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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

    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

  5. 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 ...

  6. 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

  7. 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

  8. 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.

  9. 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 ...

  10. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... Collado H, Fredericson M. Patellofemoral pain syndrome. Clin Sports ... www.ncbi.nlm.nih.gov/pubmed/20610028 . De Carlo M, Armstrong ...

  11. ANALYSIS OF THE PATHOGENETIC MECHANISMS OF CHRONIC JOINT PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    E. S. Filatova

    2014-01-01

    Full Text Available Objective: to reveal neurogenic mechanisms in the pathogenesis of chronic pain syndrome in rheumatoid arthritis (RA and knee osteoarthritis (OA in order to develop individualized pharmacotherapy.Subjects and methods. One hundred and eighty-three patients with RA and 80 with knee OA were examined. By using the neuropathic pain diagnostic questionnaire (DN4, all the patients were divided into 2 groups with and without a neuropathic pain component (NPC.Results. NPC was found in 43% of the patients with RA and it was connected with involvement of the peripheral somatosensory system. In RA, NPC was common in older patients with longer disease duration, higher X-ray stage, and severe functional insufficiency. 30% of patients with knee OA also had NPC, however the signs of nervous system involvement were absent. In OA, NPC was associated with hyperalgesia, higher pain intensity, more marked joint dysfunction on the WOMAC, and anxiety.Discussion. This investigation revealed a mixed pattern of chronic pain syndrome in patients with RA and knee OA; some patients were found to have a NPC in the presence of predominantly a nociceptive component

  12. 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

  13. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Seitsalo Seppo

    2007-12-01

    Full Text Available Abstract Background Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS. As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS. Methods A total of 56 patients with chronic PFPS were randomized into two treatment groups: an arthroscopy group (N = 28, treated with knee arthroscopy and an 8-week home exercise program, and a control group (N = 28, treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs to assess activity-related symptoms. We also estimated the direct healthcare costs. Results Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI 8.2–17.6 in the arthroscopy group and 11.4 (95% CI 6.9–15.8 in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2 or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by €901 per patient (p Conclusion In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone. Trial registration Current Controlled Trials ISRCTN 41800323

  14. Nonsurgical Management of Knee Pain in Adults.

    Science.gov (United States)

    Jones, Brandon Q; Covey, Carlton J; Sineath, Marvin H

    2015-11-15

    The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients. Effective treatment depends on the etiology of knee pain. Oral analgesics-most commonly nonsteroidal anti-inflammatory drugs and acetaminophen-are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain. The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective. Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome. Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2. Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy. Foot orthoses can be helpful for anterior knee pain. Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary; recent systematic reviews do not support a clinically significant benefit. Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis. PMID:26554281

  15. Prevalent knee pain and sport

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders

    1998-01-01

    STUDY OBJECTIVE: To estimate the prevalence of knee pain in active athletes and to investigate potential associations to type, amount and duration of sports participation. MEASUREMENTS: 339 athletes gave information about occupation, sports activity and different features of knee pain, based...... on a self-filled questionnaire. MAIN RESULTS: The prevalence of knee pain within the preceding 12 months, constant or recurrent knee pain, absence from sport and absence from work due to knee pain, was 54%, 34%, 19% and 4%, respectively. Knee pain was positively associated with years of jogging...... and with 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...

  16. Knee pain in competitive swimming.

    Science.gov (United States)

    Rodeo, S A

    1999-04-01

    The high volume of training in competitive swimming results in cumulative overload injuries. Knee pain ranks second to shoulder pain as a common complaint in competitive swimmers. Most knee pain occurs on the medial side of the knee and, most commonly, in breaststroke swimmers; however, knee pain may accompany all strokes. This article reviews the incidence of knee pain, the biomechanic and anatomic factors predisposing to injury, specific injury patterns, injury diagnosis, and the treatment and prevention of injury to the knee in swimmers. PMID:10230572

  17. Chronic pre-operative opioid use and acute pain after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Aasvang, E K; Lunn, T H; Hansen, T B;

    2016-01-01

    available for final analysis (93% follow-up rate). Post-operative pain during walk was significantly increased in both opioid-treated groups vs. non-opioid-treated patients (P ...BACKGROUND: Pre-operative opioid use has been suggested to increase post-operative pain and opioid consumption after total knee arthroplasty (TKA), but previous studies are either retrospective or inhomogeneous with regard to surgical procedures or control of analgesic regimes, or with few opioid...... had well-defined multimodal opioid-sparring perioperative analgesic therapy, and continued any pre-operative opioid medication. The primary outcome was differences between groups in pain at rest and during walk for the first 6 post-operative days. RESULTS: Among 123 patients included, 115 were...

  18. Analgesic effects of intra-articular botulinum toxin Type B in a murine model of chronic degenerative knee arthritis pain

    Directory of Open Access Journals (Sweden)

    Stephanie Anderson

    2010-09-01

    Full Text Available Stephanie Anderson1,2, Hollis Krug1,2, Christopher Dorman1, Pari McGarraugh1, Sandra Frizelle1, Maren Mahowald1,21Rheumatology Section, Veteran’s Affairs Medical Center, Minneapolis, Minnesota; 2Division of Rheumatology and Autoimmune Diseases, University of Minnesota Medical School, Minneapolis, Minnesota, USAObjective: To evaluate the analgesic effectiveness of intra-articular botulinum toxin Type B (BoNT/B in a murine model of chronic degenerative arthritis pain.Methods and materials: Chronic arthritis was produced in adult C57Bl6 mice by intra-articular injection of Type IV collagenase into the left knee. Following induction of arthritis, the treatment group received intra-articular BoNT/B. Arthritic control groups were treated with intra-articular normal saline or sham injections. Pain behavior testing was performed prior to arthritis, after induction of arthritis, and following treatments. Pain behavior measures included analysis of gait impairment (spontaneous pain behavior and joint tenderness evaluation (evoked pain response. Strength was measured as ability to grasp and cling.Results: Visual gait analysis showed significant impairment of gait in arthritic mice that improved 43% after intra-articular BoNT/B, demonstrating a substantial articular analgesic effect. Joint tenderness, measured with evoked pain response scores, increased with arthritis induction and decreased 49.5% after intra-articular BoNT/B treatment. No improvement in visual gait scores or decrease in evoked pain response scores were found in the control groups receiving intra-articular normal saline or sham injections. Intra-articular BoNT/B was safe, and no systemic effects or limb weakness was noted.Conclusions: This study is the first report of intra-articular BoNT/B for analgesia in a murine model of arthritis pain. The results of this study validate prior work using intra-articular neurotoxins in murine models. Our findings show chronic degenerative arthritis

  19. 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 ...

  20. 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...

  1. 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.

  2. Chronic pain - resources

    Science.gov (United States)

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association -- www.theacpa.org National Fibromyalgia and Chronic Pain Association -- www.fmcpaware.org ...

  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. 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 ...

  9. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.;

    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: 2008/3...

  10. 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...

  11. High volume acupuncture clinic (HVAC) for chronic knee pain--audit of a possible model for delivery of acupuncture in the National Health Service.

    Science.gov (United States)

    Berkovitz, Saul; Cummings, Mike; Perrin, Chris; Ito, Rieko

    2008-03-01

    Recent research has established the efficacy, effectiveness and cost effectiveness of acupuncture for some forms of chronic musculoskeletal pain. However, there are practical problems with delivery which currently prevent its large scale implementation in the National Health Service. We have developed a delivery model at our hospital, a 'high volume' acupuncture clinic (HVAC) in which patients are treated in a group setting for single conditions using standardised or semi-standardised electroacupuncture protocols by practitioners with basic training. We discuss our experiences using this model for chronic knee pain and present an outcome audit for the first 77 patients, demonstrating satisfactory initial (eight week) clinical results. Longer term (one year) data are currently being collected and the model should next be tested in primary care to confirm its feasibility.

  12. 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 ...

  13. 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? ...

  14. 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 ...

  15. 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

    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 tota...

  16. 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 ...

  17. 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 ...

  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. 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 ...

  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. 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 ...

  2. 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 ...

  3. 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 ...

  4. Is knee pain during adolescence a self-limiting condition?

    DEFF Research Database (Denmark)

    Rathleff, Michael S.; Rathleff, Camilla R.; Olesen, Jens L.;

    2016-01-01

    BACKGROUND: The prevalence of adolescent knee pain is 33%, and patellofemoral pain (PFP) is the most common diagnosis with a nontraumatic onset. The 2-year prognosis of adolescent PFP compared with other types of knee pain is unknown. PURPOSE: To investigate the 2-year prognosis of knee pain amon...... without knee pain at baseline. CONCLUSION: Knee pain during adolescence, and PFP in particular, is in most cases present after 2 years and thus may not be self-limiting. A greater focus on early detection and prevention of knee pain during adolescence is needed....

  5. 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....

  6. 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,” ...

  7. Anterior knee pain following primary total knee arthroplasty.

    Science.gov (United States)

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-11-18

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  8. 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 ...

  9. Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Richard Henry

    2012-01-01

    Full Text Available BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA in patients with osteoarthritis (OA.

  10. 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

  11. 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.

  12. 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 ...

  13. 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 ...

  14. 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 ...

  15. 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 ...

  16. 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 ...

  17. 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 ...

  18. 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....

  19. [Chronic pain in geriatrics].

    Science.gov (United States)

    Kennes, B

    2001-06-01

    Pain is frequent in communicative or no-communicative, ambulatory, institutionalized or hospitalized veterans. It is associated with severe comorbidity so much more than chronic pain could be neglected and expressed of atypical manner or masked by the absence of classical symptoms in particular in case of dementia or of sensory disorders. Pain detection by clinic examination or by pain assessment's methods and adequate approach by pharmacological and non pharmacological therapies are essential for correct pain management. On pharmacological plan, the strategy of the O.M.S. landings is applicable owing to a more particular attention to secondary effects and drugs interactions. AINS must be manipulated with prudence. There are no reasons to exclude opioides from the therapeutic arsenal but with a reduction of the starting doses, a regular adaptation and a very attentive survey. In drugs of landing 2, tramadol reveals itself as efficient and better tolerated as the codeine and dextropropoxyphene has to be to avoid. The obtaining of a satisfactory result depends on a regular assessment of the pain in a context of polydisciplinar approach (physicians, nurses, paramedicals, other care givers).

  20. 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.

  1. 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

  2. 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...

  3. 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;

    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...... of Malmö, Sweden, were questioned about knee pain. We classified subjects reporting knee pain with a duration of at least 4 weeks as having frequent knee pain. A random sample of 1300 individuals with frequent knee pain and 650 without were invited for assessment by the ACR clinical knee OA criteria...... and for bilateral weight-bearing knee radiography. We considered a Kellgren-Lawrence grade ≥2 as radiographic knee OA and that in combination with frequent knee pain as symptomatic knee OA. By linkage with the Skåne Healthcare Register, we determined the proportion of subjects that had consulted for knee OA or pain...

  4. 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...

  5. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty.

    Science.gov (United States)

    Park, Caroline N; White, Peter B; Meftah, Morteza; Ranawat, Amar S; Ranawat, Chitranjan S

    2016-01-01

    Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty. PMID:26811953

  6. 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

    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 stocking the day......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...

  7. ANTERIOR KNEE PAIN IN TRANSTENDINOUS AND PARATENDINOUS APPROACHES OF TIBIAL INTERLOCKING NAIL: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Gyaneshwar

    2014-07-01

    Full Text Available BACKGROUND: Anterior knee pain has been described as the most common complication after intramedullary nailing of fracture shaft of tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be as one of the contributing causes of chronic anterior knee pain. The purpose of this prospective, randomized study was to compare the incidence of anterior knee pain after intramedullary nailing of a tibial shaft fracture with transtendinous and paratendinous incision technique. MATERIAL AND METHODS: From April 2012 to October 2013 eighty patients with closed tibial shaft fractures were admitted and treated in our institution. Patients were randomized for treatment with paratendinous or transtendinous nailing (as 24 patients did not complete their follow up or were lost in follow up, so 56 patients were analyzed finally. For assessment we used visual analogue scales to report the level of anterior knee pain. The scales described by Lysholm and Gillquist and by Tegner et al., were also used to quantitate the functional results. RESULTS: 12 of the 28 (42% patients treated with transtendinous nailing. reported anterior knee pain whereas 8 patients out of 28 (28%, in which paratendinous technique was used had persistent anterior knee pain after minimum final follow up of 24 weeks, with no significant statistical difference. The Lysholm, Tegner functional scoring systems showed a significant difference between the two groups. CONCLUSION: Compared with a transtendinous approach, a paratendinous approach for nail insertion does not reduce the incidence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients. Since our study is small and have short duration of follow up, further larger studies and long duration of follow up is needed to establish the results

  8. Chronic pain in Rehabilitation Medicine

    NARCIS (Netherlands)

    Geertzen, J.H.B.; van Wilgen, C.P.; Schrier, E.; Dijkstra, P.U.

    2006-01-01

    In this paper the chronicity of pain in non-specific pain syndromes is discussed. Experts in the study of pain with several professional backgrounds in rehabilitation are the authors of this paper. Clinical experience and literature form the basis of the paper. Non-specific low back pain and Complex

  9. 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.

  10. Tibial Tubercle Osteotomy for Anterior Knee Pain

    Science.gov (United States)

    Bonasia, Davide; Rosso, Federica; Cottino, Umberto; Governale, Giorgio; Cherubini, Valeria; Dettoni, Federico; Bruzzone, Matteo; Rossi, Roberto

    2016-01-01

    Objectives: The aim of this study was to evaluate the mid-term radiological and clinical outcomes of tibial tubercle osteotomy in patients affected by anterior knee pain. In addition, prognostic factors correlated with the outcomes were evaluated. Methods: The patients treated with tibial tubercle osteotomy (anteromedialization) for anterior knee pain between 2002 and 2014 were included. Exclusion criteria: 1) previous knee surgeries; 2) different procedures to treat anterior knee pain; 3) history of patellar dislocation, 4) Rheumatic conditions. Different variables were collected, as shown in. The patients were prospectively evaluated using the WOMAC short form and Kujala scores. An objective evaluation was performed looking for different potential risk factors and using part of the International Knee Documentation Committee (IKDC) score. Radiological evaluation was performed, including the congruence angle, the grade of osteoarthritis (Kellegren-Lawrence) and the patellar tilt angle. Three main outcomes were identified. The multiple logistic regression was used to analyze the correlation between the variables and a worse outcome. Results: 72 cases were included in the study (9 bilateral). 72.2% of the cases were female, and the average age was 42,2 years (SD15,9). The average BMI was 24.4 kg/m2 (SD5,2). In 70.8% of patients a lateral release was associated to the tibial tubercle osteotomy. 77.8% of patients were evaluated clinically, the remaining, who were unable to come for the visits, were interviewed and the subjective scores were administered by phone. The average follow-up was 68.4 months (SD35.5).In 62.5% of cases a valgus lower limb alignment was detected, with 25% and 39.3% of patients having respectively an increased femoral antiversion and foot pronation. Post-operatively there was a statistical significant improvement in all the scores. No differences in the pre-operative and post-operative congruence angle or patellar tilt were detected (p>0.05). All

  11. 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...

  12. 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).

  13. 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

  14. 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

  15. 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 ...

  16. Management of chronic visceral pain

    DEFF Research Database (Denmark)

    Olesen, Anne E; Farmer, Adam D; Olesen, Søren S;

    2016-01-01

    Despite marked differences in underlying pathophysiology, the current management of visceral pain largely follows the guidelines derived from the somatic pain literature. The effective management of patients with chronic visceral pain should be multifaceted, including both pharmacological......' symptoms, adopting an empathic approach and taking time to educate patients. To optimize treatment and outcomes in chronic visceral pain we need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations...... in central pain processing....

  17. 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

  18. 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).......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)....

  19. Fighting Chronic Pain

    Science.gov (United States)

    ... leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, colitis Urinary/Reproductive: Kidney stones, pelvic pain, vulvodynia, ...

