the databases of PubMed, EMBASE, and Cochrane Library (last performed on 12 October, 2014) to retrieve eligible randomized controlled clinical trials. The primary out...

  6. [Psychological assessment and psychotherapy for chronic pain in the elderly].

    Science.gov (United States)

    Mattenklodt, P; Leonhardt, C

    2015-08-01

    Systematic reviews of psychosocial assessment and effectiveness of psychotherapy for chronic pain syndromes in older patients are rare. However, it is of particular importance to consider the psychosocial aspects of elderly people with chronic pain. This narrative review describes recommended German-language assessments of the psychosocial dimensions of pain and summarizes existing studies of psychological therapy approaches for chronic pain in old age. Effective psychometric instruments are available for the assessment of cognitive function, pain-specific attitudes, depression, fear of falling, interpersonal processes and social activities, pain management, pain acceptance, disability, psychological well-being, and quality of life. Further experience with the use of these instruments with cognitively impaired or geriatric patients is required. The efficacy of age-adapted cognitive behavioral therapy and multimodal therapy for older patients has been documented. However, there is often a lack of supporting documentation about important result parameters (e.g., quality of life, functioning in everyday life, or pain acceptance). Overall, chronic pain in elderly people requires a biopsychosocial-spiritual model of pain. More attention should be given in research and daily practice to religiosity/spirituality as a possible means of coping, while mindfulness- and acceptance-based therapies should be further explored. PMID:26024645

  7. Dynamic pain-emotion relations in chronic pain: a theoretical review of moderation studies

    OpenAIRE

    Dima, A.L.; Gillanders, D T; M. J. Power

    2011-01-01

    Current developments in chronic pain research are changing the focus in the study of pain-emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation at both intra- and interpersonal levels has significant clinical implications for psychological adjustment to chronic pain conditions, and thus represents an important topic for both clinical and ...

  8. The associations between pain sensitivity and knee muscle strength in healthy volunteers

    DEFF Research Database (Denmark)

    Henriksen, Marius; Klokker, Louise; Bartholdy, Cecilie; Graven-Nielsen, Thomas; Bliddal, Henning

    2013-01-01

    ) computer-controlled pressure algometry on the vastus lateralis and deltoid muscles and on the infrapatellar fat pad and 2) computerized cuff pressure algometry applied on the lower leg. Deep-tissue pain sensitivity (intensity and duration) was assessed by hypertonic saline injections into the vastus...... lateralis, deltoid, and infrapatellar fat pad. Quadriceps and hamstring muscle strength was assessed isometrically at 60-degree knee flexion using a dynamometer. Associations between pain sensitivity and muscle strength were investigated using multiple regressions including age, gender, and body mass index...

  9. Repression predicts outcome following multidisciplinary treatment of chronic pain.

    Science.gov (United States)

    Burns, J W

    2000-01-01

    This study examined whether repression predicts outcome following multidisciplinary treatment for chronic pain and whether links between anxiety and outcome are obscured by repressors. Ninety-three chronic pain patients completed a 4-week pain program. Lifting capacity, walking endurance, depression, pain severity, and activity were measured at pre- and posttreatment. Low-anxious, repressor, high-anxious, and defensive/high-anxious groups were formed from median splits of Anxiety Content (ACS) and Lie scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Significant ACS x Lie interactions were found for lifting capacity, depression, and pain severity changes. Planned comparisons showed that both repressors and high-anxious patients performed poorly on lifting capacity; repressors alone recovered poorly on depression and pain severity. Results imply that repression may interfere with the process and outcome of pain programs. PMID:10711590

  10. Knee Injuries and Disorders

    Science.gov (United States)

    Your knee joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is hurt or diseased, you have knee problems. Knee problems can cause pain and difficulty ...