  20. 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

  1. [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

  2. 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.

  3. 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

  4. Taping reduces pain and disability in patients with knee osteoarthritis.

    NARCIS (Netherlands)

    Ende, E. van den

    2004-01-01

    Question: Is taping of the knee effective in improving pain and disability in patients with osteoarthritis of the knee? Design Randomised controlled trial. Setting University and private practices in Melbourne, Australia. Patients: Volunteers who responded to advertisements in local newspapers. Incl

  5. Radiological Evaluation of Cystic Lesions Presenting as Painful Knee

    Directory of Open Access Journals (Sweden)

    Rajpal Yadav

    2014-06-01

    Conclusion:Painful knee can be a presenting symptom of many cystic lesions of knee. Ultrasound can show the cystic abnormality, but it is only the Magnetic Resonance Imaging which can demonstrate the complete entity. [Cukurova Med J 2014; 39(3.000: 550-558

  6. [A man with a painful knee with restricted flexion

    NARCIS (Netherlands)

    Valkering, L.J.; Zengerink, M.; Kampen, A. van

    2015-01-01

    A 39-year-old man presented with knee pain and limited knee flexion. MRI showed a mucoid degeneration of the anterior cruciate ligament (celery stalk sign). This rare condition can be treated with arthroscopic debridement with volume reduction of the anterior cruciate ligament. In severe cases, ante

  7. Anterior knee pain: an update of physical therapy.

    Science.gov (United States)

    Werner, Suzanne

    2014-10-01

    Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.

  8. What Is Chronic Pain?

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    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 ...

  9. What Is Chronic Pain?

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    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 ...

  10. Application value of 0.45T permanent magnet MRI in determining knee joint chronic pain%0.45 T永磁 MRI在膝关节慢性疼痛中的应用价值评价

    Institute of Scientific and Technical Information of China (English)

    成明富; 常小娜; 周飞; 张雷鸣

    2015-01-01

    目的:评价0.45T永磁MRI在膝关节慢性疼痛中的应用价值。方法对60例膝关节慢性疼痛患者计68个膝关节的CR平片、29例患者CT横断面容积扫描图像以及68个膝关节MRI扫描图像进行回顾性分析、对照;其中43例与关节镜检查进行对照分析。结果 CR检查:阳性27个膝关节,阴性41个膝关节;CT检查(29例计58个膝关节):患侧阳性23个膝关节中,其中关节积液19例、关节内及其周围囊肿7例、半月板损伤5例,关节面增生、硬化17例;阴性6个膝关节;MR检查阳性59个膝关节中,软骨损伤4例、关节积液35例、内侧半月板损伤45例、外侧半月板损伤39例、半月板半脱位5例、关节内及其周围囊肿13例;阴性9个膝关节。关节镜检查(43个关节):软骨损伤2例、关节积液23例、内和(或)外侧半月板损伤共33例、半月板半脱位5例,关节内及其周围囊肿7例等。 MRI、CT、CR检查与关节镜检查结果符合率分别为83.72%(36/43)、59.09%(13/22)和11.62%(5/43)。结论低场MRI在明确膝关节慢性疼痛病因方面明显优于CR平片及CT,应列为首选检查方法;引起膝关节慢性疼痛的最主要原因为半月板损伤,其次为关节积液。%Objective To evaluate the application value of 0.45T permanent magnet MRI in identifying knee joint chronic pain.Methods Retrospective analysis and contrast were conducted in terms of CR films of 60 patients suffering from knee joint chronic pain (68 knee joints),cross sectional CT volume scanning images of 29 cases,and MRI scanning images of 68 knee joints .Results of 43 cases were analyzed and contrasted with those by the arthroscopy .Results CR examination:27 posi-tive knee joints and 41 negative ones.CT examination (29 cases, 58 knee joints in all):Of the affected 23 positive knee joints,joint effusion was detected in 19,joint cyst in 7,meniscus injury in 5,and

  11. 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...

  12. 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...

  13. 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.

  14. 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.

  15. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  16. Knee Pain and the Weekend Warriors

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    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 ...

  17. Knee Pain and the Weekend Warriors

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    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 ...

  18. Arthritic Pain Relief through Partial Knee Replacement

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    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. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  20. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  1. Knee Pain and the Weekend Warriors

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    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 ...

  2. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  3. Knee Pain and the Weekend Warriors

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    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 ...

  4. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  5. Knee Pain and the Weekend Warriors

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    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 ...

  6. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  7. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  8. Pregabalin for Pain Treatment in Chronic Pancreatitis

    DEFF Research Database (Denmark)

    Olesen, Søren Schou; Bowense, S; Wilder-Smith, Oliver;

    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...

  9. Holistic approach to understanding anterior knee pain. Clinical implications.

    Science.gov (United States)

    Sanchis-Alfonso, Vicente

    2014-10-01

    Anterior knee pain is one of the most frequent reasons for consultation within knee conditions. The aetiology is not well known, which explains the sometimes unpredictable results of its treatment. Normally, when we see a patient in the office with anterior knee pain, we only study and focus on the knee. If we do this, we are making a big mistake. We must not forget to evaluate the pelvis and proximal femur, as well as the psychological factors that modulate the course of the illness. Both the pelvifemoral dysfunction as well as the psychological factors (anxiety, depression, catastrophization and kinesiophobia) must be included in our therapeutic targets of the multidisciplinary treatment of anterior knee pain. We must not only focus on the knee, we must remember to "look up" to fully understand what is happening and be able to solve this difficult problem. The aetiology of anterior knee pain is multifactorial. Therefore, diagnosis and treatment of patellofemoral disorders must be individualized. Our findings stress the importance of tailoring physiotherapy, surgery and psycho-educational interventions to each patient.

  10. 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

  11. 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.

  12. 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

  13. 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 ...

  14. 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....

  15. An Unexpected Cause of Knee Pain in a Patient with Juvenile Idiopathic Arthritis: Osteoid Osteoma

    Directory of Open Access Journals (Sweden)

    Mehmet Eroğlu

    2014-06-01

    Full Text Available Patients with chronic diseases may sometimes be underestimated because of the relapsing nature of the disease and thus some newly developing phenomena may be overlooked. In this case we present a 12- year old female patient who was followed up for juvenile idiopathic arthritis and applied to us as an exacerbation of the disease. After initiation of therapy all her complaints but the right knee improved. In the examination of knee, limitation in hip movements was detected. X- ray of the hip revealed a mass neighboring the minor trochanter. On magnetic resonance imaging the mass was detected to be an osteoid osteoma. The patient is free of pain with conservative treatment for tumor after twelve months. It is important to evaluate the patient thoroughly without focusing on a single point and keep in mind that in especially skeletally immature patients hip pain can be felt in the knee.

  16. Knee Pain and the Weekend Warriors

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    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 ...

  17. Knee Pain and the Weekend Warriors

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    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 ...

  18. Knee Pain and the Weekend Warriors

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    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 ...

  19. Knee Pain and the Weekend Warriors

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    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 ...

  20. Knee Pain and the Weekend Warriors

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    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, ...

  1. Knee Pain and the Weekend Warriors

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    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 ...

  2. Knee Pain and the Weekend Warriors

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    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 ...

  3. 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....... 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....

  4. Knee Pain and the Weekend Warriors

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    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 ...

  5. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  6. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  7. Knee Pain and the Weekend Warriors

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    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 ...

  8. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  9. Knee Pain and the Weekend Warriors

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    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 ...

  10. Knee Pain and the Weekend Warriors

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    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 ...

  11. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  12. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  13. Knee Pain and the Weekend Warriors

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    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 ...

  14. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  15. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  16. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  17. Knee Pain and the Weekend Warriors

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    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 ...

  18. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  19. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  20. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  1. Knee Pain and the Weekend Warriors

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    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. ...

  2. Arthritic Pain Relief through Partial Knee Replacement

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    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 ...

  3. 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 ...

  4. 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 ...

  5. 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 ...

  6. 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 ...

  7. 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 ...

  8. 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 ...

  9. 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 ...

  10. 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 ...

  11. 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 ...

  12. 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 ...

  13. 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 ...

  14. 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 ...

  15. 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 ...

  16. 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 ...

  17. 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 ...

  18. Clinical Testing for Extra-Articular Lateral Knee Pain. A Modification and Combination of Traditional Tests

    Science.gov (United States)

    2008-01-01

    Knee pain is one of the most common problems encountered by recreational and competitive athletes. Pain over the lateral aspect of the knee can be the result of intra or extra articular conditions. The purpose of this clinical suggestion is to present the modification of a traditional clinical test to aide in the differential diagnosis of lateral knee pain. This method has not been described elsewhere and anecdotally has been helpful in the evaluation of patients with lateral knee pain. PMID:21509133

  19. 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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    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......Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related...... to 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...

  1. Comprehensive management of chronic pain in haemophilia.

    Science.gov (United States)

    Young, G; Tachdjian, R; Baumann, K; Panopoulos, G

    2014-03-01

    Chronic pain, most often due to haemophilic arthropathy, is a pervasive problem in persons with haemophilia (PWH) that adversely impacts function and quality of life. PWH with inhibitors and older PWH may be especially vulnerable to progressive arthropathy and resulting chronic pain. The development of chronic pain from acute pain involves a complex interplay of biological and psychosocial factors that may all contribute to the perpetuation of chronic pain and the outcome of therapy. In the absence of evidence-based guidelines, an individualized, multimodal approach to chronic pain management is proposed, as it is in individuals without haemophilia who have chronic pain. Pharmacological treatment is central to the management of chronic pain and must be modified based on pain intensity, ongoing response to therapy and the risk for adverse events. Non-pharmacological interventions, including physiotherapy, complementary treatments and surgical (e.g. orthopaedic) or other invasive procedures, may be integral to chronic pain management in this population. Ongoing psychosocial assessment is critical to identify those factors that may be contributing to the perpetuation of chronic pain or acting as barriers to effective management. Additional study is needed to identify optimal pharmacological treatments for chronic pain in PWH based on the unique pathophysiology of haemophilic arthropathy and on risk profile. Systematic determination of the particular psychosocial factors impacting the experience and management of chronic pain in PWH would likewise add value to the treatment of this pervasive problem.

  2. Effects of proprioceptive circuit exercise on knee joint pain and muscle function in patients with knee osteoarthritis.

    Science.gov (United States)

    Ju, Sung-Bum; Park, Gi Duck; Kim, Sang-Soo

    2015-08-01

    [Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis.

  3. 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 ...

  4. Interesting clinical presentation of anterior knee pain causing diagnostic dilemma.

    Science.gov (United States)

    Morgan, Samer S; Balasubramanian, S; Teanby, D

    2009-09-01

    A diverse variety of lesions may occasionally occur in the patella. In this case report, we are presenting an interesting case of anterior knee pain in middle aged gentleman. Initial investigations including Magnetic Resonance Imaging not showed any abnormality. Due to prolonged continued pain he had bone scan and MRI, which confirmed the diagnosis of Brodie's abscess. We are presenting this case of Brodie's abscess of the patella causing diagnostic dilemma because of its rarity.

  5. The analgesic effects of intra-articular botulinum toxin type A and mechanisms in chronic knee arthritis pain model%A型肉毒杆菌毒素对佐剂关节炎大鼠的镇痛作用

    Institute of Scientific and Technical Information of China (English)

    茹靖涛; 曹靖; 秦涛

    2012-01-01

    目的 观察关节腔内注射A型肉毒杆菌毒素(BoNT/A)在佐剂关节炎模型中的镇痛效果及疼痛相关物质在脊神经节及脊髓的变化.方法 SD大鼠右后足跖部皮下注射完全弗氏佐剂(CFA)0.1 ml建立类风湿性关节炎的动物模型(AA).关节炎形成后随机分为3组:BoNT组(n=10):关节腔内注射Botox/A 0.02 IU/5μl;NS组(n=10):关节腔内注射生理盐水5μl;Sham组(n=10):非关节炎模型组.5d后检测疼痛行为学、力量评估;免疫组织化学检测脊神经节钠离子通道1.8(Nav1.8)、脊髓N-甲基-D-天冬氨酸受体2B亚基(NR2B)的表达.结果 肉眼步态分析显示大鼠关节炎引起的严重的步态异常,BoNT治疗组改善了40% (P <0.05);治疗组大鼠右足热痛阈升高(P<0.05);脊神经节Nav1.8高表达;脊髓NR2B表达降低.结论 通过关节腔内注射Botox/A可以抑制疼痛信号的传导,减轻关节痛.%Objective To estimate the analgesic effect of intra-articular injection of botulinum toxin type A (BoNT/A) in adjuvant arthritis model and to explore the related factors associated with arthritis pain.Methods We established murime model of chronic knee arthritis pain by injection of complete Freund's adjuvant (CFA) 0.1 ml into the right paw of Sprague Dawley rats.Following induction of arthritis,BoNT/A group (n =10) received intra-articular BoNT/A0.02 IU/5 μL; NS group (n =10) was treated with intra-articular 5 μL saline injections.In Sham group (n =10),no artiritis model was established.Pain behavior testing was performed prior to arthritis,after induction of arthritis,and following treatments.Pain behavior measures included analysis of gait impairment and thermal pain threshold.Strength was measured as ability to cling.Pain related factors Nav1.8 and NR2B were detected by using immunohistochemistry.Results Gait analysis showed that significant impairment of gait in arthritic mice wast improved by 40% ( P < 0.05 ) after intra-articular Bo

  6. Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia

    Directory of Open Access Journals (Sweden)

    G. Biasi

    2014-06-01

    Full Text Available Chronic pelvic pain (CPP is a common condition that has a major impact on the quality of life of both men and women. Male CPP is usually attributable to well-defined urogenital conditions (most frequently infectious/non infectious prostatic diseases or musculoskeletal or bowel diseases, whereas the features of female CPP are much more complex and are of particular clinical and epidemiological importance. It is a multifactorial syndrome that can be due to diseases of the urogenital, gastrointestinal, or musculoskeletal systems, or to neurological or neuropsychiatric disorders. It is not always easy to identify its predominant pathogenesis, although it often occurs as a central sensitization syndrome triggered by an initial stimulus which is no longer detectable and only manifests itself clinically through pain. In this respect, there are some very interesting relationships between vulvodynia and fibromyalgic syndrome, as identified in a preliminary study of women with chronic musculoskeletal pain in which it was demonstrated that vulvar pain plays an important role, although it is often overlooked and undiagnosed.

  7. 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

    score, during active flexion of the knee (primary endpoint), was observed in favour of Group A, 95% confidence interval (CI): 23-42, Panalysis revealed that 25......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...... 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...

  8. 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.

  9. 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 ...

  10. 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, ...

  11. 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 ...

  12. 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 ...

  13. 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 ...

  14. 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 ...

  15. 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. ...

  16. 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 ...

  17. 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 ...

  18. [Association between chronic pain and depression].

    Science.gov (United States)

    Alonso Fernández, Francisco

    2005-01-01

    The comorbidity integrated by chronic pain and depression is very common. The somatoform depressive symptoms appear often as diferent types of pain. Amon them premenstrual pain and fibromialgia are some of the most important clinical pictures. Chronic pain leads to depression as a consequence of these three kinds of factors: biomedical, psychosocial (passive attitude, disability) and pharmacological agents. Copping and acceptance of chronic pain is associated with lower pain intensity, less depression and less psychosocial disability. The appropriate use of analgesics in the management of chronic pain demands individualization. Several antidepressants have possitive effects on pain syndrom. Depression is underrecognized ad undertreated above all in patients with chronic pain. In order screening the depression seven ways are described here: personal and family history, type of the personality, clinic and evolutive aspects of somatoform symptom, search of other depressive symptoms and positive therapeutic effect determinated by an antidepressant.

  19. 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.

  20. 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 ...

  1. 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...

  2. 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

    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...... 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 association between knee alignment and knee pain in patients with knee OA indicating that alignment and pain are separate entities...

  3. 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

    ), 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). RESULTS: Two patients were lost to follow...

  4. 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...

  5. 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.

  6. Iliotibial band syndrome: a common source of knee pain.

    Science.gov (United States)

    Khaund, Razib; Flynn, Sharon H

    2005-04-15

    Iliotibial band syndrome is a common knee injury. The most common symptom is lateral knee pain caused by inflammation of the distal portion of the iliotibial band. The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon. In some athletes, repetitive flexion and extension of the knee causes the distal iliotibial band to become irritated and inflamed resulting in diffuse lateral knee pain. Iliotibial band syndrome can cause significant morbidity and lead to cessation of exercise. Although iliotibial band syndrome is easily diagnosed clinically, it can be extremely challenging to treat. Treatment requires active patient participation and compliance with activity modification. Most patients respond to conservative treatment involving stretching of the iliotibial band, strengthening of the gluteus medius, and altering training regimens. Corticosteroid injections should be considered if visible swelling or pain with ambulation persists for more than three days after initiating treatment. A small percentage of patients are refractory to conservative treatment and may require surgical release of the iliotibial band.

  7. 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.

  8. 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

  9. Future perspectives: pathogenesis of chronic muscle pain.

    Science.gov (United States)

    Staud, Roland

    2007-06-01

    Chronic painful muscle conditions include non-inflammatory and inflammatory illnesses. This review is focused on chronic non-inflammatory pain conditions such as myofascial pain syndrome (MPS) and fibromyalgia syndrome (FM), and will not discuss metabolic, genetic or inflammatory muscle diseases such as McArdle's disease, muscular dystrophy, polymyositis, dermatomyositis, or inclusion body myositis.

  10. 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 ...

  11. 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 ...

  12. 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 ...

  13. 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 ...

  14. 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 ...

  15. 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 ...

  16. 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. ...

  17. 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 ...

  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 ... opposed to men. Are there any factors that affect how females do in recovering from the surgery ...

  19. 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 ...

  20. 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 ...

  1. 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 ...

  2. 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 ...

  3. 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)

  4. 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

  5. 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.

  6. 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.

  7. The burden of chronic pain

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per; Juel, Knud;

    2012-01-01

    in 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. 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

  9. 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

  10. 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...

  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. 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...

  13. 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.…

  14. Knee Muscle Forces during Walking and Running in Patellofemoral Pain Patients and Pain-Free Controls

    Science.gov (United States)

    Besier, Thor F.; Fredericson, Michael; Gold, Garry E.; Beaupré, Gary S.; Delp, Scott L.

    2009-01-01

    One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n=27, 16 female; 11 male) and compare these to pain-free controls (n=16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p=0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30-50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (pjoint contact forces and joint stresses than pain-free subjects. PMID:19268945

  15. Treatment of knee flexion contracture in patients with chronic juvenile arthritis: A case report

    OpenAIRE

    Matijević Radmila; Stanković Milan; Ninković Srđan; Savić Dragan; Milankov Miroslav

    2006-01-01

    Introduction. Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. Case report. A 23-year-old female patient with chronic juvenile arthriti...

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. The Keele community knee pain forum: action research to engage with stakeholders about the prevention of knee pain and disability

    Directory of Open Access Journals (Sweden)

    Ong Bie

    2009-07-01

    Full Text Available Abstract Background Involvement of users in health care research is central to UK health care policy, and guidelines for involvement exist. However, there are limited examples in rheumatology research. The aim of this study was to establish a community knee pain forum aimed at engaging stakeholders in design, dissemination and prioritisation of knee pain research. Methods Ten people were recruited to the forum representing a wide range of agencies. These included Weight Watchers, the leisure industry, Beth Johnson Foundation, health and social care professionals and the public. Three two-hour meetings over a two-year period were held. Experienced qualitative researchers facilitated each meeting. Written feedback after each meeting was elicited, and a short evaluation form was mailed to all members after the final meeting. Results Establishing and maintaining a forum of mixed members required careful preparation and ongoing support. Meetings had to be well-structured in order to allow for balanced participation of lay and professional users. Users contributed to the design of methods, provided ideas for dissemination and set priorities for further research. Clear documentation of meetings ensured that users' contributions to the research cycle were transparent. Conclusion Our knee pain forum illustrates that community engagement can have a positive impact on the development, dissemination and implementation of health research. Engaging with non-academic partners enables mutual learning and this enhances the quality of NHS research.

  2. 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.

  3. Assessment of patients with chronic pain.

    Science.gov (United States)

    Dansie, E J; Turk, D C

    2013-07-01

    Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Although there have been many scientific advances in the understanding of the neurophysiology of pain, precisely assessing and diagnosing a patient's chronic pain problem is not straightforward or well-defined. How chronic pain is conceptualized influences how pain is evaluated and the factors considered when making a chronic pain diagnosis. There is no one-to-one relationship between the amount or type of organic pathology and pain intensity, but instead, the chronic pain experience is shaped by a myriad of biomedical, psychosocial (e.g. patients' beliefs, expectations, and mood), and behavioural factors (e.g. context, responses by significant others). Assessing each of these three domains through a comprehensive evaluation of the person with chronic pain is essential for treatment decisions and to facilitate optimal outcomes. This evaluation should include a thorough patient history and medical evaluation and a brief screening interview where the patient's behaviour can be observed. Further assessment to address questions identified during the initial evaluation will guide decisions as to what additional assessments, if any, may be appropriate. Standardized self-reported instruments to evaluate the patient's pain intensity, functional abilities, beliefs and expectations, and emotional distress are available, and can be administered by the physician, or a referral for in depth evaluation can be made to assist in treatment planning.

  4. Muscle strength in patients with chronic pain

    NARCIS (Netherlands)

    van Wilgen, C.P.; Akkerman, L.; Wieringa, J.; Dijkstra, P.U.

    2003-01-01

    Objective: To analyse the influence of chronic pain on muscle strength. Design: Muscle strength of patients with unilateral nonspecific chronic pain, in an upper or lower limb, were measured according to a standardized protocol using a hand-held dynamometer. Before and after muscle strength measurem

  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. 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

  8. 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

  9. Half of 12-15-year-olds with knee pain still have pain after one year

    DEFF Research Database (Denmark)

    Rathleff, Camilla Rams; Olesen, Jens Lykkegaard; Roos, Ewa M.;

    2013-01-01

    Adolescent knee pain is considered benign and presumed to disappear without treatment. However, this has never been investigated. The purpose of this study was to 1) compare leisure time sports participation, health-related quality of life (HRQoL) and body mass index between adolescents with and ......Adolescent knee pain is considered benign and presumed to disappear without treatment. However, this has never been investigated. The purpose of this study was to 1) compare leisure time sports participation, health-related quality of life (HRQoL) and body mass index between adolescents...... with and without self-reported knee pain, 2) investigate how many adolescents still have knee pain after one year and 3) identify risk factors for one-year persistence of knee pain....

  10. 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.

  11. Treatment of knee flexion contracture in patients with chronic juvenile arthritis: A case report

    Directory of Open Access Journals (Sweden)

    Matijević Radmila

    2006-01-01

    Full Text Available Introduction. Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. Case report. A 23-year-old female patient with chronic juvenile arthritis since the age of one was admitted for treatment of flexion con­tractures in both knees, muscle hypotrophy, loss of strength and gait disability. The patient underwent arthroscopic synovectomy. The operation was first performed on the right and after 3 mouths on the left knee. The pre operative range of motion in the rigth knee was 30°-70° and in the left 40°-80°. The patient underwent intensive physical therapy to reduce postoperative swelling of knees and firstly passive and then active kinesitherapy. Nine months after the first surgery and six months after the second, the range of motion in the right knee was 0°-100° and in the left 0°-105°. The strength of tested muscles was increased and gait was improved. Conclusion. Management and rehabilitation of patients with chronic juvenile arthritis include maintenance or improvement in position and function of joints that is achieved with synovectomy. The results depend on combined interdisciplinary rehabilitation, well-experienced staff, and pre- and post-operative physiotherapy as well as kinesitherapy. Arthroscopic synovectomy has many advantages and we believe that it was a better solution than open capsulosynovectomy in this patient with chronic juvenile arthritis of the knee. .

  12. 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

  13. 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

    postoperative pain after total knee arthroplasty (TKA). Patients scheduled for elective, unilateral, primary TKA under spinal anesthesia were consecutively included in this prospective, observational study. Perioperative analgesia was standardized for all patients. Outcomes were postoperative pain during walk......: From 6-24hrs (primary), from postoperative day (POD) 1-7 (secondary), and from POD14-30 (tertiary). Two preoperative tonic heat stimuli with 47°C were used; short (5sec) and long (7min) stimulation upon which patients rated their pain response on an electronic VAS. Multivariate stepwise linear...

  14. Osteomalacia as a Cause of Chronic Pain

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

    Full Text Available Osteomalacia is a form of metabolic bone disease that can present as chronic pain. A 36-year-old woman presented with a three-year history of bilateral leg and back pain, and proximal leg weakness. Repeated consultations and investigations failed to discover a cause for her pain, and a diagnosis of chronic benign pain was made. She was admitted to hospital where the bone scan, laboratory investigation and bone biopsy established a diagnosis of renal phosphate-wasting adult-onset rickets (osteomalacia. Radiographs of the hip and magnetic resonance imaging revealed bilateral femoral neck fractures and segmental, avascular necrosis of the femoral heads. The patient was treated with high dose phosphate and vitamin D with marked relief of pain. Osteomalacia should be considered in unusual cases of intractable chronic pain.

  15. A Survey On The Effects Of Iontophoresis Of Piroxicam Gel On Pain And Knee Muscles Strengthn Patients With Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Asghar RezaSoltani

    2012-04-01

    Full Text Available Background and Aim: Knee osteoarthritis is the most common cause of disability in many societies. Therapeutic measures such as using anti-inflammation drugs and physiotherapy programs have been used to suppress knee pain and improve knee joint function in patients with knee osteoarthritis. The aim of this study was to compare the effects of iontophoresis of piroxicam gel, galvanic current with or without piroxicam gel on pain, functional ability and knee muscle strength in patients with knee osteoarthritis.Materials and Method: This study was a clinical trial conducted in Akhtar hospital. Forty two female patients (mean age 58.52 years old with knee osteoarthritis participated in this study. The protocol was performed in Physiotherapy Clinic of Mazandaran Medical University, Mazandaran, Iran. All patients were randomly assigned to three groups. Iontophoresis of piroxicam gel was applied for group 1 (n=14, proxicam gel for group 2 (n=14 and galvanic current for group 3 (n=14. The procedure was carried out for 20-minutes, three times a week and for two following weeks. Knee pain and functional ability were estimated by knee injury and osteoarthritis outcome score (KOOS questioner and the strength of knee extensor and flexor muscles by an isometric device just before the first treatment and immediately after the last treatment times.Results: A significant decrease in pain and a significant increase in functional ability and the strength of knee extensor muscles were resulted in all studied groups (P < 0.05. According to ANOVA test, the level of the percentage difference which was computed for KOOS and knee muscle strength before and after treatments was significantly higher in group 1 than the other two (P < 0.01.Conclusion: Pain and knee functional ability were significantly improved in patients in all three methods. But iontophoresis of piroxicam gel appeared to be more effective in relieving pain and improving knee functional abilities than the

  16. Hostility and Anger in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Sara Oliveira

    2013-11-01

    Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

  17. Hostility and Anger in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Lúcia Ribeiro

    2012-06-01

    Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

  18. Myofascial Pain Syndrome in Chronic Back Pain Patients

    Science.gov (United States)

    Nizar, Abd Jalil

    2011-01-01

    Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome. PMID:21716607

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    -minute-walk-test (6MWT), and 6-min-walk-test with subsequent pain rating (6MWTpain), and once with a transition questionnaire (TRANS-Q) for the patient-reported change in pain after 12 weeks of exercise. Construct validity (baseline-scores) and responsiveness (change-scores) were estimated by Spearman Correlation...... subscales (r = -0.31 to-0.45) and the 6MWT (r = -0.25) was supported. Convergent validity with the 6MWTpain was not supported (r = 0.54). The DAP change-scores corresponded to patient-reported change in pain (TRANS-Q), while correlations with change-scores on the other instruments were ....4 DAP points. CONCLUSIONS: The DAP possesses divergent validity compared to other instruments for knee OA, supporting the potential for this new way of assessing pain directly during activity. Importantly, the DAP change-scores correspond to patient-reported changes in pain, showing responsiveness...

  20. 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(...

  1. [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

  2. 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...

  3. The role of pain for early rehabilitation in fast track total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis;

    2010-01-01

    To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA).......To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA)....

  4. Ultrasound imaging for the rheumatologist XXX. Sonographic assessment of the painful knee.

    Science.gov (United States)

    Meenagh, G; Filippucci, E; Delle Sedie, A; Iagnocco, A; Scirè, C A; Riente, L; Montecucco, C; Valesini, G; Bombardieri, S; Grassi, W

    2010-01-01

    The knee joint is a frequent focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound findings in patients presenting with a variety of rheumatic disorders and knee pain. US imaging provides for a sensitive and detailed identification of different intra- and peri-articular pathology responsible for knee pain.

  5. Chronic pain in Australia: a prevalence study.

    Science.gov (United States)

    Blyth, F M; March, L M; Brnabic, A J; Jorm, L R; Williamson, M; Cousins, M J

    2001-01-01

    This study reports chronic pain prevalence in a randomly selected sample of the adult Australian population. Data were collected by Computer-Assisted Telephone Interview (CATI) using randomly generated telephone numbers and a two-stage stratified sample design. Chronic pain was defined as pain experienced every day for three months in the six months prior to interview. There were 17,543 completed interviews (response rate=70.8%). Chronic pain was reported by 17.1% of males and 20.0% of females. For males, prevalence peaked at 27.0% in the 65--69 year age group and for females, prevalence peaked at 31.0% in the oldest age group (80--84 years). Having chronic pain was significantly associated with older age, female gender, lower levels of completed education, and not having private health insurance; it was also strongly associated with receiving a disability benefit (adjusted OR=3.89, Punemployment benefit (adjusted OR=1.99, Punemployed for health reasons (adjusted OR=6.41, Pinsurance. There were strong associations between having interfering chronic pain and receiving disability benefits (adjusted OR=3.31, Punemployed due to health reasons (adjusted OR=7.94, P<0.001, respectively). The results show that chronic pain impacts upon a large proportion of the adult Australian population, including the working age population, and is strongly associated with markers of social disadvantage. PMID:11166468

  6. 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

  7. Neuroimmunological mechanisms of chronic pain syndrome

    Directory of Open Access Journals (Sweden)

    I. A. Vyshlova

    2016-01-01

    Full Text Available The article considers the mechanisms of chronic low back pain. Three pathophysiological mechanisms: nociceptive, neurogenic (neuropathic, and psychogenic are noted to be involved in the development of pain syndrome. The role of cellular and molecular changes in the posterior horn and in the somatosensory dysregulated mechanism of neuropathic pain is shown. Immunological processes, including neurohumoral (serotoninergic and hormonal (sex hormones and specific proteins ones, play an important role in the development of pain. The generalization and further study of these mechanisms are embodied in approaches to therapy for pain syndromes and hence these require analysis and further investigation. 

  8. Acute and Chronic Low Back Pain.

    Science.gov (United States)

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2016-01-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function. PMID:26614726

  9. [Treatment of chronic back pain: current standards].

    Science.gov (United States)

    Märker-Hermann, E; Kiltz, U; Braun, J

    2014-12-01

    Back pain is a significant medical problem and one of the most common causes of medical consultations and missed work. In acute low back pain, patients with "red flags" indicating a serious underlying spinal or extraspinal disease must be identified by medical evaluation. Most cases of acute back pain are non-specific, and education, physical activity and pain medication is recommended. In addition, yellow flags (risks of developing chronic pain) should be recognized. The management of low back pain has been addressed by the German National Disease Management Guideline (NVL) low back pain published in 2010. This guideline evaluates the evidence and effectiveness of diagnostic and therapeutic interventions with a focus on nonspecific back pain. For chronic nonspecific low back pain intervention based on nondrug and drug therapy and a multiprofessional assessment is recommended. In patients with chronic inflammatory low back pain with onset before the age of 45, rheumatic spondyloarthritis should be considered. Recently, a guideline (S3-Leitlinie) for the management of axial spondyloarthritis including ankylosing spondylitis has become available. It provides evidence of physical and drug therapy including nonsteroidal antirheumatic and Tumor necrosis factor (TNF) inhibitor therapy. PMID:25465277

  10. Transdermal fentanyl in chronic nonmalignant pain

    Directory of Open Access Journals (Sweden)

    Vittorio Iorno

    2006-09-01

    Full Text Available Chronic non malignant pain is always a therapeutic challenge of great significance because a inappropriate and insufficient treatment is able to reduce the life’s quality of the patients. Many therapeutic strategies were used to solve these issues, no one exhaustive. In the treatment of cancer pain, opiates use is common, is not the same for the chronic non-malignant pain. The fear of possible side effects (addiction, tolerance, respiratory depression restrain the therapist to apply this remedy. The aim of our work is to demonstrate how a correct application of the opiates in patients with chronic benign pain is not only possible but also desirable to relieving the pain and improving the quality of life.

  11. Pain in chronic pancreatitis and pancreatic cancer.

    Science.gov (United States)

    Fasanella, Kenneth E; Davis, Brian; Lyons, John; Chen, Zongfu; Lee, Kenneth K; Slivka, Adam; Whitcomb, David C

    2007-06-01

    Chronic, debilitating abdominal pain is arguably the most important component of chronic pancreatitis, leading to significant morbidity and disability. Attempting to treat this pain, which is too often unsuccessful, is a frustrating experience for physician and patient. Multiple studies to improve understanding of the pathophysiology that causes pain in some patients but not in others have been performed since the most recent reviews on this topic. In addition, new treatment modalities have been developed and evaluated in this population. This review discusses new advances in neuroscience and the study of visceral pain mechanisms, as well as genetic factors that may play a role. Updates of established therapies, as well as new techniques used in addressing pain from chronic pancreatitis, are reviewed. Lastly, outcome measures, which have been highly variable in this field over the years, are addressed. PMID:17533083

  12. 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.

  13. 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...

  14. 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...

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Gabriel Peixoto Leão Almeida

    2016-04-01

    Full Text Available 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.

  17. 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

  18. [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

  19. 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...

  20. 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

  1. Mindfulness, Acceptance and Catastrophizing in Chronic Pain

    NARCIS (Netherlands)

    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 exami

  2. 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.

  3. 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

  4. Synovitis assessed on static and dynamic contrast-enhanced magnetic resonance imaging and its association with pain in knee osteoarthritis

    DEFF Research Database (Denmark)

    Riis, Robert G C; Gudbergsen, Henrik; Henriksen, Marius;

    2016-01-01

    OBJECTIVES: To investigate the association between pain and peripatellar-synovitis on static and dynamic contrast-enhanced MRI in knee osteoarthritis. METHODS: In a cross-sectional setting, knee synovitis was assessed using 3-Tesla MRI and correlated with pain using the knee injury and osteoarthr......OBJECTIVES: To investigate the association between pain and peripatellar-synovitis on static and dynamic contrast-enhanced MRI in knee osteoarthritis. METHODS: In a cross-sectional setting, knee synovitis was assessed using 3-Tesla MRI and correlated with pain using the knee injury...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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.)

  14. 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.)

  15. 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.

  16. 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 (

  17. 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 (

  18. 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...

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

    Directory of Open Access Journals (Sweden)

    Hiroki Sugiura

    2014-01-01

    Full Text Available 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 completed a 12 m walk test with maximum effort. Stance time, swing time, and step length were selected as evaluation parameters. A two-way ANOVA (group × leg was used for analysis. No significant differences were found in interaction or in either main factor of the group and leg. In conclusion, elderly females do not show group-related differences or gait laterality regardless of the degree (mild or severe of unilateral knee pain.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. Combined use of Compound Nanxing Pain Paste with blood-promoting and diuretic Chinese herbal medicines in treatment of chronic knee synovitis%活血利水中药联合复方南星止痛膏治疗慢性膝关节滑膜炎的病例对照研究

    Institute of Scientific and Technical Information of China (English)

    陈树清; 孙保国; 周厚明; 陈泽雄

    2012-01-01

    Objective:To observe the clinical efficacy of combined use of Compound Nanxing Pain Paste with blood-promoting and diuretic Chinese herbal medicines in treatment of chronic knee synovitis. Methods: From October 2008 to March 2011,120 patients with chronic knee synovitis were equally divided into three groups :oral treatment group .external treatment group and combined treatment group. Patients in oral treatment group had a mean age of (56.58?.47) years and a course of disease about (7.35?.59) months,involving the left knee in 18 cases,the right knee in 17 cases and both knees in 5 cases, who were administered orally with blood-promoting and diuretic Chinese herbal medicines composed of Wu Ling San and Tao Hong Si Wu Decoction. Patients in external treatment group had a mean age of (56.25*6.35) years and a course of disease about (7.68?.76) months,involving the left knee in 16 cases,the right knee in 20 and both knees in 4 cases,who were treated externally with Compound Nanxing Pain Paste. Patients in combined treatment group had a mean age of (55.65?.49) years and a course of disease about (7.50?.36) months, involving the left knee in 16 cases, the right knee in 18 and both knees in 6 cases,who were given both oral and external treatments. The clinical effects and knee function of the three groups were assessed and compared. Results: Finally, a total of 118 patients were included in the result analysis, including 40 patients in oral treatment group,39 patients in external treatment group and 39 patients in combined treatment group. In combined treatment group,27 patients were clinically cured,9 were improved,and 3 patients were ineffective vs 15,16 and 8 patients in external treatment group, and 13,16 and 11 in oral treatment group. The overall effective rate of combined treatment group was better than that of oral group and external treatment groups (P<0.05). The function comprehensive score of knee joints in combined treatment group was better than that of oral

  5. 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.

  6. 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…

  7. 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

  8. 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...

  9. [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

  10. 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...... 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 primary outcome...... (nonsignificant) effect sizes were found for pain measures. There were no significant differences in the measures just after the intervention vs the 6-month follow-up. CONCLUSION: A standardized mindfulness program (MBSR) contributes positively to pain management and can exert clinically relevant effects...

  11. 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.

  12. Muscle power is an independent determinant of pain and quality of life in knee osteoarthritis

    Science.gov (United States)

    OBJECTIVE: This study examined the relationships between leg muscle strength, power, and perceived disease severity in subjects with knee osteoarthritis (OA) in order to determine whether dynamic leg extensor muscle power would be associated with pain and quality of life in knee OA. METHODS: Baseli...

  13. 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

  14. 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.

  15. Validity of summing painful joint sites to assess joint-pain comorbidity in hip or knee osteoarthritis

    NARCIS (Netherlands)

    Siemons, Liseth; Klooster, ten Peter M.; Laar, van de Mart A.F.J.; Ende, van den Cornelia H.M.; Hoogeboom, Thomas J.

    2013-01-01

    BACKGROUND: Previous studies in patients with hip and knee osteoarthritis (OA) have advocated the relevance of assessing the number of painful joint sites, other than the primary affected joint, in both research and clinical practice. However, it is unclear whether joint-pain comorbidities can simpl

  16. Influence of patellofemoral bracing on pain, knee extensor torque, and gait function in females with patellofemoral pain.

    Science.gov (United States)

    Powers, Christopher M; Doubleday, Kathryn L; Escudero, Carina

    2008-01-01

    Our purpose was to evaluate the effects of a patellofemoral brace on pain response, knee extensor torque production, and gait function in females with patellofemoral pain (PFP). Sixteen females between the ages of 14 and 46 with diagnosis of PFP participated. Knee extensor torque was measured by using a LIDO isokinetic dynamometer. Pain levels were documented by using the Visual Analog Pain Scale. Stride characteristics during the conditions of free walk, fast walk, ascend stairs, descend stairs, ascend ramp, and descend ramp were obtained with a stride analyzer unit. EMG activity of the vasti musculature was recorded by using indwelling, bipolar, wire electrodes. Knee joint motion was assessed by using a VICON motion analysis system. All testing was performed with and without the Bauerfeind Genutrain P3 patellofemoral brace. There were no significant differences in torque production, pain levels, and stride characteristics between braced and non-braced trials. In addition, there were no significant differences in mean vasti EMG between braced and non-braced trials. When averaged across all conditions, a small but statistically significant increase in knee flexion was found during the braced trials. Although the current study did not find significant improvements in the clinical measures evaluated, 8 of the 16 subjects did experience a decrease in knee pain. This finding suggests that certain patients with PFP may respond favorably to bracing, and criteria must be established to determine which patients would best benefit from such an intervention.

  17. Psychological Assessment in Chronic Pain.

    Science.gov (United States)

    Duckro, Paul N.; And Others

    1985-01-01

    Compares several instruments of potential usefulness in assessment of anxiety and depression among pain patients (N=34). Results showed that the SCL-90-R appeared to offer the best combination of relevant data and efficient assessment. However, significant intercorrelations among SCL-90-R subscales suggest a unitary factor structure. (NRB)

  18. 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...

  19. Beyond pain: modeling decision-making deficits in chronic pain

    Directory of Open Access Journals (Sweden)

    Leonardo Emanuel Hess

    2014-08-01

    Full Text Available Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls. In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and healthy controls at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in healthy controls was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis.

  20. 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.

  1. Effects of strengthening and aerobic exercises on pain severity and function in patients with knee rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Nader Rahnama

    2012-01-01

    Conclusions: It can be concluded that an aerobic exercise program improves functional and walking ability in patients with knee RA, and strengthening exercise has more efficient effect on knee ROM, both aerobic and strengthening exercises can equally relieve pain.

  2. Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre

    DEFF Research Database (Denmark)

    Sjøgren, Per; Christrup, Lona Louring; Petersen, Morten Aa;

    2005-01-01

    The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex ma...

  3. The characteristics of chronic central pain after traumatic brain injury.

    Science.gov (United States)

    Ofek, Hadas; Defrin, Ruth

    2007-10-01

    Central pain following traumatic brain injury (TBI) has not been studied in depth. Our purpose was to conduct a systematic study of patients with TBI suffering from chronic central pain, and to describe the characteristics of the central pain. Groups were TBI patients with (TBIP) and without central pain (TBINP) and healthy controls. TBI patients with other pain mechanisms were excluded from the study. Participants underwent quantitative somatosensory testing in the painful and pain-free body regions. Thresholds for warmth, cold, heat-pain, touch and graphesthesia were measured and pathologically evoked pain (allodynia, hyperpathia and wind-up pain) evaluated. Chronic pain was mapped and characterized. Chronic pain developed at a relatively late onset (6.6+/-9 months) was almost exclusively unilateral and reported as pricking, throbbing and burning. Although both TBIP and TBINP exhibited a significant reduction in thermal and tactile sensations compared to controls, thermal sensations in the painful regions of TBIP were significantly more impaired than pain-free regions in the same patients (p<0.01) and in TBINP (p<0.01). Painful regions also exhibited very high rates of allodynia, hyperpathia and exaggerated wind-up. The characteristics of the chronic pain resembled those of other central pain patients although TBIP displayed several unique features. The sensory profile indicated that damage to the pain and temperature systems is a necessary but not sufficient condition for the development of chronic central pain following TBI. Neuronal hyperexcitability may be a contributing factor to the chronic pain.

  4. 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 ...

  5. Ziconotide for treatment of severe chronic pain.

    Science.gov (United States)

    Schmidtko, Achim; Lötsch, Jörn; Freynhagen, Rainer; Geisslinger, Gerd

    2010-05-01

    Pharmacological management of severe chronic pain is difficult to achieve with currently available analgesic drugs, and remains a large unmet therapeutic need. The synthetic peptide ziconotide has been approved by the US Food and Drug Administration and the European Medicines Agency for intrathecal treatment of patients with severe chronic pain that is refractory to other treatment modalities. Ziconotide is the first member in the new drug class of selective N-type voltage-sensitive calcium-channel blockers. The ziconotide-induced blockade of N-type calcium channels in the spinal cord inhibits release of pain-relevant neurotransmitters from central terminals of primary afferent neurons. By this mechanism, ziconotide can effectively reduce pain. However, ziconotide has a narrow therapeutic window because of substantial CNS side-effects, and thus treatment with ziconotide is appropriate for only a small subset of patients with severe chronic pain. We provide an overview of the benefits and limitations of intrathecal ziconotide treatment and review potential future developments in this new drug class. PMID:20413151

  6. Chronic joint pain in the lower body is associated with gait differences independent from radiographic osteoarthritis.

    Science.gov (United States)

    de Kruijf, Marjolein; Verlinden, Vincentius J A; Huygen, Frank J P M; Hofman, Albert; van der Geest, Jos N; Uitterlinden, Andre G; Bierma-Zeinstra, Sita M A; Ikram, M Arfan; van Meurs, Joyce B J

    2015-09-01

    Gait is an important indicator of health. Chronic lower body pain may impair gait and lead to morbidity and mortality. We investigated the associations between lower body pain and gait in community-dwelling individuals, independent from osteoarthritis (OA). This population based cohort study included 2304 Rotterdam Study participants who underwent electronic walkway gait assessment. Thirty different variables resulting from gait assessment were summarized into seven gait domains using principle components analysis: i.e. Rhythm, Variability, Phases, Pace, Tandem, Turning, and Base of Support. Chronic lower body pain was assessed using pain drawings. OA was defined as a Kellgren & Lawrence score of 2 or higher on radiographs of the hip and/or knee. Linear regression analysis was used to study associations. Participants with chronic pain in the leg and hip, had lower Rhythm, Phases, and Pace, independent from OA. Additionally, we found unilateral pain to associate with larger gait asymmetry. No associations were found between chronic pain and the other gait domains, including gait variability. However, within individuals with hip pain, gait variability was higher in individuals with radiographic OA compared to those without OA. This is the first population based study showing chronic lower body pain associates with gait differences independent from OA. Participants with pain were found to walk with slower and smaller steps, longer double support and more asymmetry. Proper care and treatment of chronic pain could be a way of reducing gait problems and thereby fall risk and associated mortality. In addition, gait assessment may help identifying individuals with OA from those having pain due to other causes.

  7. 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

  8. Antioxidants for pain in chronic pancreatitis

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Jens, Sjoerd; Busch, Olivier R C; Keus, Frederik; van Goor, Harry; Gooszen, Hein G; Boermeester, Marja A

    2014-01-01

    BACKGROUND: Reduced intake and absorption of antioxidants due to pain and malabsorption are probable causes of the lower levels of antioxidants observed in patients with chronic pancreatitis (CP). Improving the status of antioxidants might be effective in slowing the disease process and reducing pai

  9. Unexplained severe chronic pain in general practice.

    NARCIS (Netherlands)

    Kerssens, J.J.; Verhaak, P.F.M.; Bartelds, A.I.M.; Sorbi, M.J.; Bensing, J.M.

    2002-01-01

    The aim of this study was to estimate the prevalence of unexplained severe chronic pain (USCP) in general practice and to report medical as well as psychological descriptions of patients suffering from this condition. A total of 45 GPs in 35 different practices included patients throughout the year

  10. 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...

  11. 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

  12. ["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

  13. 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...

  14. 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

  15. Chronic Pain in Canada: Have We Improved Our Management of Chronic Noncancer Pain?

    Directory of Open Access Journals (Sweden)

    Aline Boulanger

    2007-01-01

    Full Text Available BACKGROUND: Chronic noncancer pain (CNCP is a global issue, not only affecting individual suffering, but also impacting the delivery of health care and the strength of local economies.

  16. Acute and chronic pain syndromes in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    A representative sample of 117 patients with definite multiple sclerosis (MS) was interviewed on pain syndromes. Chronic syndromes lasting more than one month included dysaestesthesia, low back pain, spasms, tonic seizures, tightening and painful sensations in the extremities. Acute syndromes...

  17. Fibromyalgia, chronic fatigue syndrome, and myofascial pain.

    Science.gov (United States)

    Bennett, R

    1998-03-01

    Epidemiologic studies continue to provide evidence that fibromyalgia is part of a spectrum of chronic widespread pain. The prevalence of chronic widespread pain is several times higher than fibromyalgia as defined by the 1990 American College of Rheumatology guidelines. There is now compelling evidence of a familial clustering of fibromyalgia cases in female sufferers; whether this clustering results from nature or nature remains to be elucidated. A wide spectrum of fibromyalgia-associated symptomatology and syndromes continues to be described. During the past year the association with interstitial cystitis has been explored, and neurally mediated hypotension has been documented in both fibromyalgia and chronic fatigue syndrome. Abnormalities of the growth hormone-insulin-like growth factor-1 axis have been also documented in both fibromyalgia and chronic fatigue syndrome. The commonly reported but anecdotal association of fibromyalgia with whiplash-type neck trauma was validated in a report from Israel. However, unlike North America, 100% of Israeli patients with posttraumatic fibromyalgia returned to work. Basic research in fibromyalgia continues to pinpoint abnormal sensory processing as being integral to understanding fibromyalgia pain. Drugs such as ketamine, which block N-methyl-D-aspartate receptors (which are often upregulated in central pain states) were shown to benefit fibromyalgia pain in an experimental setting. The combination of fluoxetine and amitriptyline was reported to be more beneficial than either drug alone in patients with fibromyalgia. A high prevalence of autoantibodies to cytoskeletal and nuclear envelope proteins was found in chronic fatigue syndrome, and an increased prevalence of antipolymer antibodies was found in symptomatic silicone breast implant recipients who often have fibromyalgia.

  18. 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...

  19. 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...

  20. 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.

  1. 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...

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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 ...

  8. 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

  9. 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.

  10. 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

  11. Comparable effects of exercise and analgesics for pain secondary to knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Hansen, Julie B; Klokker, Louise;

    2016-01-01

    administered analgesics for pain in patients with knee osteoarthritis. METHODS: The Cochrane Database of systematic reviews was searched for meta-analyses of randomized controlled studies comparing exercise or analgesics with a control group (placebo or usual care) and with pain as an outcome. Individual study...

  12. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

    Directory of Open Access Journals (Sweden)

    Taras I. Usichenko

    2005-01-01

    Full Text Available Auricular acupuncture (AA is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points or sham procedure (three non-acupuncture points on the auricular helix before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

  13. 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.

  14. Psychosocial factors associated with chronic pain in adolescents.

    Science.gov (United States)

    Merlijn, Vivian P B M; Hunfeld, Joke A M; van der Wouden, Johannes C; Hazebroek-Kampschreur, Alice A J M; Koes, Bart W; Passchier, Jan

    2003-01-01

    A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account. PMID:12507698

  15. Psychosocial factors associated with chronic pain in adolescents.

    Science.gov (United States)

    Merlijn, Vivian P B M; Hunfeld, Joke A M; van der Wouden, Johannes C; Hazebroek-Kampschreur, Alice A J M; Koes, Bart W; Passchier, Jan

    2003-01-01

    A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account.

  16. Acupuncture For Severe Chronic Perineal Pain

    Institute of Scientific and Technical Information of China (English)

    W. Watere

    2004-01-01

    @@ A 42-year-old man (1.8 m, 80 kg), a postal employee, presented to our TCM-Centre, Elisabeth Hospital, Recklinghausen, Germany, with severe chronic perineal pain and hyperhidrosis, especially head, forehead, hand plains, and foot soles. Due to pain, the patient was unable to sit, unable to work for 3 months,and was depressed and fearful. He had bronchial asthma with no complaints under medication. The patient smoked 20 cigarettes daily; he reported no alcohol usage.During a 3-month period (summer 2002), he had consulted an urologist, internist, neurologist, psychiatrist, and radiologist.

  17. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint.

    Science.gov (United States)

    Burston, James J; Sagar, Devi Rani; Shao, Pin; Bai, Mingfeng; King, Emma; Brailsford, Louis; Turner, Jenna M; Hathway, Gareth J; Bennett, Andrew J; Walsh, David A; Kendall, David A; Lichtman, Aron; Chapman, Victoria

    2013-01-01

    Osteoarthritis (OA) of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2) receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behaviour, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA. Hallmarks of central sensitization, significant spinal astrogliosis and increases in activity of metalloproteases MMP-2 and MMP-9 in the spinal cord were evident in the model of OA pain. Systemic administration of JWH133 attenuated these markers of central sensitization, providing a neurobiological basis for analgesic effects of the CB2 receptor in this model of OA pain. Analysis of human spinal cord revealed a negative correlation between spinal cord CB2 receptor mRNA and macroscopic knee chondropathy. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation of chronic OA

  18. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint.

    Directory of Open Access Journals (Sweden)

    James J Burston

    Full Text Available Osteoarthritis (OA of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2 receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behaviour, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA. Hallmarks of central sensitization, significant spinal astrogliosis and increases in activity of metalloproteases MMP-2 and MMP-9 in the spinal cord were evident in the model of OA pain. Systemic administration of JWH133 attenuated these markers of central sensitization, providing a neurobiological basis for analgesic effects of the CB2 receptor in this model of OA pain. Analysis of human spinal cord revealed a negative correlation between spinal cord CB2 receptor mRNA and macroscopic knee chondropathy. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation

  19. 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...

  20. 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 ...

  1. 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…

  2. 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.

  3. 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....... of human quantitative pain assessment tools (quantitative sensory testing (QST)) have been developed providing new opportunities for profiling patients and reaching a greater understanding of the mechanisms involved in chronic joint pain. As joint pain is a complex interaction between many different pain...

  4. 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

  5. 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.

  6. Epidemiology of chronic pain in Denmark: an update

    DEFF Research Database (Denmark)

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

    2008-01-01

    was associated with female gender and increasing age. Higher prevalence of chronic pain were associated with being divorced, separated or widowed, having less than 10 years of education and high BMI. Musculoskeletal diseases (66.8%) were the most common cause for chronic pain and most persons with chronic pain...... 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...

  7. 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

  8. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement

    Directory of Open Access Journals (Sweden)

    Tonelli Shalome M

    2011-11-01

    Full Text Available Abstract Background Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown. Methods This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity between women and men with knee osteoarthritis (N = 208 immediately prior to total knee arthroplasty. We assessed: (1 pain using self-report measures and a numerical rating scale at rest and during functional tasks, (2 pain sensitivity using quantitative sensory measures, (3 function with self-report measures and specific function tasks (timed walk, maximal active flexion and extension, (4 psychosocial measures (depression, anxiety, catastrophizing, and social support, and (5 physical activity using accelerometry. The ability of these mixed variables to explain physical activity, function and pain was assessed using regression analysis. Results Our findings showed significant differences on pain intensity, pain sensitivity, and function tasks, but not on psychosocial measures or physical activity. Women had significantly worse pain and more impaired function than men. Their levels of depression, anxiety, pain catastrophizing, social support, and physical activity, however, did not differ significantly. Factors explaining differences in (1 pain during movement (during gait speed test were pain at rest, knee extension, state anxiety, and pressure pain threshold; (2 function (gait speed test were sex, age, knee extension, knee flexion opioid medications, pain

  9. Comparison of the effects of knee and hip and single knee muscles strengthening/ stretching exercises on pain intensity and function in athletes with patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Vahid Mazloum

    2016-08-01

    Full Text Available Background: Patellofemoral pain syndrome (PFPS is a common musculoskeletal condition among athletes. The evidence emphasizes on the importance of hip musculature strengthening exercises for such patients. Objective: To investigate the effects of strengthening-stretching knee muscles exercises and hip posterolateral musculature exercises in athletes with PFPS. Methods: In this clinical trial, 28 athletes with age average of 22.7±2.4 years with PFPS were allocated into conventional knee muscles exercises (CKME (n=14 and posterolateral hip muscles exercises (PHME (n=14. The subjects of both groups performed the supervised exercise protocols in 12 sessions. The Visual Analogue Scale and 6-minute walking tests were administrated respectively to evaluate pain intensity and function. The data were analyzed using Shapiro-wilk test, Independent-sample t test, and Repeated Measure ANOVA test. Findings: Demographic, pain intensity, and physical function data were similar between groups at baseline. Both groups significantly improved in pain intensity and function following a 4-week exercise program. Additionally, the athletes in PHME group had higher level of decreased pain intensity and improved function in follow-up assessment than the subjects in CKME group. Conclusion: Using hip posterolateral musculature exercises in addition to the knee conventional exercises is more effective for athletes with PFPS.

  10. Knee pain during activities of daily living and its relationship with physical activity in patients with early and severe knee osteoarthritis.

    Science.gov (United States)

    Fukutani, Naoto; Iijima, Hirotaka; Aoyama, Tomoki; Yamamoto, Yuko; Hiraoka, Masakazu; Miyanobu, Kazuyuki; Jinnouchi, Masashi; Kaneda, Eishi; Tsuboyama, Tadao; Matsuda, Shuichi

    2016-09-01

    This study aimed to investigate whether knee pain during various activities of daily living (ADLs) is associated with physical activity in patients with early and severe knee osteoarthritis (OA). We hypothesized that the painful ADLs associated with decreased physical activity differ according to disease severity. This cross-sectional study enrolled 270 patients with medial knee OA, assigned to either the early (Kellgren Lawrence [K/L] grade 1-2) or the severe group (K/L grade 3-4). Physical activity was assessed using a pedometer. Knee pain during six ADLs (waking up in the morning, walking on a flat surface, ascending stairs, etc.) was evaluated using a questionnaire. We performed multiple regression and quantile regression analysis to investigate whether knee pain during each ADL was associated with physical activity. In the early group, the more knee pain they experienced while ascending stairs, the lower their physical activity was (75th regression coefficient = -1033.70, P = 0.018). In the severe group, the more knee pain they experienced while walking on a flat surface or bending to the floor or standing up, the lower their physical activity was (unstandardized coefficients = -1850.87, P = 0.026; unstandardized coefficients = -2640.35, P = 0.010). Knee pain while ascending stairs and while walking on a flat surface or bending to the floor or standing up was a probable limiting factor for physical activity in early and severe knee OA, respectively. These findings suggested that a reduction in task-specific knee pain according to disease severity could improve physical activity levels.

  11. Chronic low back pain in housewives

    Directory of Open Access Journals (Sweden)

    Mehmet Bulut

    2011-09-01

    Full Text Available Objectives: The aim of this study is to investigate low back pain of housewives and to deteremine relationships between psychological status, education and physical health in housewives.Materials and methods: Thirty premenopausal housewives aged 33-45 years with chronic low back pain were included and the control group consisted of 30 healthy premenopausal housewives. Physical examinations were performed. Age, height, weight, educational level, number of children, consumption of cigarettes and alcohol were recorded. The body mass index (BDI was measured. The severity of back pain was measured by the Oswestry Disability Index (ODI, psychological status was evaluated by the Beck Depression Inventory (BDI and muscle strength by manual technique.Results: There was no difference between demographic data of patients and controls. BDI scores of patients were significantly higher than the controls (p<0,01. Abdominal and dorsal muscle strength were higher in the control group but different was not significant. OBAS values in the patient group, were positively correlated with BDI and BMI (p= 0.011; p= 0.001, respectively, and negatively correlated with abdominal and dorsal muscle strength (p= 0.006 and p= 0.001. Significant correlations were found between abdominal and dorsal muscle strength and the BMI, ODI and BDI scores and high educational level positively affected the ODI and the BDI scores in patients.Conclusion: The housewives with chronic back pain and do not exercise regularly limit activities of daily living. Because of higher BDI scores of patients with chronic low back pain, these patients should also undergo psychiatric examination. J Clin Exp Invest 2011; 2 (3: 295-298.

  12. Effects of obesity and chronic low back pain on gait

    Directory of Open Access Journals (Sweden)

    Galli Manuela

    2011-09-01

    Full Text Available Abstract Background Obesity is often associated with low back pain (LBP. Despite empirical evidence that LBP induces gait abnormalities, there is a lack of quantitative analysis of the combined effect of obesity and LBP on gait. The aim of our study was to quantify the gait pattern of obese subjects with and without LBP and normal-mass controls by using Gait Analysis (GA, in order to investigate the cumulative effects of obesity and LBP on gait. Methods Eight obese females with chronic LBP (OLG; age: 40.5 ± 10.1 years; BMI: 42.39 ± 5.47 Kg/m2, 10 obese females (OG; age: 33.6 ± 5.2 years; BMI: 39.26 ± 2.39 Kg/m2 and 10 healthy female subjects (CG; age: 33.4 ± 9.6 years; BMI: 22.8 ± 3.2 Kg/m2, were enrolled in this study and assessed with video recording and GA. Results and Discussion OLG showed longer stance duration and shorter step length when compared to OG and CG. They also had a low pelvis and hip ROM on the frontal plane, a low knee flexion in the swing phase and knee range of motion, a low dorsiflexion in stance and swing as compared to OG. No statistically significant differences were found in ankle power generation at push-off between OLG and OG, which appeared lower if compared to CG. At hip level, both OLG and OG exhibited high power generation levels during stance, with OLG showing the highest values. Conclusions Our results demonstrated that the association of obesity and LBP affects more the gait pattern than obesity alone. OLG were in fact characterised by an altered knee and ankle strategy during gait as compared to OG and CG. These elements may help optimizing rehabilitation planning and treatment in these patients.

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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

  18. 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

  19. 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

  20. Brain Connectivity Predicts Placebo Response across Chronic Pain Clinical Trials

    Science.gov (United States)

    Tétreault, Pascal; Mansour, Ali; Vachon-Presseau, Etienne; Schnitzer, Thomas J.; Apkarian, A. Vania

    2016-01-01

    Placebo response in the clinical trial setting is poorly understood and alleged to be driven by statistical confounds, and its biological underpinnings are questioned. Here we identified and validated that clinical placebo response is predictable from resting-state functional magnetic-resonance-imaging (fMRI) brain connectivity. This also led to discovering a brain region predicting active drug response and demonstrating the adverse effect of active drug interfering with placebo analgesia. Chronic knee osteoarthritis (OA) pain patients (n = 56) underwent pretreatment brain scans in two clinical trials. Study 1 (n = 17) was a 2-wk single-blinded placebo pill trial. Study 2 (n = 39) was a 3-mo double-blinded randomized trial comparing placebo pill to duloxetine. Study 3, which was conducted in additional knee OA pain patients (n = 42), was observational. fMRI-derived brain connectivity maps in study 1 were contrasted between placebo responders and nonresponders and compared to healthy controls (n = 20). Study 2 validated the primary biomarker and identified a brain region predicting drug response. In both studies, approximately half of the participants exhibited analgesia with placebo treatment. In study 1, right midfrontal gyrus connectivity best identified placebo responders. In study 2, the same measure identified placebo responders (95% correct) and predicted the magnitude of placebo’s effectiveness. By subtracting away linearly modeled placebo analgesia from duloxetine response, we uncovered in 6/19 participants a tendency of duloxetine enhancing predicted placebo response, while in another 6/19, we uncovered a tendency for duloxetine to diminish it. Moreover, the approach led to discovering that right parahippocampus gyrus connectivity predicts drug analgesia after correcting for modeled placebo-related analgesia. Our evidence is consistent with clinical placebo response having biological underpinnings and shows that the method can also reveal that active

  1. 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

  2. Prevalence of Baker’s cyst in patients with knee pain: an ultrasonographic study

    Directory of Open Access Journals (Sweden)

    V. Picerno

    2014-03-01

    Full Text Available The objectives of this study are to investigate the prevalence of Baker’s cyst (BC in patients with knee pain, and to assess the correlation between BC and severity of osteophytes and joint effusion. A retrospective study was conducted on a group of patients with knee pain referred to our outpatient clinic for ultrasonography of the knee between January 2010 and February 2011. Patients underwent an ultrasonographic exam of the knees to assess the presence of marginal femorotibial osteophytosis, joint effusion and BC. A dichotomous score was assigned to each item (1 present, 0 absent and severity of US signs of osteoarthritis and joint effusion were also graded semiquantitatively. Collected data were processed using logistic regression analysis to evaluate the correlation between degree of osteophytosis and joint effusion and BC. Patients affected by inflammatory joint conditions or with history of joint surgery or recent trauma were excluded. A total of 399 patients with knee pain were studied (299 women, in the age range 18-89 years (mean 56.2, SD 16.3 years. 293 patients (73.4% showed sonographic features of osteoarthritis and 251 (62.9% joint effusion. BC was found in 102 patients (25.8% together with a positive association with sonographic features of osteoarthritis and joint effusion. Our data show a prevalence of BC of 25.8% in a population of patients with knee pain, and suggest that BC is positively related to osteoarthritis and joint effusion. Ultrasonographic examination of knee is worthwhile in patients with painful osteoarthritis or evidence of effusion.

  3. Knee extensor strength is associated with pressure pain thresholds in adults with fibromyalgia.

    Directory of Open Access Journals (Sweden)

    W Michael Hooten

    Full Text Available OBJECTIVE: Individuals with fibromyalgia (FM have lower muscle strength and lower pressure pain thresholds (PPT. The primary aim of this study was to determine the associations between muscle strength and PPT in adults with FM to test the hypothesis that greater measures of muscle strength would be associated with greater values of PPT. Secondary aims included determining the effects of pain severity and the peak uptake of oxygen (VO2 on the associations between muscle strength and PPT. METHODS: Knee extensor and flexor strength (N = 69 was measured in the dominant leg using a dynamometer, and PPT was assessed using an electronic algometer. Pain severity was determined using the Multidimensional Pain Inventory, and peak VO2 uptake was quantified using an electronically braked cycle ergometer. RESULTS: Univariable linear regression analysis demonstrated a significant association between PPT (dependent variable and isometric knee extensor (P<.001, isokinetic (60°/s knee extensor (P = .002, and isokinetic (60°/s knee flexor strength (P = .043. In a multiple variable linear regression analysis adjusted for age, sex, pain severity, body mass index and peak VO2 uptake, a significant association was found between PPT and isometric knee extensor strength (P = .008. In a similar multiple variable analysis, a significant association was found between PPT and isokinetic knee extensor strength (P = .044. CONCLUSION: Greater measures of isometric and isokinetic knee extensor strength were significantly associated with greater values of PPT in both univariable and multiple variable linear regression models. TRIAL REGISTRATION: ClinicalTrials.gov NCT01253395.

  4. 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

  5. Association between chronic pain and the sperm motion characteristics

    DEFF Research Database (Denmark)

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

    2015-01-01

    stimulation, it can be speculated that the observed difference in sperm kinematic parameters could be related to the alterations in serum sex hormone levels emanating from the chronic pain. Further studies are required to explain the possible mechanism of action of chronic pain on male fertility.......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......-exist. Neat (fresh semen) and processed sperm from 15 males with orthopedic chronic pain (CP) were assessed and compared with 15 healthy age matched controls. Sperm analysis was performed using the SCA computer-aided sperm analyzer. There was no significant difference in any parameters of the neat semen...

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    of 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...

  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. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials.

    Science.gov (United States)

    Collins, Natalie J; Bisset, Leanne M; Crossley, Kay M; Vicenzino, Bill

    2012-01-01

    Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0

  9. 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.

  10. 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...... with opioids....

  11. Chronic Pain: Where the Body Meets the Brain.

    Science.gov (United States)

    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 disorders may have alterations in their psychological or behavioral responses to pain that contribute significantly to the clinical presentation. Genetic, physiologic, and psychological factors associated with central pain amplification are beginning to be understood. One important contributor to chronic pain is perceived stress and stress response systems. We and others have shown a complex relationship between the physiologic stress response and chronic pain symptoms. Unfortunately, treatments for chronic pain are woefully inadequate and often worsen clinical outcomes. Developing new treatment strategies for patients with chronic pain is of utmost urgency. This essay provides a framework for thinking about chronic pain and developing new treatment approaches. PMID:26330672

  12. 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

  13. Managing acute back pain patients to avoid the transition to chronic pain.

    Science.gov (United States)

    Chou, Roger; McCarberg, Bill

    2011-01-01

    Chronic back pain is a major source of disability, decreased quality of life and healthcare costs. Treating chronic back pain is difficult, with even effective therapies only being modestly effective. Helping patients avoid the transition from acute to chronic low back pain is a promising strategy for preventing suffering and reducing healthcare utilization. The biopsychosocial model provides a useful framework for understanding factors that contribute to chronicity in low back pain, and are important targets for interventions. This article reviews recent research on predictors of chronicity and treatment strategies in higher risk patients that may be helpful for preventing chronicity. PMID:24654586

  14. 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.)

  15. 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 ...

  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. Correlates of Improvement in Multidisciplinary Treatment of Chronic Pain.

    Science.gov (United States)

    Jensen, Mark P.; And Others

    1994-01-01

    Chronic pain patients (n=94) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and three to six months after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping…

  18. 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…

  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. Cyberhugs: creating a voice for chronic pain sufferers through technology.

    Science.gov (United States)

    Becker, Karin L

    2013-02-01

    Chronic pain is a pervasive and expensive public health problem affecting roughly one-third of the American population. The inability of language to accurately convey pain expressions combined with the social stigmas associated with discussing pain persuade many sufferers to remain silent about their pain. Gender politics and fear of professional repercussions further encourage silence. This article explores the need for a safe and secure place for chronic pain sufferers to talk of their pain experiences. The extent to which digital communication technology can fulfill this need is examined. This descriptive study examines the use of one online chronic pain management workshop for its ability to create an engaged community of choice. Workshop admittance was based on participants having a qualifying chronic pain condition. A thematic discourse analysis is conducted of all entries chronic pain participants posted. In addition to goal setting, participants discuss the ways in which pain affects them on a daily basis. Two themes emerge: validation and encouragement. This study suggests that chronic pain users need a discursive space to legitimate their chronic pain identity. It confirms that online websites and virtual audiences facilitate disclosure and allow for authentic communication. The benefits of computer-mediated discussion as well as its limitations are examined. PMID:23276258

  1. Medical marijuana use for chronic pain: risks and benefits.

    Science.gov (United States)

    Greenwell, Garth T

    2012-01-01

    Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

  2. Seniors and Chronic Pain | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... their own and 75-85 percent of the elderly in care facilities suffer from chronic pain. Yet, pain among older adults is largely undertreated, with serious health consequences, such as depression, anxiety, decreased mobility, social isolation, poor sleep, and ...

  3. 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

    for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment...... the 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....

  4. Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

    NARCIS (Netherlands)

    Nijs, J.; Crombez, G.; Meeus, M.; Knoop, H.; Damme, S.V.; Cauwenbergh, V.; Bleijenberg, G.

    2012-01-01

    BACKGROUND: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. OBJECTIVES: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as ot

  5. Epidemiology of chronic non-malignant pain in Denmark

    DEFF Research Database (Denmark)

    Eriksen, Jørgen; Jensen, Marianne K; Sjøgren, Per;

    2003-01-01

    or more'? An overall chronic pain prevalence of 19% was found -16% for men and 21% for women. Prevalence of chronic pain increased with increasing age. Persons >/=67 years had 3.9 higher odds of suffering from chronic pain than persons in the age group 16-24 years. Compared with married persons, divorced...... health were seven times higher among people belonging to the PG. A strong association between chronic pain and poor self-rated health was also demonstrated. The PG had twice as many contacts with various health professionals compared with the CG, and the health care system was, on average, utilised 25...

  6. 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 ...

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

    DEFF Research Database (Denmark)

    Jenstrup, M T; Jæger, P; Lund, J;

    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...... hypothesized that the adductor-canal-blockade may reduce morphine consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with placebo....

  8. 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.

  9. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    Science.gov (United States)

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented.

  10. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    Science.gov (United States)

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

  11. 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

  12. Anserina Bursitis—A Treatable Cause of Knee Pain in Patients with Degenerative Arthritis

    Science.gov (United States)

    Brookler, Morton I.; Mongan, Edward S.

    1973-01-01

    The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient. PMID:4731586

  13. Anserina bursitis. A treatable cause of knee pain in patients with degenerative arthritis.

    Science.gov (United States)

    Brookler, M I; Mongan, E S

    1973-07-01

    The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient.

  14. 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.;

    2016-01-01

    BACKGROUND: Female adolescents with patellofemoral pain are characterized by altered neuromuscular knee control and reduced maximal quadriceps torque. The purpose of this study is to investigate whether exercise therapy and patient education are associated with larger improvements in neuromuscular...... knee control and maximal quadriceps torque compared with patient education alone. METHODS: This is an ancillary analysis of a cluster randomized controlled trial investigating the effect of patient education and exercise therapy on self-reported recovery in 121 adolescents with patellofemoral pain...... flexion/extension kinematics and maximal quadriceps torque. FINDINGS: There was an 8-15% greater decrease in the complexity of surface electromyography suggesting an improvement in neuromuscular knee control among those randomized to exercise therapy (0.08

  15. 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

  16. 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)

  17. 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

  18. 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

  19. Hip and knee muscle function following aerobic exercise in individuals with patellofemoral pain syndrome.

    Science.gov (United States)

    Ott, Brittany; Cosby, Nicole L; Grindstaff, Terry L; Hart, Joseph M

    2011-08-01

    Patellofemoral pain syndrome (PFPS) is a commonly experienced knee disorder that can result in altered muscle activation of the surrounding musculature. There is little evidence on effects of aerobic exercise on quadriceps torque and EMG activation of the vastus medialis obliquus (VMO), vastus lateralis (VL), and gluteus medius (GM). In this study 20 healthy individuals and 20 patients with PFPS had measures of torque and muscle activation taken following aerobic exercise. A modified Balke-Ware protocol was used for the exercise intervention. Baseline and post-aerobic measurements of knee extension torque and VMO, VL, and GM activation during a single leg anterior reaching task. These measurements were only taken on the injured limb. Following exercise, knee extension torque was lower in PFPS patients when compared to controls (p=0.03). Patients reporting no pain after exercise experienced decreases (p=0.021) in GM activation following exercise. There was a decrease in VMO (p=0.010) and VL (p=0.021) activation in PFPS patients with elevated knee pain. Recreationally active individuals with PFPS may experience different responses in the quadriceps and GM after exercise. Responses may be confounded by whether or not pain is exacerbated by exercise.

  20. 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.

  1. Basolateral amygdala lesion inhibits the development of pain chronicity in neuropathic pain rats.

    Directory of Open Access Journals (Sweden)

    Zheng Li

    Full Text Available BACKGROUND: Chronicity of pain is one of the most interesting questions in chronic pain study. Clinical and experimental data suggest that supraspinal areas responsible for negative emotions such as depression and anxiety contribute to the chronicity of pain. The amygdala is suspected to be a potential structure for the pain chronicity due to its critical role in processing negative emotions and pain information. OBJECTIVE: This study aimed to investigate whether amygdala or its subregions, the basolateral amygdala (BLA and the central medial amygdala (CeA, contributes to the pain chronicity in the spared nerve injury (SNI-induced neuropathic pain model of rats. METHODOLOGY/PRINCIPAL FINDINGS: (1 Before the establishment of the SNI-induced neuropathic pain model of rats, lesion of the amygdaloid complex with stereotaxic injection of ibotenic acid (IBO alleviated mechanical allodynia significantly at days 7 and 14, even no mechanical allodynia at day 28 after SNI; Lesion of the BLA, but not the CeA had similar effects; (2 however, 7 days after SNI when the neuropathic pain model was established, lesion of the amygdala complex or the BLA or the CeA, mechanical allodynia was not affected. CONCLUSION: These results suggest that BLA activities in the early stage after nerve injury might be crucial to the development of pain chronicity, and amygdala-related negative emotions and pain-related memories could promote pain chronicity.

  2. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria......, 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...

  3. Biofeedback therapy for chronic pelvic pain syndrome

    Institute of Scientific and Technical Information of China (English)

    Zhang-QunYE; DanCAI; Ru-ZhuLAN; Guang-HuiDU; Xiao-YiYUAN; ZhongCHEN; Yang-ZhiMA; You-MingHU; Gui-YunZENG

    2003-01-01

    Aim: To evaluate the efficacy of biofeedback therapy in patients with chronic pelvic pain syndrome(CPPS). Methods: From November 2001 to April 2002, patients visiting the Urological Outpatient Clinic of this Hospital were evaluated by means of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI)and classified by the NIH classification standard. Sixty-two patients of CPPS category Ⅲ were involved in this study. All patients had been treated by conventional approaches such as antibiotics and alpha-blockers for more than half a year without any improvement. The expressed prostatic secretion results were as follows: WBC 5 to 9/high power field, lipid +-+++ and bacterial culture negative. Their NIH-CPSI were 12-40. All the 62 cases complained of micturitional irritation (frequency, urgency, splitted stream and sense of residual urine), 32 cases, of pain or discomfort at the testicular, penile, scrotal, pelvic or rectal region and 13 cases, of white secretion-dripping. The patients were treated by the Urostym Biofeedback equipment (Laborie Co., Canada) 5 times a week for 2 weeks with a stimulus intensity of 15 mA-23 mA and duration of 20 minutes. Results: Sixty patients were significantly improved or cured, while no significant improvement in the remaining 2. No apparent side effect was observed. The NIH-CPSI dropped to 6 to 14 with an average reduction of 21 (P<0.01). In the 60 improved cases, pain was relieved after 2-3treatment courses and other symptoms disappeared after 4-5 courses. Conclusion: Biofeedback therapy is a safe and effective treatment for CPPS. Large randomized clinical trials are needed to confirm its efficacy and to explore the mechanism of action. ( Asian J Androl 2003 Jun; 5:155-158 )

  4. '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

  5. 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

  6. Diagnosis and Management of Extra-articular Causes of Pain After Total Knee Arthroplasty.

    Science.gov (United States)

    Manning, Blaine T; Lewis, Natasha; Tzeng, Tony H; Saleh, Jamal K; Potty, Anish G R; Dennis, Douglas A; Mihalko, William M; Goodman, Stuart B; Saleh, Khaled J

    2015-01-01

    Postoperative pain, which has been attributed to poor outcomes after total knee arthroplasty (TKA), remains problematic for many patients. Although the source of TKA pain can often be delineated, establishing a precise diagnosis can be challenging. It is often classified as intra-articular or extra-articular pain, depending on etiology. After intra-articular causes, such as instability, aseptic loosening, infection, or osteolysis, have been ruled out, extra-articular sources of pain should be considered. Physical examination of the other joints may reveal sources of localized knee pain, including diseases of the spine, hip, foot, and ankle. Additional extra-articular pathologies that have potential to instigate pain after TKA include vascular pathologies, tendinitis, bursitis, and iliotibial band friction syndrome. Patients with medical comorbidities, such as metabolic bone disease and psychological illness, may also experience prolonged postoperative pain. By better understanding the diagnosis and treatment options for extra-articular causes of pain after TKA, orthopaedic surgeons may better treat patients with this potentially debilitating complication. PMID:25745922

  7. 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.

  8. Dor aguda no joelho do paciente idoso Acute knee pain in elderly patients

    Directory of Open Access Journals (Sweden)

    Gilberto Luís Camanho

    2008-09-01

    Full Text Available A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga. Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load, predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis.

  9. 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...

  10. Validity of electrical stimulus magnitude matching in chronic pain

    DEFF Research Database (Denmark)

    Persson, Ann L; Westermark, Sofia; Merrick, Daniel;

    2009-01-01

    OBJECTIVE: To examine the validity of the PainMatcher in chronic pain. DESIGN: Comparison of parallel pain estimates from visual analogue scales with electrical stimulus magnitude matching. PATIENTS: Thirty-one patients with chronic musculoskeletal pain. METHODS: Twice a day ongoing pain was rated...... range of the instrument, the PainMatcher readings utilized only a small part of the instrument range and, importantly, had little or no relation to the visual analogue scale estimates. The validity of the PainMatcher procedure is doubtful....... on a standard 100-mm visual analogue scale, and thereafter magnitude matching was performed using a PainMatcher. The sensory threshold to electrical stimulation was tested twice on separate occasions. RESULTS: In 438 observations visual analogue scale ranged from 3 to 95 (median 41) mm, and Pain...