  11. CE: Appropriate Use of Opioids in Managing Chronic Pain.

    Science.gov (United States)

    Denenberg, Risa; Curtiss, Carol P

    2016-07-01

    : Over the past two decades, the use of opioids to manage chronic pain has increased substantially, primarily in response to the recognized functional, emotional, and financial burden associated with chronic pain. Within this same period, unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal. PMID:27294667

  12. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomised, single-blind controlled trial

    Directory of Open Access Journals (Sweden)

    Hunter David J

    2007-12-01

    Full Text Available Abstract Background Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis (OA. Strengthening the hip abductor and adductor muscles may influence joint loading and/or OA-related symptoms, but no study has evaluated these hypotheses directly. The aim of this randomised, single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA. Methods/Design 88 participants with painful, radiographically confirmed medial compartment knee OA and varus alignment will be recruited from the community and randomly allocated to a hip strengthening or control group using concealed allocation stratified by disease severity. The hip strengthening group will perform 6 exercises to strengthen the hip abductor and adductor muscles at home 5 times per week for 12 weeks. They will consult with a physiotherapist on 7 occasions to be taught the exercises and progress exercise resistance. The control group will be requested to continue with their usual care. Blinded follow up assessment will be conducted at 12 weeks after randomisation. The primary outcome measure is the change in the peak external knee adduction moment measured during walking. Questionnaires will assess changes in pain and physical function as well as overall perceived rating of change. An intention-to-treat analysis will be performed using linear regression modelling and adjusting for baseline outcome values and other demographic characteristics. Discussion Results from this trial will contribute to the evidence regarding the effect of hip strengthening on knee loads and symptoms in people with medial compartment knee OA. If shown to reduce the knee adduction moment, hip strengthening has the potential to slow disease progression. Trial Registration Australia New Zealand Clinical Trials Registry ACTR12607000001493

  13. Evidence for a central mode of action for etoricoxib (COX-2 inhibitor) in patients with painful knee osteoarthritis.

    Science.gov (United States)

    Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær

    2016-08-01

    The COX-2 inhibitor etoricoxib modulates the peripheral and central nociceptive mechanisms in animals. This interaction has not been studied in patients with pain. This randomized, double-blind, placebo-controlled, 2-way crossover, 4-week treatment study investigated the pain mechanisms modulated by etoricoxib in patients with painful knee osteoarthritis. Patients were randomized to group A (60 mg/d etoricoxib followed by placebo) or B (placebo followed by 60 mg/d etoricoxib). The quantitative, mechanistic pain biomarkers were pressure pain thresholds, temporal summation (TS), and conditioning pain modulation. Clinical readouts were Brief Pain Inventory, WOMAC, painDETECT questionnaire (PD-Q), and time and pain intensity during walking and stair climbing. Etoricoxib as compared with placebo significantly modulated the pressure pain thresholds (P = 0.012, localized sensitization) at the knee and leg (control site) (P = 0.025, spreading sensitization) and TS assessed from the knee (P = 0.038) and leg (P = 0.045). Conditioning pain modulation was not modulated. The Brief Pain Inventory (pain scores), PD-Q, WOMAC, and walking and stair climbing tests were all significantly improved by etoricoxib. Based on a minimum of 30% or 50% pain alleviation (day 0-day 28), responders and nonresponders were defined. The nonresponders showed a significant association between increased facilitation of TS and increased pain alleviation. None of the other parameters predicted the degree of pain alleviation. Generally, a responder to etoricoxib has the most facilitated TS. In conclusion, etoricoxib (1) modulated central pain modulatory mechanisms and (2) improved pain and function in painful osteoarthritis. Stronger facilitation of TS may indicate a better response to etoricoxib, supporting the central mode-of-action of the drug. PMID:27007068

  14. Prevalence and characteristics of chronic pain in the general population of Hong Kong

    OpenAIRE

    Wong, WS; Fielding, R.

    2011-01-01

    Western studies document the prevalence of chronic pain in the general adult population to be between 2 and 55%. Knowing the prevalence of chronic pain among Chinese populations provides important comparative perspective: To determine the prevalence of chronic pain in the general population of Hong Kong; evaluate the relationship of chronic pain with sociodemographic and lifestyle factors; and describe the pain characteristics among chronic pain sufferers. A total of 5,001 adults aged ≥18 yea...