  11. 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.

  12. 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.

  13. 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

  14. THE EFFECT OF PATELLAR TAPING ON KNEE JOINT PROPRIOCEPTION IN PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    H. Mokhtarinia

    2008-06-01

    Full Text Available Proprioception has been found to have a relation to subjective knee function and patients with patellofemoral pain syndrome (PFPS seem to have larger deficits than asymptomatic individuals little is known about whether taping can restore defects in proprioception or by which mechanisms it can improve anterior knee pain. To determine the effect of patellar taping on knee joint proprioception a pre and post intervention repeated measures design was conducted on 25 male with PFPS (23.6 ± 3.04 years and 25 healthy male (23.5 ± 3.1 years. Active angle reproduction, passive angle reproduction, and threshold to detection of passive movement tests were measured. Each of the tests was done under taped and no-taped conditions in 20 and 60 degree of knee flexion. We found significant difference between taped and no-taped conditions in active angle reproduction test for both groups (P < 0.05. The other tests did not show any significant difference (P > 0.05. Obtained results suggest that patellar taping may improve knee proprioception during active angle reproduction. Two groups could benefit from taping but further researches are needed to determine whether the present results are applicable to other situations or not.

  15. Chronic Pain Rehabilitation: A Challenge for Mental Health Counselors.

    Science.gov (United States)

    Finn, Paul E.

    1988-01-01

    Presents overview of multiple factors affecting the life style of chronic pain patients, with an emphasis on assessment and rehabilitation. Focuses on chronic pain rehabilitation, including assessment, treatment, and evaluation of the rehabilitation outcome with the understanding that the goal of therapy is to restore the patient as closely as…

  16. Chronic pain in children and adolescents: observational studies

    NARCIS (Netherlands)

    C.W. Perquin (Christel)

    2002-01-01

    textabstractIn adults, chronic pain is by most people involved considered to be a serious disorder. Although chronic pain in adults is in general not life-threatening, a considerable amount of literature elucidates the large number of sufferers, the high cost to the person in question and to the soc

  17. 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

  18. 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

  19. A standard for terminology in chronic pelvic pain syndromes

    DEFF Research Database (Denmark)

    Doggweiler, Regula; Whitmore, Kristene E; Meijlink, Jane M;

    2016-01-01

    AIMS: Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected b...

  20. Limitations associated with managing chronic low back pain.

    Science.gov (United States)

    Beland, Paul

    2016-04-20

    Non-specific chronic low back pain is an occupational hazard for nurses. It may result in persistent and disabling pain for some people. There are many techniques for investigating, assessing and treating chronic low back pain. However, research to support some of these interventions and the assumptions that underlie them is limited. Interventions that may be beneficial are not always available to those who need them. Changes to service provision are required to rectify this situation and provide effective treatment for patients with non-specific chronic low back pain. PMID:27097211

  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. 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

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

    Science.gov (United States)

    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 view of pain, which has focused on encoding and representation of nociceptive signals. We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace, implying that supraspinal/cortical manipulations may be a more fruitful venue for adequately modulating suffering and related behavior for chronic pain. We briefly review the evidence generated to date for the proposed model and emphasize that the details of underlying mechanisms remain to be expounded.

  4. 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

  5. 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.

  6. Assessment of Cognitive Factors in Chronic Pain: A Worthwhile Enterprise?

    Science.gov (United States)

    Turk, Dennis C.; Rudy, Thomas E.

    1986-01-01

    Provides a brief review of the history of pain theory and the recurrent role of cognition in various conceptualizations of pain. Discusses research evidence supporting the continued inclusion of cognitive factors in conceptualizations and treatment of chronic pain, relevant assessment instruments, the Diagnostic and Statistical Manual of Mental…

  7. Outpatient Group Treatment of Chronic Pain: Effects of Spouse Involvement.

    Science.gov (United States)

    Moore, James E.; Chaney, Edmund F.

    1985-01-01

    Assigned 43 chronic pain patients to couples group treatment, patient-only group treatment, or waiting-list control. The 16-hour cognitive-behavioral program produced reduction in pain, spouse-observed pain behavior, physical and psychosocial dysfunction, marital satisfaction, and use of health care resources. Spouse involvement did not facilitate…

  8. Control Beliefs, Coping Efforts, and Adjustment to Chronic Pain.

    Science.gov (United States)

    Jensen, Mark P.; Karoly, Paul

    1991-01-01

    Examined adaptation to chronic pain in 118 patients. Control appraisals, ignoring pain, using coping self-statements, and increasing activities were positively related to psychological functioning. Control appraisals, diverting attention, ignoring pain, and using coping self-statements were positively related to activity level for patients…

  9. [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

  10. 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

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

    NARCIS (Netherlands)

    van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

    2013-01-01

    Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

  16. 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

  17. 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.

  18. Impact of exercise type and dose on pain and disability in knee osteoarthritis

    DEFF Research Database (Denmark)

    Juhl, Carsten Bogh; Christensen, Robin Daniel Kjersgaard; Roos, Ewa M.;

    2011-01-01

    on quadriceps strengthening only compared to lower limb strengthening or strengthening the whole body (SMD[pain]: 0.72, 0.42 respectively, P=0.04). CONCLUSION: Exercise programs have on average a moderate effect for reducing pain in knee osteoarthritis trials. However, inconsistency across studies suggests...... effects for programs aiming at improving muscle strength, aerobic capacity or functional performance (SMD[pain]: 0.56, 0.67, and 0.49, respectively, P=0.822; pooled SMD= 0.57 [95% CI: 0.44; 0.69], I2= 53%). Whereas combined programs were less effective in reducing pain (SMD [pain]: 0.14 [95%CI: -0.11; 0...... that it will not always imply benefit in comparison with a matched control group. Stratified analyses provide evidence that exercise programs aiming at improving strength, aerobic capacity or functional performance are more efficacious than combined exercise programs. While the number of supervised sessions may enhance...

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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.

  7. Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain

    Science.gov (United States)

    Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H. R.; Weiss, Thomas

    2016-01-01

    Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients’ current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation. PMID:27517967

  8. A neural model for chronic pain and pain relief by extracorporeal shock wave treatment.

    Science.gov (United States)

    Wess, Othmar J

    2008-12-01

    The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reflexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an efficient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.

  9. Could stress contribute to pain-related fear in chronic pain?

    Directory of Open Access Journals (Sweden)

    Sigrid eElsenbruch

    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.

  10. Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain.

    Science.gov (United States)

    Sharpe, Louise; Haggman, Sonia; Nicholas, Michael; Dear, Blake F; Refshauge, Kathryn

    2014-01-01

    This prospective study of acute and sub-acute low back pain (LBP) patients was conducted to assess whether attentional biases predicted chronic pain status 3 and 6 months later. The attentional biases of 100 LBP patients were assessed within 3 months of developing pain and 6 months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6 months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who did not (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not differentiate those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6 months later, but again it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n=22) and 6 (n=21) months demonstrated biases away from affective pain words at baseline but not 6 months later, in comparison to other participants. These results remained significant in multivariate analyses. These findings are consistent with patterns observed in the previous research, and suggest that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase. This research suggests that attentional biases in relation to pain-related stimuli are important for the development of chronic pain, but are more complex than initially thought. PMID:24028848

  11. Dynamic muscular endurance in primary fibromyalgia compared with chronic myofascial pain syndrome

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Danneskiold-Samsøe, B

    1992-01-01

    investigated. Thirty-six patients with PF were compared with 18 patients with chronic myofascial pain (CMP) syndrome. Subjects were matched according to gender, age, height, weight, peak torque, and contractional work. The DME was defined as the number of repeated knee extensions necessary......The objective of the study was to quantify the voluntary dynamic muscular endurance (DME) in patients with primary fibromyalgia (PF) since easy fatigability of muscles is one of the major symptoms in this syndrome. Consecutive outpatients referred to a rheumatology clinic specializing in PF were...

  12. 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.)

  13. Improvement and care seeking for temporomandibular-pain complaints: The complexity of chronic pain

    NARCIS (Netherlands)

    A. Rollman

    2013-01-01

    "Temporomandibular disorders" (TMD) is a collective term used to describe a group of musculoskeletal conditions occurring in the temporomandibular region. TMD shares features with other chronic musculoskeletal syndromes (such as low back pain and neck pain) including pain, limited range of motion an

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

    NARCIS (Netherlands)

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

    2016-01-01

    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 a

  15. 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

  16. 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

    OpenAIRE

    Hunter David J; Wrigley Tim V; Hunt Michael A; Bennell Kim L; Hinman Rana S

    2007-01-01

    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 me...

  17. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study.

    Science.gov (United States)

    Czurda, Thomas; Fennema, Peter; Baumgartner, Martin; Ritschl, Peter

    2010-07-01

    Previous studies have noted an adverse relationship between implant malalignment during total knee arthroplasty (TKA) and post-operative pain. Although some evidence exists indicating that computer-assisted surgical navigation for TKA can improve the accuracy of component alignment, its impact on clinical outcomes is currently unknown. The dual goals of the present cohort/nested case-control study were to (1) compare self-reported responses to the Western Ontario-McMaster Osteoarthritis Index (WOMAC) questionnaire between computer-assisted TKA (123 patients) using the imageless PiGalileo navigation system and conventional TKA (207 patients) [cohort analysis], and (2) to investigate a potential association between malalignment and post-operative pain in 19 painful knees and 19 asymptomatic knees obtained from the cohort analysis using matched sampling [nested case-control study]. In the cohort analysis, a relevant but non-significant (P = 0.06) difference in the occurrence of chronic pain was observed between the navigated (12%) and conventional arms (20%). Median post-operative WOMAC pain score was 100 (range, 50-100) in the conventional group and 100 (range, 65-100) in the navigated group. However, the Mann-Whitney test revealed a significant difference in favor of the navigated group (P = 0.01). In the nested case-control analysis, radiological outcomes and computer tomography (CT) measurements of femoral rotation were compared between the groups. The CT rotation measurements yielded evidence of a relationship between post-operative pain and incorrect rotational alignment of the femoral component of more than 3 degrees (OR: 7; 95% CI: 1.2-42; P = .033). In conclusion, there was no clinical benefit to computer-assisted navigation; however, a statistically significant relationship was observed between incorrect rotational alignment of the femoral component and symptoms of post-operative pain following TKA.

  18. 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

  19. 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

  20. Painful knee joint after ACL reconstruction using biodegradable interference screws- SPECT/CT a valuable diagnostic tool? A case report

    Directory of Open Access Journals (Sweden)

    Hirschmann Michael T

    2010-09-01

    Full Text Available Abstract With the presented case we strive to introduce combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT as new diagnostic imaging modality and illustrate the possible clinical value in patients after ACL reconstruction. We report the case of a painful knee due to a foreign body reaction and delayed degradation of the biodegradable interference screws after ACL reconstruction. The MRI showed an intact ACL graft, a possible tibial cyclops lesion and a patella infera. There was no increased fluid collection within the bone tunnels. The 99mTc-HDP-SPECT/CT clearly identified a highly increased tracer uptake around and within the tibial and femoral tunnels and the patellofemoral joint. On 3D-CT out of the SPECT/CT data the femoral graft attachment was shallow (50% along the Blumensaat's line and high in the notch. At revision arthroscopy a diffuse hypertrophy of the synovium, scarring of the Hoffa fat pad and a cyclops lesion of the former ACL graft was found. The interference screws were partially degraded and under palpation and pressure a grey fluid-like substance drained into the joint. The interference screws and the ACL graft were removed and an arthrolysis performed. In the case presented it was most likely a combination of improper graft placement, delayed degradation of the interference screws and unknown biological factors. The too shallow and high ACL graft placement might have led to roof impingement, chronic intraarticular inflammation and hence the delayed degradation of the screws. SPECT/CT has facilitated the establishment of diagnosis, process of decision making and further treatment in patients with knee pain after ACL reconstruction. From the combination of structural (tunnel position in 3D-CT and metabolic information (tracer uptake in SPECT/CT the patient's cause of the pain was established.

  1. 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

  2. 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

  3. 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.

  4. Complementary and alternative medicine therapies for chronic pain.

    Science.gov (United States)

    Bauer, Brent A; Tilburt, Jon C; Sood, Amit; Li, Guang-Xi; Wang, Shi-Han

    2016-06-01

    Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain. PMID:27339090

  5. Psychological therapies for the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Sturgeon JA

    2014-04-01

    Full Text Available 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 for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed. Keywords: pain management, multidisciplinary pain treatment, psychological therapy

  6. Chronic pain and quality of life in schizophrenic patients

    Directory of Open Access Journals (Sweden)

    Jouce Gabriela de Almeida

    2013-03-01

    Full Text Available OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia. Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001. There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

  7. 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.)

  8. 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.)

  9. Alexithymia and anxiety in female chronic pain patients

    Directory of Open Access Journals (Sweden)

    Saatcioglu Omer

    2006-08-01

    Full Text Available 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 psychiatry clinic at a public hospital with the diagnosis of chronic pain disorder (DSM-IV, were included in the study. Thirty seven healthy females (mean age: 34,46 ± 7,43 years, who matched for sociodemographic features with the patient group, consisted the control group. A sociodemographic data form, 26-item Toronto Alexithymia Scale (TAS-26, Spielberger Trait Anxiety Inventory (STAI were administered to each subject and information was obtained on several aspects of the patients' pain, including intensity (measured by VAS, and duration. Results Chronic pain patients were found significantly more alexithymic than controls. There was a positive correlation between TAS-26 scores and the duration of pain. The alexithymic and nonalexithymic group did not differ in their perception of pain. Neither positive correlation nor significant difference was found between alexithymia and trait anxiety in pain patients. Discussion Alexithymia may be important in addressing the diversity of subjective factors involved in pain. The conceptualization of alexithymia as a personality trait as well as a secondary state reaction is underlined by our data.

  10. 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

  11. Clinical study of acute and chronic pain after temporal craniotomy

    Directory of Open Access Journals (Sweden)

    WANG Cheng-wei

    2013-10-01

    Full Text Available Objective To investigate the correlation of chronic pain after surgery and acute pain within 48 h after temporal craniotomy. Methods One hundred and seventy-six patients who underwent surgery through temporal approach were divided into 3 groups and treated with morphine 30 mg (Group M, N = 57, tramadol 1000 mg (Group T, N = 60 and morphine 20 mg + flurbiprofen 200 mg (Group F, N = 59 by patient-controlled intravenous analgesia (PCIA. Postoperative acute pain (resting and movement was evaluated by Visual Analogue Scale (VAS at 4, 16, 24 and 48 h respectively. Chronic pain was measured by Short-Form McGill Pain Questionnaire (SF-MPQ 3 months after surgery. The characteristics of acute and chronic pain, the relationship between them and analgesic effect of 3 kinds of analgesic drugs were analyzed. Results The differences of observed indicators including gender, age, weight and operating time, which might affect the degree of postoperative pain between before and after surgery were not statistically significant (P > 0.05. VAS scores at different time points within 48 h after surgery in each group decreased gradually. The VAS scores in group T (2.91 ± 1.64 was significantly higher than group M (2.19 ± 1.68 and group F (1.71 ± 1.17, P 0.05. The overall incidence rate of chronic pain was 71.02% (125/176, with moderate and severe pain in 15.91% (28/176. Chronic pain and acute postoperative pain severity were positively correlated (resting: rs = 0.171, P = 0.012; movement: rs = 0.190, P = 0.006. The difference of the acute pain (VAS corresponding to SF-MPQ Ⅱ score > 0 and SF-MPQ Ⅱ score = 0 was statistically significant (P < 0.05. Conclusion The postoperative chronic pain following temporal craniotomy is related to acute pain within 48 h after operation. Effective treatment of early postoperative acute pain may reduce the incidence of chronic pain.

  12. Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations

    Directory of Open Access Journals (Sweden)

    Arpana Jaiswal

    2016-06-01

    Full Text Available Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP vs. chronic pain of other location (CPOL. Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression–opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP.

  13. Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations.

    Science.gov (United States)

    Jaiswal, Arpana; Scherrer, Jeffrey F; Salas, Joanne; van den Berk-Clark, Carissa; Fernando, Sheran; Herndon, Christopher M

    2016-01-01

    Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP) vs. chronic pain of other location (CPOL). Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression-opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP. PMID:27417622

  14. Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effects.

    Science.gov (United States)

    Richardson, Elizabeth J; Ness, Timothy J; Doleys, Daniel M; Baños, James H; Cianfrini, Leanne; Richards, J Scott

    2009-12-15

    Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

  15. 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

  16. Managing chronic pain in older people.

    Science.gov (United States)

    Schofield, Patricia

    This article presents the results of a collaborative project between the British Pain Society and British Geriatric Society to produce guidelines on the management of pain in older adults. The guidelines are the first of their kind in the UK and aim to provide best practice for the management of pain to all health professionals working with older adults in any care setting.

  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. Meditation as an intervention for chronic pain: an integrative review.

    Science.gov (United States)

    Teixeira, M Elizabeth

    2008-01-01

    Chronic pain is a complex phenomenon that causes a significant disruption in the lives of those affected. Chronic pain is difficult to treat and challenges healthcare professionals' abilities to implement effective treatments. Therefore, chronic pain sufferers often seek complementary alternative medicine therapies such as meditation. Literature reviews have examined studies using mindfulness-based stress reduction program as an intervention for a variety of health problems. However, no reviews exist looking at a specific patient population's utilization of meditation-based programs. Therefore, the purpose of this integrative review is to examine studies that have investigated meditation as an intervention for chronic pain, identify gaps in the literature, and make recommendations for further research.

  19. Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost

    Science.gov (United States)

    Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost What are opioids? Opioids are very strong prescription ... using opioids. We compared the effectiveness, safety, and cost of different opioids. We chose these as Consumer ...

  20. Phenomenology, Hypnosis, and Chronic Pain: Steps for Clinical Understanding

    Directory of Open Access Journals (Sweden)

    Mauricio da Silva Neubern

    2014-04-01

    Full Text Available This paper proposes phenomenological notions of self-image and body schema as an explicative and clinical possibility for the relationship between hypnosis and chronic pain. It begins with a critique of the medical and nomothetic approach taken by contemporary research that does not usually address clinical issues, and then addresses a case study where a person suffering from chronic pain related both body schema and self-image is submitted to hypnotherapy. The study concludes that there is no linear relationship between such notions and that chronic pain is uniquely configured to each person. This requires a clinical and qualitative approach to access and understand chronic pain, both in terms of classic phenomenological notions of time, space, and material experiences, as well as socio-cultural dimensions that contribute to producing feelings related to the daily experiences of the subjects.

  1. Study Suggests Brain Is Hard-Wired for Chronic Pain

    Science.gov (United States)

    ... News Release Tuesday, September 17, 2013 NIH-funded study suggests brain is hard-wired for chronic pain ... Apkarian, Ph.D., a senior author of the study and professor of physiology at Northwestern University Feinberg ...

  2. 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

    and KAM impulses were obtained from gait analyses. Mixed linear regression analyses were performed with KAM variables as the outcome, and pain and disease severity as independent variables, adjusting for age, gender, and walking speed. RESULTS: In adjusted analyses, less severe patients demonstrated...... between pain intensity and dynamic knee joint loading indicate a natural reaction to pain, which will limit the stress on the joint. In contrast, either absent or positive relationships between pain and dynamic loading in severe OA may lead to overuse and accelerated disease progression. These findings...

  3. 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 ...

  4. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria...... 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...... are concerned with the fact that pain may be under treated because of fear of addiction, and the guidelines in management of non-malignant pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during...

  5. Treatment of chronic regional pain syndrome type 1 with palmitoylethanolamide and topical ketamine cream: modulation of nonneuronal cells

    Directory of Open Access Journals (Sweden)

    Keppel Hesselink JM

    2013-03-01

    Full Text Available Jan M Keppel Hesselink,1 David J Kopsky21Institute for Neuropathic Pain, Bosch en Duin, The Netherlands; 2Institute for Neuropathic Pain, Amsterdam, The NetherlandsAbstract: Chronic regional pain syndrome (CRPS can be intractable to treat and patients sometimes suffer for many years. Therefore, new treatment strategies are needed to alleviate symptoms in CRPS patients. This case report describes a patient suffering from intractable CRPS type 1 for 13 years. Due to her swollen painful feet and left knee she is wheelchair-bound. The combination of palmitoylethanolamide and ketamine 10% cream reduced her pain by more than 50% after 1 month of treatment, and a marked reduction in swelling and skin discoloration was noticed. Furthermore, she could walk independently again and she experienced no side effects. Thus, palmitoylethanolamide and topical ketamine could be a combination therapy option for treating CRPS patients.Keywords: palmitoylethanolamide, ketamine, cream, CRPS, endocannabinoid, sudeck, mast cells

  6. A Phase IIIb, Multicentre, Randomised, Parallel-Group, Placebo-Controlled, Double-Blind Study to Investigate the Efficacy and Safety of OROS Hydromorphone in Subjects with Moderate-to-Severe Chronic Pain Induced by Osteoarthritis of the Hip or the Knee

    Directory of Open Access Journals (Sweden)

    Jozef Vojtaššák

    2011-01-01

    Full Text Available Background. Opioid analgesics are included in treatment guidelines for the symptomatic management of osteoarthritis (OA. Starting with a low dose of opioid and slowly titrating to a higher dose may help avoid intolerable side effects. Methods. Subjects aged ≥40 years, with moderate to severe pain induced by OA of the hip or knee not adequately controlled by previous non-steroidal anti-inflammatory drugs (NSAIDs or paracetamol treatment, were enrolled. Subjects received OROS hydromorphone 4 mg or placebo once-daily. The dose was titrated every 3-4 days in case of unsatisfactory pain control during the 4-week titration phase. A 12 week maintenance phase followed. The primary efficacy endpoint was the change in “pain on average” measured on the Brief Pain Inventory (BPI scale from baseline to the end of the maintenance phase. Results. 139 subjects received OROS hydromorphone and 149 subjects received placebo. All efficacy endpoints showed similar improvements from baseline to end of study in the 2 groups. The safety results were consistent with the safety profile of OROS hydromorphone. Conclusion.The study did not meet the primary endpoint; although many subjects' pain was not adequately controlled at inclusion, their pain may have improved with continued paracetamol or NSAID treatment.

  7. Accuracy of the unassisted pain drawings by patients with chronic pain.

    Science.gov (United States)

    Cummings, G S; Routan, J L

    1987-01-01

    This investigation was conducted to test the accuracy of unassisted pain maps drawn by patients with chronic pain. Three aspects of accuracy were investigated, the accuracy of the area of pain reported, whether all existing pains were reported, and whether related symptoms were reported. Thirty-six successive new admissions to a chronic pain rehabilitation center were used as subjects. Each patient filled out the pain map prior to meeting any professional staff. During their examination the investigators completed a new pain map without seeing the patient's map. Thirty-one pairs of pain maps were compared and scored, with most maps showing several pain areas. Area of pain was accurately represented 43% of the time. Of 139 distinct pains found during examination, only 58% were reported in the pain maps. Thirtyfour percent of related symptoms were reported. It appears that unassisted pain maps are sufficiently flawed to discourage their use as an indicator of the patients symptom location J Orthop Sports Phys Ther 1987;8(8):391-396.

  8. Phenomenology, Hypnosis, and Chronic Pain: Steps for Clinical Understanding

    OpenAIRE

    Mauricio da Silva Neubern

    2014-01-01

    This paper proposes phenomenological notions of self-image and body schema as an explicative and clinical possibility for the relationship between hypnosis and chronic pain. It begins with a critique of the medical and nomothetic approach taken by contemporary research that does not usually address clinical issues, and then addresses a case study where a person suffering from chronic pain related both body schema and self-image is submitted to hypnotherapy. The study concludes that there is n...

  9. Opioids Switching with Transdermal Systems in Chronic Cancer Pain

    OpenAIRE

    Barbarisi M; Sansone P; Pota V; Pace MC; Aurilio C; Grella E; Passavanti MB

    2009-01-01

    Abstract Background Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy Objective To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment. Methods A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switche...

  10. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study

    OpenAIRE

    O'Leary, Helen; Smart, Keith M; Moloney, Niamh A; Blake, Catherine; Doody, Catherine M

    2015-01-01

    Introduction Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. S...

  11. Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

    Science.gov (United States)

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

    2015-07-01

    The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS.

  12. Intervention treatments for chronic pain syndrome in cancer patients

    OpenAIRE

    V. V. Bryuzgin

    2010-01-01

    Noninvasive treatments for chronic pain syndrome benefit in 80-90% of cancer patients. Invasive, intervention procedures for analgesia should be used in other cases. These include neuroablative and neuromodulatory measures. Neuroablation is defined as the physical suspension of painful impulse transmission pathways by a surgical, chemical, or thermal method and comprises lytic and other blocks. Neuromodulation is the dynamic and functional suppression of pain impulse pathways by the intraspin...

  13. Chronic Pain May Trigger Many Cases of Painkiller Addiction

    Science.gov (United States)

    ... use of prescription or illegal drugs, or heavy alcohol consumption. The researchers found that 87 percent reported chronic pain. About ... to reduce their pain, the study said. The researchers said their findings ... and alcohol-abuse counseling strategies should consider if people turned ...

  14. Chronic neck pain disability due to an acute whiplash injury

    NARCIS (Netherlands)

    Nederhand, Marc J.; Hermens, Hermie J.; IJzerman, Maarten J.; Turk, Dennis C.; Zilvold, Gerrit

    2003-01-01

    Several theories about musculoskeletal pain syndromes such as whiplash-associated disorder (WAD) suggest that pain and muscle activity interact and may contribute to the chronicity of symptoms. Studies using surface electromyography (sEMG) have demonstrated abnormal muscle activation patterns of the

  15. Office management of chronic pain in the elderly.

    Science.gov (United States)

    Weiner, Debra K

    2007-04-01

    Chronic pain plagues older adults more than any other age group; thus, practitioners must be able to approach this problem with confidence and skill. This article reviews the assessment and treatment of the most common chronic nonmalignant pain conditions that affect older adults--myofascial pain, generalized osteoarthritis, chronic low back pain (CLBP), fibromyalgia syndrome, and peripheral neuropathy. Specific topics include essential components of the physical examination; how and when to use basic and advanced imaging in older adults with CLBP; a stepped care approach to treating older adults with generalized osteoarthritis and CLBP, including noninvasive and invasive management techniques; how to diagnose and treat myofascial pain; strategies to identify the older adult with fibromyalgia syndrome and avoid unnecessary "diagnostic" testing; pharmacological treatment for the older adult with peripheral neuropathy; identification and treatment of other factors such as dementia and depression that may significantly influence response to pain treatment; and when to refer the patient to a pain specialist. While common, chronic pain is not a normal part of aging, and it should be treated with an emphasis on improved physical function and quality of life.

  16. Validation of the Danish-language chronic pain acceptance questionnaire

    DEFF Research Database (Denmark)

    la Cour, P; Højsted, J

    2015-01-01

    version of the CPAQ. METHODS: A total of 114 patients with chronic pain completed the questionnaire as well as other measures of pain, anxiety, depression, coping, and health-related quality of life. RESULTS: Internal consistency was satisfactory and the factorial analysis yielded a two-factor solution...

  17. Genitofemoral neuralgia: adding to the burden of chronic vulvar pain

    Directory of Open Access Journals (Sweden)

    Verstraelen H

    2015-11-01

    Full Text Available Hans Verstraelen,1 Eline De Zutter,1 Martine De Muynck2 1Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium Abstract: The vulva is a particularly common locus of chronic pain with neuropathic characteristics that occurs in women of any age, though most women with neuropathic type chronic vulvar pain will remain undiagnosed even following multiple physician visits. Here, we report on an exemplary case of a middle-aged woman who was referred to the Vulvovaginal Disease Clinic with debilitating vulvar burning and itching over the right labium majus that had been persisting for 2 years and was considered intractable. Careful history taking and clinical examination, followed by electrophysiological assessment through somatosensory evoked potentials was consistent with genitofemoral neuralgia, for which no obvious cause could be identified. Adequate pain relief was obtained with a serotonin–noradrenaline reuptake inhibitor and topical gabapentin cream. We briefly discuss the epidemiology, diagnosis, and treatment of genitofemoral neuralgia and provide a series of clues to guide clinicians in obtaining a presumptive diagnosis of specific neuropathic pain syndromes that may underlie chronic vulvar pain. We further aim to draw attention to the tremendous burden of chronic, unrecognized vulvar pain. Keywords: vulvar pain, genitofemoral nerve, neuropathic pain, vulvodynia, vulvar disease

  18. Psychosocial perspectives in the treatment of pediatric chronic pain

    OpenAIRE

    Carter Bryan D; Threlkeld Brooke M

    2012-01-01

    Abstract Chronic pain in children and adolescents is associated with major disruption to developmental experiences crucial to personal adjustment, quality of life, academic, vocational and social success. Caring for these patients involves understanding cognitive, affective, social and family dynamic factors associated with persistent pain syndromes. Evaluation and treatment necessitate a comprehensive multimodal approach including psychological and behavioral interventions that maximize retu...

  19. Development of Viral Vectors for Gene Therapy for Chronic Pain

    Directory of Open Access Journals (Sweden)

    Yu Huang

    2011-01-01

    Full Text Available Chronic pain is a major health concern that affects millions of people. There are no adequate long-term therapies for chronic pain sufferers, leading to significant cost for both society and the individual. The most commonly used therapy for chronic pain is the application of opioid analgesics and nonsteroidal anti-inflammatory drugs, but these drugs can lead to addiction and may cause side effects. Further studies of the mechanisms of chronic pain have opened the way for development of new treatment strategies, one of which is gene therapy. The key to gene therapy is selecting safe and highly efficient gene delivery systems that can deliver therapeutic genes to overexpress or suppress relevant targets in specific cell types. Here we review several promising viral vectors that could be applied in gene transfer for the treatment of chronic pain and further discuss the possible mechanisms of genes of interest that could be delivered with viral vectors for the treatment of chronic pain.

  20. Behavioural alteration in chronic pain: are brain glia involved?

    Science.gov (United States)

    Panigada, T; Gosselin, R-D

    2011-10-01

    Behavioural symptoms such as abnormal emotionality (including anxious and depressive episodes) and cognition (for instance weakened decision-making) are highly frequent in both chronic pain patients and their animal models. The theory developed in the present article posits that alterations in glial cells (astrocytes and microglia) in cortical and limbic brain regions might be the origin of such emotional and cognitive chronic pain-associated impairments. Indeed, in mood disorders (unipolar depression, anxiety disorders, autism or schizophrenia) glial changes in brain regions involved in mood control (prefrontal and cingulate cortices, amygdala and the hippocampus) have been recurrently described. Besides, glial cells have been undoubtedly identified as key actors in the sensory component of chronic pain, owing to the profound phenotypical changes they undergo throughout the sensory pathway. Hence, the possibility arises that brain astrocytes and microglia react in upper brain structures as well, mediating the related mood and cognitive dysfunctions in chronic pain. So far, only very few studies have provided results in this prospect, mainly indirectly in pain-independent researches. Nevertheless, the first scant available data seem to merge in a unified description of a brain glial reaction occurring after chronic peripheral lesion. The present article uses this scarce literature to formulate the provocative theory of a glia-driven mood and cognitive dysfunction in chronic pain, expounding upon its validity and putative therapeutical impact as well as its current limitations and expected future developments. PMID:21741179