  15. New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty.

    Science.gov (United States)

    Elmallah, Randa K; Cherian, Jeffrey J; Pierce, Todd P; Jauregui, Julio J; Harwin, Steven F; Mont, Michael A

    2016-02-01

    Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed. PMID:25892004

  16. Management of insomnia in patients with chronic pain conditions.

    Science.gov (United States)

    Stiefel, Frederic; Stagno, Daniele

    2004-01-01

    The management of insomnia in patients experiencing chronic pain requires careful evaluation, good diagnostic skills, familiarity with cognitive-behavioural interventions and a sound knowledge of pharmacological treatments. Sleep disorders are characterised by a circular interrelationship with chronic pain such that pain leads to sleep disorders and sleep disorders increase the perception of pain. Sleep disorders in individuals with chronic pain remain under-reported, under-diagnosed and under-treated, which may lead--together with the individual's emotional, cognitive and behavioural maladaptive responses--to the frequent development of chronic sleep disorders. The moderately positive relationship between pain severity and sleep complaints, and the specificity of pain-related arousal and mediating variables such as depression, illustrate that insomnia in relation to chronic pain is multifaceted and poorly understood. This may explain the limited success of the available treatments. This article discusses the evaluation of patients with chronic pain and insomnia and the available pharmacological and nonpharmacological interventions to manage the sleep disorder. Non-pharmacological interventions should not be considered as single interventions, but in association with one another. Some non-pharmacological interventions especially the cognitive and behavioural approaches, can be easily implemented in general practice (e.g. stimulus control, sleep restriction, imagery training and progressive muscle relaxation). Hypnotics are routinely prescribed in the medically ill, regardless of their adverse effects; however, their long-term efficacy is not supported by robust evidence. Antidepressants provide an interesting alternative to hypnotics, since they can improve pain perception as well as sleep disorders in selected patients. Sedative antipsychotics can be considered for sleep disturbances in those patients exhibiting psychotic features, or for those with

  17. The influence of biomechanical characteristics on pain and function outcomes from exercise in medial knee osteoarthritis and varus malalignment

    DEFF Research Database (Denmark)

    Bennell, Kim L; Dobson, Fiona; Roos, Ewa M.;

    2015-01-01

    influence the pain-relieving effects of two different types of exercise. Further research is needed to confirm whether exercise that is prescribed according to specific biomechanical characteristics optimises knee OA outcomes. This article is protected by copyright. All rights reserved.......Objective: To investigate whether selected biomechanical characteristics influence changes in pain and physical function with exercise in people with medial knee osteoarthritis (OA) and varus malalignment. Methods: Post-hoc exploratory analyses from a randomised controlled trial involving 100...... people with medial knee OA and varus malalignment who were randomly allocated to one of two 12-week exercise programs; quadriceps strengthening or neuromuscular exercise. Outcome measures were change in overall average knee pain (visual analogue scale) and self-reported physical function (Western Ontario...

  18. Experimental muscle pain during a forward lunge--the effects on knee joint dynamics and electromyographic activity

    DEFF Research Database (Denmark)

    Henriksen, Marius; Alkjaer, T; Simonsen, Erik Bruun;

    2009-01-01

    OBJECTIVE: The purpose of this study was to investigate whether the knee joint dynamics during a forward lunge could be modulated by experimentally induced vastus medialis pain in healthy subjects. DESIGN: Randomised cross-over study. SETTING: Biomechanical movement laboratory. PARTICIPANTS: 20 h...... muscle pain and prevention of injuries during activities involving the knee joint.......OBJECTIVE: The purpose of this study was to investigate whether the knee joint dynamics during a forward lunge could be modulated by experimentally induced vastus medialis pain in healthy subjects. DESIGN: Randomised cross-over study. SETTING: Biomechanical movement laboratory. PARTICIPANTS: 20....... Isotonic saline (0.9%) was used as control. MAIN OUTCOME MEASUREMENTS: Three-dimensional movement analyses were performed and inverse dynamics were used to calculate joint kinematics and kinetics for ankle, knee and hip joints. Electromyographic (EMG) signals of the hamstrings and quadriceps muscles were...

  19. The Continuing and Growing Epidemic of Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    Robert J. Gatchel

    2015-09-01

    Full Text Available Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic problems caused by it, and the need for better pain-management programs. The present article briefly reviews these reports, and then focuses on three important areas that need to be considered when addressing the continuing and growing epidemic of one of the most prevalent types of chronic pain [chronic low back pain (CLBP]: the biopsychosocial model of chronic pain; the paradigm shift in medicine from a disease model to an illness model of CLBP; and a review of the treatment- and cost-effectiveness of interdisciplinary chronic pain management programs. This overview will serve as an important prelude to other topics related to low back pain included in this Special Issue of Healthcare. Topics covered will range from assessment and treatment approaches, to important psychosocial mediators/moderators such as coping and pain beliefs.

  20. Duloxetine in the management of chronic musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Smith EJ

    2012-06-01

    Full Text Available Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor